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Sample records for comparative evaluation cost

  1. Cost Effectiveness Ratio: Evaluation Tool for Comparing the Effectiveness of Similar Extension Programs

    Science.gov (United States)

    Jayaratne, K. S. U.

    2015-01-01

    Extension educators have been challenged to be cost effective in their educational programming. The cost effectiveness ratio is a versatile evaluation indicator for Extension educators to compare the cost of achieving a unit of outcomes or educating a client in similar educational programs. This article describes the cost effectiveness ratio and…

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

    Science.gov (United States)

    Olsson, Tina M

    2011-10-01

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

  3. Comparing costing results in across country economic evaluations: the use of technology specific purchasing power parities.

    Science.gov (United States)

    Wordsworth, Sarah; Ludbrook, Anne

    2005-01-01

    The number of economic evaluations conducted on a multinational basis is increasing. Therefore, techniques are required to compare the results of such studies in a meaningful manner. This paper explores different approaches to comparing across country cost data applied to a European study of dialysis therapy for end-stage renal disease. A price and volume index is created at the level of the individual health care technology and compared to an exchange rate conversion and published purchasing power parities (PPPs). Both exchange rate and PPP conversions when published rates are used fail to accurately reflect the true resource use of the applied health care example. These differences can be related to specific issues of input mix and price variation. Alternatively, the use of technology specific PPPs provided a more robust approach for international comparisons and also have the potential for use in multi-centre economic evaluations within the same country. Copyright 2004 John Wiley & Sons, Ltd.

  4. A cost-effectiveness evaluation comparing originator follitropin alfa to the biosimilar for the treatment of infertility

    Directory of Open Access Journals (Sweden)

    Gizzo S

    2016-12-01

    Full Text Available Salvatore Gizzo,1 Juan A Garcia-Velasco,2 Franca Heiman,3 Claudio Ripellino,3 Klaus Bühler4 1Department of Woman and Child Health, University of Padua, Padua, Italy; 2Department of Obstetrics and Gynecology, Rey Juan Carlos University Madrid, Madrid, Spain; 3IMS Health Information Solutions Italy Srl, Milan, Italy; 4Centre for Gynaecology, Endocrinology, and Reproductive Medicine, Ulm and Stuttgart, Germany Objectives: To perform a cost-effectiveness evaluation comparing the originator follitropin alfa (Gonal-f® to the biosimilar (Bemfola® in the Italian and Spanish contexts, with an assessment of the German and UK backgrounds. Methods: Starting from the study by Rettenbacher et al, a cost-effectiveness model was developed in the Italian and Spanish contexts. Clinical data on subjects, doses of gonadotropin, pregnancies, live-born children, and ovarian hyperstimulation syndrome were used to feed the model. Costs related to drugs, hospitalizations, specialist visits, and examinations were retrieved from Italian and Spanish tariffs. Gonadotropin acquisition costs for Germany and the UK were also taken into account to expand the economical assessment to the other countries. The evaluation was done based on the National Health Service perspective. Sensitivity analyses, both univariate and probabilistic, as long as scenario analyses, tested the robustness of the model. Results: Originator follicle-stimulating hormone (FSH costs were €3,663 and €6,387 in Italy and Spain, respectively, whereas biosimilar FSH costs were €3,483 and €6,342. The efficacy was found to be 0.52 for the originator and 0.47 for the biosimilar. The average cost per live birth was estimated to be €7,044 and €12,283 for the originator FSH and €7,411 and €13,494 for the biosimilar for Italy and Spain, respectively. Furthermore, the originator FSH generated an incremental cost-effectiveness ratio of €3,600 for Italy and €900 for Spain compared to the

  5. Cost-effectiveness analysis of clinical specialist outreach as compared to referral system in Ethiopia: an economic evaluation

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    Nigatu Tilahun H

    2010-06-01

    Full Text Available Abstract Background In countries with scarce specialized Human resource for health, patients are usually referred. The other alternative has been mobilizing specialists, clinical specialist outreach. This study examines whether clinical specialist outreach is a cost effective way of using scarce health expertise to provide specialist care as compared to provision of such services through referral system in Ethiopia. Methods A cross-sectional study on four purposively selected regional hospitals and three central referral hospitals was conducted from Feb 4-24, 2009. The perspective of analysis was societal covering analytic horizon and time frame from 1 April 2007 to 31 Dec 2008. Data were collected using interview of specialists, project focal persons, patients and review of records. To ensure the propriety standards of evaluation, Ethical clearance was obtained from Jimma University. Results It was found that 532 patients were operated at outreach hospitals in 125 specialist days. The unit cost of surgical procedures was found to be ETB 4,499.43. On the other hand, if the 125 clinical specialist days were spent to serve patients referred from zonal and regional hospitals at central referral hospitals, 438 patients could have been served. And the unit cost of surgical procedures through referral would have been ETB 6,523.27 per patient. This makes clinical specialist outreach 1.45 times more cost effective way of using scarce clinical specialists' time as compared to referral system. Conclusion Clinical specialist outreach is a cost effective and cost saving way of spending clinical specialists' time as compared to provision of similar services through referral system.

  6. Comparative evaluations.

    Science.gov (United States)

    Bibace, Roger

    2008-03-01

    My response to Engelmann (2008) will be based on several questions that will allow both its author and the general reader to determine whether the assumptions I make as an interpreter of this complex paper are congruent or incongruent with their own interpretations of the text. The interpretations by the writer, by any commentator, and the diverse interpretations of a general audience together with my own interpretations will, I hope, facilitate some fruitful 'comparative evaluations.' I articulate my inferences of the most dense part of the paper, namely the 'concrete immediate Consciousness and the developing absent outside.' My hope is to address Engelmann's question: "Am I in a better disposition to judge modern theories of consciousness?" The last section of my response spells out more personal comments to my all too brief and single encounter with Arno Engelmann. It is there that Arno Engelmann's fascinating statement "I am a citizen of the world" is addressed through its counterparts in my life.

  7. Advanced Regional SDIs in Europe: Comparative Cost-Benefit Evaluation and Impact Assessment Perspectives

    OpenAIRE

    Craglia, Massimo; Campagna, Michele

    2009-01-01

    This paper reports the findings of two studies on the socio-economic impacts of the regional spatial data infrastructures (SDIs) in Catalonia, and Lombardia, and then compares the developments in these two regions with those in other nine advanced regional SDIs to explore the extent to which the findings reported for the two detailed case-studies could be generalised. The significance of this paper is that the studies it reports are to date the only ones substantiating with real evidence the ...

  8. Cost Evaluation of Dried Blood Spot Home Sampling as Compared to Conventional Sampling for Therapeutic Drug Monitoring in Children

    Science.gov (United States)

    Martial, Lisa C.; Aarnoutse, Rob E.; Schreuder, Michiel F.; Henriet, Stefanie S.; Brüggemann, Roger J. M.; Joore, Manuela A.

    2016-01-01

    Dried blood spot (DBS) sampling for the purpose of therapeutic drug monitoring can be an attractive alternative for conventional blood sampling, especially in children. This study aimed to compare all costs involved in conventional sampling versus DBS home sampling in two pediatric populations: renal transplant patients and hemato-oncology patients. Total costs were computed from a societal perspective by adding up healthcare cost, patient related costs and costs related to loss of productivity of the caregiver. Switching to DBS home sampling was associated with a cost reduction of 43% for hemato-oncology patients (€277 to €158) and 61% for nephrology patients (€259 to €102) from a societal perspective (total costs) per blood draw. From a healthcare perspective, costs reduced with 7% for hemato-oncology patients and with 21% for nephrology patients. Total savings depend on the number of hospital visits that can be avoided by using home sampling instead of conventional sampling. PMID:27941974

  9. 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.

  10. [Analysis and comparative evaluations of the costs of supports and treatments of schizophrenia, affective psychosis, paranoia and neurosis].

    Science.gov (United States)

    Grassi, A; Bruni, R; Pileggi, F; Chiappelli, M; Boldrini, M; Franceschi, E; Scarafoni, D

    2001-01-01

    The aim of the study was to show, trough the calculation of the direct costs of supports and treatments actually provided by a NHS Mental Health Department, the presence of associations between four diagnostic groups (schizophrenia, affective psychosis, paranoia and neurotic disorders) and their overall and items (community care, rehabilitation facilities and in-patients services) costs. Mental Health Department and CSM "Scalo" (NHS Mental Centre), AUSL "Città di Bologna", Emilia-Romagna Region. Yearly direct costs were calculated for a sample (n = 75) of all patients (N = 745) who during 365 days had more than four contacts with CSM and also for four randomised diagnostic groups (n = 30 per group). We calculated unit costs of 15 types of services provided by CSM, selected according to the yearly number of services provided and the time spent by each health professional, and the in patient-cost per all days spent in a public or private sector hospital for psychiatric care. The statistic analysis, performed with the help of the Kruskal-Wallis test, showed significantly higher overall costs for the schizophrenic patients than the sample-group and the neurotic disorders-group; besides a significant difference in the item costs for rehabilitation facilities was found between the schizophrenic group and the paranoia, neurotic disorders groups and the sample one, whereas no significant differences in costs of inpatients services and drugs administration were tested between the groups. The results of our study allow to demonstrate that there are cost differences between the diagnosis (direct costs are highest for schizophrenic patients and lowest for those with neurotic disorders) and that the costs evaluation can be used to ensure appropriate provisions to Mental Health Department for support and treatment of a wide range of psychiatric disorders.

  11. Low Cost Reversible Signed Comparator

    Directory of Open Access Journals (Sweden)

    Farah Sharmin

    2013-10-01

    Full Text Available Nowadays exponential advancement in reversible comp utation has lead to better fabrication and integration process. It has become very popular ove r the last few years since reversible logic circuit s dramatically reduce energy loss. It consumes less p ower by recovering bit loss from its unique input-o utput mapping. This paper presents two new gates called RC-I and RC-II to design an n-bit signed binary comparator where simulation results show that the p roposed circuit works correctly and gives significa ntly better performance than the existing counterparts. An algorithm has been presented in this paper for constructing an optimized reversible n-bit signed c omparator circuit. Moreover some lower bounds have been proposed on the quantum cost, the numbers of g ates used and the number of garbage outputs generated for designing a low cost reversible sign ed comparator. The comparative study shows that the proposed design exhibits superior performance consi dering all the efficiency parameters of reversible logic design which includes number of gates used, quantum cost, garbage output and constant inputs. This proposed design has certainly outperformed all the other existing approaches.

  12. AB041. Effectiveness and cost impact evaluation of fluticasone propionate/formoterol compared to fluticasone propionate/salmeterol

    Science.gov (United States)

    Ming, Simon Wan Yau; Small, Iain; Wolfe, Stephanie; Hamil, John; Gruffydd-Jones, Kevin; Daly, Cathal; Soriano, Joan B.; Gardner, Liz; Skinner, Derek; Price, David

    2016-01-01

    Background Treatment of asthmatics with an inhaled corticosteroid (ICS) and long-acting beta agonist (LABA) is recommended for maintenance treatment according to Step 3 in the GINA guidelines. Fixed-dose combination (FDC) inhalers simplify the dosing regimen and may improve adherence over their separate components. However, the effectiveness and cost impact of FDC devices containing fluticasone propionate/formoterol (FP/FOR) compared to fluticasone/salmeterol (FP/SAL) in asthma patients who initiate or switch to FDC ICS/LABA inhalers have not been studied in real-life patients in the United Kingdom. To determine whether FP/FOR is non-inferior to FP/SAL in patients who initiate or switch to a FDC ICS/LABA therapy with respect to decreasing the occurrence of asthma exacerbations and overall cost impact. Methods This study used a matched, historical cohort design to compare the two FDC ICS/LABA treatments using the Optimal Patient Care Database. Based on a 1-year exploratory analysis of baseline variables such as comorbidities, current treatment, demographics and clinical measurements, cohorts were matched to ensure similar patients were compared over a 1-year outcome. Two cohorts of patients were studied: one of patients initiated on combination therapy (either FP/FOR or FP/SAL) and one of patients either switched from FP/SAL to FP/FOR or who remained on FP/SAL. The primary outcome studied non-inferiority in terms of percentage of patients who were free from severe asthma exacerbations (defined by ATS/ERS position statements) for patients prescribed FP/FORversusFP/SAL in the outcome year. Secondary outcomes included the rate of asthma exacerbations, clinical exacerbations, asthma control, treatment stability, and lower respiratory tract hospitalisations. Cost impact outcomes included a comparison of resource costs, drug costs and combined drug and resource costs. Results The study included 2,472 patients (618 patients in FP/FOR and 1,854 patients in FP/SAL cohorts

  13. Individualized Positron Emission Tomography–Based Isotoxic Accelerated Radiation Therapy Is Cost-Effective Compared With Conventional Radiation Therapy: A Model-Based Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Bongers, Mathilda L., E-mail: ml.bongers@vumc.nl [Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam (Netherlands); Coupé, Veerle M.H. [Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam (Netherlands); De Ruysscher, Dirk [Radiation Oncology University Hospitals Leuven/KU Leuven, Leuven (Belgium); Department of Radiation Oncology, GROW Research Institute, Maastricht University Medical Center, Maastricht (Netherlands); Oberije, Cary; Lambin, Philippe [Department of Radiation Oncology, GROW Research Institute, Maastricht University Medical Center, Maastricht (Netherlands); Uyl-de Groot, Cornelia A. [Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam (Netherlands); Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam (Netherlands)

    2015-03-15

    Purpose: To evaluate long-term health effects, costs, and cost-effectiveness of positron emission tomography (PET)-based isotoxic accelerated radiation therapy treatment (PET-ART) compared with conventional fixed-dose CT-based radiation therapy treatment (CRT) in non-small cell lung cancer (NSCLC). Methods and Materials: Our analysis uses a validated decision model, based on data of 200 NSCLC patients with inoperable stage I-IIIB. Clinical outcomes, resource use, costs, and utilities were obtained from the Maastro Clinic and the literature. Primary model outcomes were the difference in life-years (LYs), quality-adjusted life-years (QALYs), costs, and the incremental cost-effectiveness and cost/utility ratio (ICER and ICUR) of PET-ART versus CRT. Model outcomes were obtained from averaging the predictions for 50,000 simulated patients. A probabilistic sensitivity analysis and scenario analyses were carried out. Results: The average incremental costs per patient of PET-ART were €569 (95% confidence interval [CI] €−5327-€6936) for 0.42 incremental LYs (95% CI 0.19-0.61) and 0.33 QALYs gained (95% CI 0.13-0.49). The base-case scenario resulted in an ICER of €1360 per LY gained and an ICUR of €1744 per QALY gained. The probabilistic analysis gave a 36% probability that PET-ART improves health outcomes at reduced costs and a 64% probability that PET-ART is more effective at slightly higher costs. Conclusion: On the basis of the available data, individualized PET-ART for NSCLC seems to be cost-effective compared with CRT.

  14. An Overview on Coronary Heart Disease (A Comparative Evaluation of Turkey and Europe and Cost-effectiveness of Diagnostic Strategies

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    Cengiz Taşçı

    2011-12-01

    Full Text Available Objective: Coronary heart disease (CHD is the leading cause of death for men and women in Turkey as it is in Europe and US. The prevalence of the disease is 3.8% in Turkey and 200,000 patients are added to the pool of CHD annually Because of genetic predis¬position and high proportions of physical inactivity, smoking habit, and obesity, CHD is encountered in earlier ages in our country So, the economic burden of the disease is expected to be relatively high, but the amount of health expenditure is not always parallel to the prevalence of a disease in the community. This article was written to overview CHD statistics to make a comparison between Turkey and some European countries and to investigate the value of myocardial perfusion scan (MPS as a gatekeeper in diagnosing CHD before invasive coronary angiography (ICA. The consequences were evaluated for Turkey In diagnosis; noninvasive testing gains impor¬tance in connection with the new approaches in treatment strategies, because a direct ICA strategy results in higher rates of revascu¬larization without improvement in clinical outcomes. A "gatekeeper" is needed to select the patients who are not required to under¬go angiography. MPS with its proved power in diagnosis and predicting prognosis, provides a cost-effective solution, and is accepted in some extensive analyses as a "gatekeeper" particularly in intermediate and high risk patients and in patients with known CHD. In conclusion, MPS may provide an optimal solution better than the ongoing situation in Turkey as well, when it is approved as a "gatekeeper in an algorithm before ICA. (MIRT 2011;20:75-93

  15. On farm evaluation of the effect of low cost drip irrigation on water and crop productivity compared to conventional surface irrigation system

    Science.gov (United States)

    Maisiri, N.; Senzanje, A.; Rockstrom, J.; Twomlow, S. J.

    This on-farm research study was carried out at Zholube irrigation scheme in a semi-arid agro tropical climate of Zimbabwe to determine how low cost drip irrigation technologies compare with conventional surface irrigation systems in terms of water and crop productivity. A total of nine farmers who were practicing surface irrigation were chosen to participate in the study. The vegetable English giant rape ( Brassica napus) was grown under the two irrigation systems with three fertilizer treatments in each system: ordinary granular fertilizer, liquid fertilizer (fertigation) and the last treatment with no fertilizer. These trials were replicated three times in a randomized block design. Biometric parameters of leaf area index (LAI) and fresh weight of the produce, water use efficiency (WUE) were used to compare the performance of the two irrigation systems. A water balance of the inflows and outflows was kept for analysis of WUE. The economic profitability and the operation, maintenance and management requirements of the different systems were also evaluated. There was no significant difference in vegetable yield between the irrigation systems at 8.5 ton/ha for drip compared to 7.8 ton/ha in surface irrigation. There were significant increases in yields due to use of fertilizers. Drip irrigation used about 35% of the water used by the surface irrigation systems thus giving much higher water use efficiencies. The leaf area indices were comparable in both systems with the same fertilizer treatment ranging between 0.05 for surface without fertilizer to 6.8 for low cost drip with fertigation. Low cost drip systems did not reflect any labour saving especially when manually lifting the water into the drum compared to the use of siphons in surface irrigation systems. The gross margin level for surface irrigation was lower than for low cost drip irrigation but the gross margin to total variable cost ratio was higher in surface irrigation systems, which meant that surface

  16. Measurement of costs for health economic evaluation.

    Science.gov (United States)

    Riewpaiboon, Arthorn

    2014-05-01

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

  17. Comparative costs and benefits of hydrogen vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Berry, G.D. [Lawrence Livermore National Lab., CA (United States)

    1996-10-01

    The costs and benefits of hydrogen as a vehicle fuel are compared to gasoline, natural gas, and battery-powered vehicles. Costs, energy, efficiency, and tail-pipe and full fuel cycle emissions of air pollutants and greenhouse gases were estimated for hydrogen from a broad range of delivery pathways and scales: from individual vehicle refueling systems to large stations refueling 300 cars/day. Hydrogen production from natural gas, methanol, and ammonia, as well as water electrolysis based on alkaline or polymer electrolytes and steam electrolysis using solid oxide electrolytes are considered. These estimates were compared to estimates for competing fuels and vehicles, and used to construct oil use, air pollutant, and greenhouse gas emission scenarios for the U.S. passenger car fleet from 2005-2050. Fuel costs need not be an overriding concern in evaluating the suitability of hydrogen as a fuel for passenger vehicles. The combined emissions and oil import reduction benefits of hydrogen cars are estimated to be significant, valued at up to {approximately}$400/yr for each hydrogen car when primarily clean energy sources are used for hydrogen production. These benefits alone, however, become tenuous as the basis supporting a compelling rationale for hydrogen fueled vehicles, if efficient, advanced fossil-fuel hybrid electric vehicles (HEV`s) can achieve actual on-road emissions at or below ULEV standards in the 2005-2015 timeframe. It appears a robust rationale for hydrogen fuel and vehicles will need to also consider unique, strategic, and long-range benefits of hydrogen vehicles which can be achieved through the use of production, storage, delivery, and utilization methods for hydrogen which are unique among fuels: efficient use of intermittent renewable energy sources, (e,g, wind, solar), small-scale feasibility, fuel production at or near the point of use, electrolytic production, diverse storage technologies, and electrochemical conversion to electricity.

  18. Evaluating cost center productivity.

    Science.gov (United States)

    DiJerome, L; Dunham-Taylor, J; Ash, D; Brown, R

    1999-01-01

    The monthly and yearly productivity summaries were developed and applied to a computer spreadsheet to aid the nurse manager in better understanding and communicating budget issues for diverse ambulatory care departments. A computerized spreadsheet using a commercially available personal computer program, such as Lotus, Quattro Pro, or Excel, can be used to more quickly and accurately track and summarize monthly budget reports. The data can be entered into the spreadsheet either manually or imported by query from the financial mainframe system. Contact your agency's finance or information department for information on how to accomplish this. Periodically acuity and resources should be measured and compared with quality monitors to maintain standards. For the past 10 years, our facility has successfully used this tool to make more informed decisions by identifying trouble spots early, and taking corrective action to avoid crisis management.

  19. Quality evaluation of four hemoglobin screening methods in a blood donor setting along with their comparative cost analysis in an Indian scenario

    Directory of Open Access Journals (Sweden)

    Tondon Rashmi

    2009-01-01

    Full Text Available Background: Despite the wide range of methods available for measurement of hemoglobin, no single technique has emerged as the most appropriate and ideal for a blood donation setup. Materials and Methods: A prospective study utilizing 1014 blood samples was carried out in a blood donation setting for quality evaluation of four methods of hemoglobin estimation along with cost analysis: Hematology cell analyzer (reference, HCS, CuSO4 method and HemoCue. Results: Mean value of HemoCue (mean ± SD = 14.7 ± 1.49 g/dl was higher by 0.24 compared to reference (mean ± SD = 13.8 ± 1.52 g/dl but not statistically significant ( P > 0.05. HemoCue proved to be the best technique (sensitivity 99.4% and specificity 84.4% whereas HCS was most subjective with 25.2% incorrect estimations. CuSO4 proved to be good with 7.9% false results. Comparative cost analysis of each method was calculated to be 35 INR/test for HemoCue, 0.76 INR /test for HCS and 0.06-0.08 INR /test for CuSO4. Conclusion: CuSO4 method gives accurate results, if strict quality control is applied. HemoCue is too expensive to be used as a primary screening method in an economically restricted country like India.

  20. NPR (New Production Reactor) capacity cost evaluation

    Energy Technology Data Exchange (ETDEWEB)

    None

    1988-07-01

    The ORNL Cost Evaluation Technical Support Group (CETSG) has been assigned by DOE-HQ Defense Programs (DP) the task defining, obtaining, and evaluating the capital and life-cycle costs for each of the technology/proponent/site/revenue possibilities envisioned for the New Production Reactor (NPR). The first part of this exercise is largely one of accounting, since all NPR proponents use different accounting methodologies in preparing their costs. In order to address this problem of comparing ''apples and oranges,'' the proponent-provided costs must be partitioned into a framework suitable for all proponents and concepts. If this is done, major cost categories can then be compared between concepts and major cost differences identified. Since the technologies proposed for the NPR and its needed fuel and target support facilities vary considerably in level of technical and operational maturity, considerable care must be taken to evaluate the proponent-derived costs in an equitable manner. The use of cost-risk analysis along with derivation of single point or deterministic estimates allows one to take into account these very real differences in technical and operational maturity. Chapter 2 summarizes the results of this study in tabular and bar graph form. The remaining chapters discuss each generic reactor type as follows: Chapter 3, LWR concepts (SWR and WNP-1); Chapter 4, HWR concepts; Chapter 5, HTGR concept; and Chapter 6, LMR concept. Each of these chapters could be a stand-alone report. 39 refs., 36 figs., 115 tabs.

  1. Comparative evaluation of activity-based costing and variable costing: a case study at IPEN; Avaliacao comparativa do custeio baseado em atividades e do custeio variavel: um estudo de caso no IPEN

    Energy Technology Data Exchange (ETDEWEB)

    Esteves, Josefina Maria da Silva SILVA

    2010-07-01

    This research aims to compare the results with the application of Activity Based Costing and Variable Costing methods in an administrative unit of the Brazilian Federal Government: the Radiopharmacy Facility of IPEN (Institute for Energy and Nuclear Research), which produces radiopharmaceuticals products and develops R and D activities. Faced with the need to adopt a more economical and managerial public administration, this research has provided information to assess which of the two costing methods proves more suitable for cost management in that unit. The research is exploratory and a single-case study. We traced about 80% of material costs by observation 'in loco' of the entire manufacturing process of technetium generator, which represents the main product in terms of production volume and revenues. The results show that the Contribution Margin Variable Costing of 29.12% is very close to the operating income of 28.86%, ahead of support activities, obtained by ABC. It is also noted that the operational result of the product does not change by using either one or another costing method. In the two costing methods the end result is 24.20%. This occurs because the production is on demand. There is no inventory of finished product because it is radioactive. The research has revealed that both methods provide useful information for the management and optimization of costs and results of processes/activities, and that the two methods, in this case, may be used in an integrated and complementary approach, enabling to use the best information content of both. (author)

  2. Comparing oil based ointment versus standard practice for the treatment of moderate burns in Greece: a trial based cost effectiveness evaluation

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    Carayanni Vilelmine J

    2011-12-01

    Full Text Available Abstract Background The local treatment of burn wounds has long been a subject of debate. The objective of this study was to compare the cost and the effectiveness of Moist Exposed Burn Ointment -MEBO versus a combination of povidone iodine plus bepanthenol cream for partial thickness burns. Methods The study was carried out in the Burn Center of a state hospital in Athens, Greece. 211 patients needing conservative therapy were prospectively selected according to the depth of the burn wound. The treatment was allocated according to the Stratified Randomization Design. The outcomes measured were mean cost of in-hospital stay, rate of complications, time of 50% wound healing, pain scores, in hospital stay diminution. We have adopted a societal perspective. Results In the total groups MEBO presented lower cost, (although not significantly different: p = 0.10 and better effectiveness. The data suggest that MEBO is the dominant therapy for superficial partial burn wound with significantly lower costs and significantly higher effectiveness due to a lesser time of recovery and consequently lower time of hospitalization and follow-up. MEBO presented similar percentages of complications with the comparator, lower pain levels and smaller time of no healthy appearance of the burn limits for superficial partial thickness burns. Conclusions The data suggested that topical application of MEBO may be considered for further investigation as a potential first-line treatment modality for superficial partial thickness burns. Trial registration The trial has been registered on the International Standard Randomised Controlled Trial Number Register (ISRCTN and given the registration number ISRCTN74058791.

  3. Evaluation of Federal Energy Savings Performance Contracting -- Methodology for Comparing Processes and Costs of ESPC and Appropriatins-Funded Energy Projects

    Energy Technology Data Exchange (ETDEWEB)

    Hughes, P.J.

    2002-10-08

    lower interest rates than the private sector, but appropriations for energy projects are scarce. What are the costs associated with requesting funding and waiting for appropriations? And how is the value of an energy project affected if savings that are not guaranteed do not last? The objective of this study was to develop and demonstrate methods to help federal energy managers take some of the guesswork out of obtaining best value from spending on building retrofit energy improvements. We developed a method for comparing all-inclusive prices of energy conservation measures (ECMs) implemented using appropriated funds and through ESPCs that illustrates how agencies can use their own appropriations-funded project experience to ensure fair ESPC pricing. The second method documented in this report is for comparing life-cycle costs. This method illustrates how agencies can use their experience, and their judgment concerning their prospects for appropriations, to decide between financing and waiting.

  4. A comparative evaluation of money-based and energy-based cost-benefit analyses of tertiary municipal wastewater treatment using forested wetlands vs. sand filtration in Louisiana

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Jae-Young; Day, John W.; Lane, Robert R.; Day, Jason N. [Coastal Ecology Institute, School of the Coast and Environment, Louisiana State University, Baton Rouge, LA 70803 (United States)

    2004-07-01

    Forested wetlands have been used to provide advanced secondary and tertiary treatment for municipal wastewater for a number of cities in southern Louisiana. Wetland assimilation provides the same services as conventional methods in improving wastewater quality, while having positive impacts on wetlands. Suspended solids and nutrients in wastewater increase net primary productivity (NPP), which leads to increased organic soil formation. This leads to increased elevation that offsets subsidence, a major cause of coastal wetland loss in Louisiana. The City of Breaux Bridge, LA, has discharged secondarily treated municipal wastewater into a forested wetland since 1950, and wetland assimilation was permitted by the Louisiana Department of Environmental Quality and the US Environmental Protection Agency (US EPA) in 1997. We compared benefits and costs of utilizing forested wetlands and conventional sand treatment using money-based and energy-based cost-benefit analyses (CBA). The wetland method had a higher benefit-cost ratio than conventional treatment by 6.0 times based on dollar-based CBA, and by 21.7 times from the energy analysis. Methodologically, dollar-based CBA is a market price-based assessment, liming to an anthropocentric framework, while embodied energy analysis accounts for monetary and nonmonetary values such as carbon sequestration by wetlands, which contributes a more complete assessment of the interaction between the natural environment and the human economy. Wetlands treat more wastewater per unit of energy and with less financial cost than conventional methods, because the wetland method utilizes natural energies such as sunlight, wind and rain, while conventional treatment methods depend on imported nonrenewable energies and materials such as chemicals and electricity and require additional capital investment. Increasing application of natural energies is becoming more important with depleting fossil fuels. Further, wastewater addition increases NPP

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

    NARCIS (Netherlands)

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

    2012-01-01

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

  6. Cost analysis helps evaluate contract profitability.

    Science.gov (United States)

    Sides, R W

    2000-02-01

    A cost-accounting analysis can help group practices assess their costs of doing business and determine the profitability of managed care contracts. Group practices also can use cost accounting to develop budgets and financial benchmarks. To begin a cost analysis, group practices need to determine their revenue and cost centers. Then they can allocate their costs to each center, using an appropriate allocation basis. The next step is to calculate costs per procedure. The results can be used to evaluate operational cost efficiency as well as help negotiate managed care contracts.

  7. A Comparative Study on Evaluating the Service Quality Attributes based on Kano Model: A Case of Low-cost Carrier and Full-service Carrier

    Directory of Open Access Journals (Sweden)

    Byun Hyojeong

    2014-01-01

    Full Text Available The emergence and development of low-cost carriers(LCC with competitive price is heating up the competition in the aviation market more, especially between low-cost carriers(LCC and full-service carriers(FSC. Therefore, it became more important than ever to implement service differentiation strategies of each airline for securing customers and competitiveness. In this sense, the purpose of this study is to compare and assess the different expectations of the customers for airline service attributes pursued by FSCs and LCCs. Three main dimensions of airline service quality attributes (physical, human, and system service, were selected and this study clarified the service quality attributes of each airline carrier using Kano Model. Data were collected from Korean passengers who experienced both LCCs and FSCs for international or domestic flights. As results, this study demonstrated several differences in airline service quality attributes between FSCs and LCCs, which imply that each airline needs to adopt differential strategies to be more competitive. In particular, most physical-related attributes for FSCs were a ‘must-be’ dimension while the majority of attributes for LCCs was clarified ‘one-dimensional’ attribute. The current study also presented implications to be helpful in developing the quality of service and establishing marketing strategies for improvement in customer satisfaction.

  8. Economic evaluation comparing intraoperative cone beam CT-based navigation and conventional fluoroscopy for the placement of spinal pedicle screws: a patient-level data cost-effectiveness analysis.

    Science.gov (United States)

    Dea, Nicolas; Fisher, Charles G; Batke, Juliet; Strelzow, Jason; Mendelsohn, Daniel; Paquette, Scott J; Kwon, Brian K; Boyd, Michael D; Dvorak, Marcel F S; Street, John T

    2016-01-01

    Pedicle screws are routinely used in contemporary spinal surgery. Screw misplacement may be asymptomatic but is also correlated with potential adverse events. Computer-assisted surgery (CAS) has been associated with improved screw placement accuracy rates. However, this technology has substantial acquisition and maintenance costs. Despite its increasing usage, no rigorous full economic evaluation comparing this technology to current standard of care has been reported. Medical costs are exploding in an unsustainable way. Health economic theory requires that medical equipment costs be compared with expected benefits. To answer this question for computer-assisted spinal surgery, we present an economic evaluation looking specifically at symptomatic misplaced screws leading to reoperation secondary to neurologic deficits or biomechanical concerns. The study design was an observational case-control study from prospectively collected data of consecutive patients treated with the aid of CAS (treatment group) compared with a matched historical cohort of patients treated with conventional fluoroscopy (control group). The patient sample consisted of consecutive patients treated surgically at a quaternary academic center. The primary effectiveness measure studied was the number of reoperations for misplaced screws within 1 year of the index surgery. Secondary outcome measures included were total adverse event rate and postoperative computed tomography usage for pedicle screw examination. A patient-level data cost-effectiveness analysis from the hospital perspective was conducted to determine the value of a navigation system coupled with intraoperative 3-D imaging (O-arm Imaging and the StealthStation S7 Navigation Systems, Medtronic, Louisville, CO, USA) in adult spinal surgery. The capital costs for both alternatives were reported as equivalent annual costs based on the annuitization of capital expenditures method using a 3% discount rate and a 7-year amortization period

  9. Hydrogen Station Cost Estimates: Comparing Hydrogen Station Cost Calculator Results with other Recent Estimates

    Energy Technology Data Exchange (ETDEWEB)

    Melaina, M. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Penev, M. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2013-09-01

    This report compares hydrogen station cost estimates conveyed by expert stakeholders through the Hydrogen Station Cost Calculation (HSCC) to a select number of other cost estimates. These other cost estimates include projections based upon cost models and costs associated with recently funded stations.

  10. COMPARATIVE COST AND STRENGTH ANALYSIS OF CEMENT ...

    African Journals Online (AJOL)

    2012-07-02

    Jul 2, 2012 ... ment materials which is aimed at reducing the cost of concrete production. Tests were performed ... crease shrinkage in concrete. The result of a ..... of Palm Kernel Husk Ash PKHA and Free Lime (CaO) as an admix-ture in ...

  11. An open, parallel, randomized, comparative, multicenter study to evaluate the cost-effectiveness, performance, tolerance, and safety of a silver-containing soft silicone foam dressing (intervention) vs silver sulfadiazine cream.

    Science.gov (United States)

    Silverstein, Paul; Heimbach, David; Meites, Herbert; Latenser, Barbara; Mozingo, David; Mullins, Fred; Garner, Warren; Turkowski, Joseph; Shupp, Jeffrey; Glat, Paul; Purdue, Gary

    2011-01-01

    An open, parallel, randomized, comparative, multicenter study was implemented to evaluate the cost-effectiveness, performance, tolerance, and safety of a silver-containing soft silicone foam dressing (Mepilex Ag) vs silver sulfadiazine cream (control) in the treatment of partial-thickness thermal burns. Individuals aged 5 years and older with partial-thickness thermal burns (2.5-20% BSA) were randomized into two groups and treated with the trial products for 21 days or until healed, whichever occurred first. Data were obtained and analyzed on cost (direct and indirect), healing rates, pain, comfort, ease of product use, and adverse events. A total of 101 subjects were recruited. There were no significant differences in burn area profiles within the groups. The cost of dressing-related analgesia was lower in the intervention group (P = .03) as was the cost of background analgesia (P = .07). The mean total cost of treatment was $309 vs $513 in the control (P < .001). The average cost-effectiveness per treatment regime was $381 lower in the intervention product, producing an incremental cost-effectiveness ratio of $1688 in favor of the soft silicone foam dressing. Mean healing rates were 71.7 vs 60.8% at final visit, and the number of dressing changes were 2.2 vs 12.4 in the treatment and control groups, respectively. Subjects reported significantly less pain at application (P = .02) and during wear (P = .048) of the Mepilex Ag dressing in the acute stages of wound healing. Clinicians reported the intervention dressing was significantly easier to use (P = .03) and flexible (P = .04). Both treatments were well tolerated; however, the total incidence of adverse events was higher in the control group. The silver-containing soft silicone foam dressing was as effective in the treatment of patients as the standard care (silver sulfadiazine). In addition, the group of patients treated with the soft silicone foam dressing demonstrated decreased pain and lower costs associated

  12. Use of a cost accounting system to evaluate costs of a VA special program.

    Science.gov (United States)

    Menke, T J; Wray, N P

    1999-04-01

    The Department of Veterans Affairs (VA) established six mobile clinics to provide care for rural veterans. Each was operated by a parent VA Medical Center (VAMC). To describe the use of a cost-accounting system which does not provide costs at the service or patient level to determine the costs of the mobile clinics. Costs per visit were compared among the mobile clinics with the parent VAMCs and with simulated fixed-location clinics. Cost data came from VA's Centralized Accounting for Local Management (CALM) data. Utilization data came from VA's outpatient file. Information was obtained from the VAMCs' fiscal services to reallocate costs among the CALM subaccounts to generate cost data that was comparable among the mobile clinics. Costs per visit for the mobile clinics were twice as high as those of the parent VAMCs. Costs per visit would be lower at fixed-location clinics unless the volume were substantially less than that provided by the mobile clinics. Differences between cost allocations for accounting purposes and research are likely to necessitate adjusting cost accounting data for research purposes. Fortunately, information from the accountants or primary data can lead to a cost database which is appropriate for research evaluations. In the mobile clinics study, the analysis of cost accounting data led to the conclusion that mobile clinics were not a cost-effective way in which to provide care to rural veterans.

  13. Comparative cost-effectiveness of fine needle aspiration biopsy versus image-guided biopsy, and open surgical biopsy in the evaluation of breast cancer in the era of Affordable Care Act: a changing landscape.

    Science.gov (United States)

    Masood, Shahla; Rosa, Marilin; Kraemer, Dale F; Smotherman, Carmen; Mohammadi, Amir

    2015-08-01

    Proven as a time challenged and cost-effective sampling procedure, the use of FNAB has still remained controversial among the scientific community. Currently, other minimally invasive sampling procedures such as ultrasound guided fine needle aspiration biopsy (US-FNAB) and image guided core needle biopsy (IG-CNB) have become the preferred sampling procedures for evaluation of breast lesions. However, changes in the medical economy and the current growing emphasis on cost containment in the era of the Affordable Care Act make it necessary to stimulate a renewed interest in the use of FNAB as the initial diagnostic sampling procedure. This study was designed to define the changing trend in the practice of tissue sampling during the last several years, and to assess the comparative effectiveness and appropriateness of the procedure of choice for breast cancer diagnosis. After Institutional Review Board (IRB) approval, the computer database of the Pathology Department, University of Florida, College of Medicine-Jacksonville at UF Health was retrospectively searched to identify all breast biopsy pathology reports issued during the period of January 2004 to December 2011. The inclusion criteria were all women that underwent any of the following biopsy types: FNAB, US-FNAB, IG-CNB, and surgical biopsy (SB). Diagnostic procedures were identified using current procedural terminology (CPT) codes recorded on claims from the UF Health Jacksonville patient accounting application files. The data obtained was used to determine which technique has the best cost-effectiveness in the diagnosis of breast cancer. The outcome variable for this project was a positive breast cancer diagnosis resulting from these methodologies. The predictor variable was the biopsy type used for sampling. The rate of cancer detection for each procedure was also determined. Among the four groups of procedures compared, the lower cost was attributed to FNAB, followed by US-FNAB, and SB. IG-CNB was the most

  14. Hypergolic Propellant Destruction Evaluation Cost Benefit Analysis

    Science.gov (United States)

    Kessel, Kurt

    2010-01-01

    At space vehicle launch sites such as Vandenberg Air Force Base (VAFB), Cape Canaveral Air Force Station (CCAFS) and Kennedy Space Center (KSC), toxic vapors and hazardous liquid wastes result from the handling of commodities (hypergolic fuels and oxidizers), most notably from transfer operations where fuel and oxidizer are transferred from bulk storage tanks or transfer tankers to space launch vehicles. During commodity transfer at CCAFS and KSC, wet chemical scrubbers (typically containing four scrubbing towers) are used to neutralize fuel saturated vapors from vent systems on tanks and tanker trailers. For fuel vapors, a citric acid solution is used to scrub out most of the hydrazine. Operation of both the hypergolic fuel and oxidizer vapor scrubbers generates waste scrubber liquor. Currently, scrubber liquor from the fuel vapor scrubber is considered non-hazardous. The scrubber liquor is defined as spent citric acid scrubber solution; the solution contains complexed hydrazine I methylhydrazine and is used to neutralize nonspecification hypergolic fuel generated by CCAFS and KSC. This project is a collaborative effort between Air Force Space Command (AFSPC), Space and Missile Center (SMC), the CCAFS, and National Aeronautics and Space Administration (NASA) to evaluate microwave destruction technology for the treatment of non-specification hypergolic fuel generated at CCAFS and KSC. The project will capitalize on knowledge gained from microwave treatment work being accomplished by AFSPC and SMC at V AFB. This report focuses on the costs associated with the current non-specification hypergolic fuel neutralization process (Section 2.0) as well as the estimated costs of operating a mobile microwave unit to treat non-specification hypergolic fuel (Section 3.0), and compares the costs for each (Section 4.0).The purpose of this document is to assess the costs associated with waste hypergolic fuel. This document will report the costs associated with the current fuel

  15. 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.

  16. A cost evaluation methodology for surgical technologies.

    Science.gov (United States)

    Ismail, Imad; Wolff, Sandrine; Gronfier, Agnes; Mutter, Didier; Swanström, Lee L; Swantröm, Lee L

    2015-08-01

    To create and validate a micro-costing methodology that surgeons and hospital administrators can use to evaluate the cost of implementing innovative surgical technologies. Our analysis is broken down into several elements of fixed and variable costs which are used to effectively and easily calculate the cost of surgical operations. As an example of application, we use data from 86 robot assisted gastric bypass operations made in our hospital. To validate our methodology, we discuss the cost reporting approaches used in 16 surgical publications with respect to 7 predefined criteria. Four formulas are created which allow users to import data from their health system or particular situation and derive the total cost. We have established that the robotic surgical system represents 97.53 % of our operating room's medical device costs which amounts to $4320.11. With a mean surgery time of 303 min, personnel cost per operation amounts to $1244.73, whereas reusable instruments and disposable costs are, respectively, $1539.69 and $3629.55 per case. The literature survey demonstrates that the cost of surgery is rarely reported or emphasized, and authors who do cover this concept do so with variable methodologies which make their findings difficult to interpret. Using a micro-costing methodology, it is possible to identify the cost of any new surgical procedure/technology using formulas that can be adapted to a variety of operations and healthcare systems. We hope that this paper will provide guidance for decision makers and a means for surgeons to harmonise cost reporting in the literature.

  17. THE COMPARATIVE COST-EFFICACY ANALYSIS OF VARIOUS ANTIHYPERTENSIVE THERAPIES

    Directory of Open Access Journals (Sweden)

    S. V. Malchikova

    2016-01-01

    Full Text Available Aim. To perform the comparative cost-efficacy analysis of various antihypertensive therapies in hypertensives patients.Material and methods. 140 hypertensive patients with history of ineffective antihypertensive therapy were randomized in to 4 groups, 35 patients in each one. Patients of Group A received indapamide retard plus perindopril; group B - indapamide retard plus amlodipine; group C - amlodipine plus lisinopril; group D - amlodipine plus bisoprolol. The Russian version of general questionnaire MOS-SF-36 was applied for quality of a life estimated. Endothelium function was evaluated with B-mode ultrasonography (Acuson 128 ХР/10. Albuminuria level was detected by immunoturbometric method (Integra-700, Roche.Results. The drug combination B had the least cost. The drug combination C was the most effective. The drug combination C was the most economically rational. The drug combination A was the least economically rational for BP reduction. However the drug combination A was comparable with drug combination C in effects on quality of life and on endothelium function, and it was the most economically rational for albuminuria reduction.Conclusion. Indapamide retard plus perindopril combination is the most economically rational in patients with target-organ lesions (nephropathy. Lisinopril plus amlodipine combination is economically rational in patients without target-organ lesions. 

  18. Comparing Usage and Cost- Effectiveness Analysis of English Printed and Electronic Books for University of Tehran

    OpenAIRE

    Davoud Haseli; Nader Naghshineh; fatemeh Fahimnia

    2014-01-01

    Libraries operate in a competitive environment, and this is essentially needed to prove its benefits for stockholders, and continuously evaluate and compare advantages for printed and electronic resources. In these cases, economic evaluation methods such as cost- effectiveness analysis, is one of the best methods, because of a comprehensive study of the use and cost of library sources. The purpose of this study is to discovery of use and cost- effectiveness analysis of English printed and ebo...

  19. Evaluating the cost of adult voluntary medical male circumcision in a mixed (surgical and PrePex site compared to a hypothetical PrePex-only site in South Africa

    Directory of Open Access Journals (Sweden)

    Hae-Young Kim

    2015-12-01

    Full Text Available Background: Several circumcision devices have been evaluated for a safe and simplified male circumcision among adults. The PrePex device was prequalified for voluntary male medical circumcision (VMMC in May 2013 by the World Health Organization and is expected to simplify the procedure safely while reducing cost. South Africa is scaling up VMMC. Objective: To evaluate the overall unit cost of VMMC at a mixed site vs. a hypothetical PrePex-only site in South Africa. Design: We evaluated the overall unit cost of VMMC at a mixed site where PrePex VMMC procedure was added to routine forceps-guided scalpel-based VMMC in Soweto, South Africa. We abstracted costs and then modeled these costs for a hypothetical PrePex-only site, at which 9,600 PrePex circumcisions per year could be done. We examined cost drivers and modeled costs, varying the price of the PrePex device. The healthcare system perspective was used. Results: In both sites, the main contributors of cost were personnel and consumables. If 10% of all VMMC were by PrePex at the mixed site, the overall costs of the surgical method and PrePex were similar – US$59.62 and $59.53, respectively. At the hypothetical PrePex-only site, the unit cost was US$51.10 with PrePex circumcisions having markedly lower personnel and biohazardous waste management costs. In sensitivity analysis with the cost of PrePex kit reduced to US$10 and $2, the cost of VMMC was further reduced. Conclusions: Adding PrePex to an existing site did not necessarily reduce the overall costs of VMMC. However, starting a new PrePex-only site is feasible and may significantly reduce the overall cost by lowering both personnel and capital costs, thus being cost-effective in the long term. Achieving a lower cost for PrePex will be an important contributor to the scale-up of VMMC.

  20. Noise Figure Evaluation Using Low Cost BIST

    CERN Document Server

    Negreiros, Marcelo; Susin, Altamiro A

    2011-01-01

    A technique for evaluating noise figure suitable for BIST implementation is described. It is based on a low cost single-bit digitizer, which allows the simultaneous evaluation of noise figure in several test points of the analog circuit. The method is also able to benefit from SoC resources, like memory and processing power. Theoretical background and experimental results are presented in order to demonstrate the feasibility of the approach.

  1. Program Evaluation in Cost Benefit Terms.

    Science.gov (United States)

    Tanner, C. Kenneth

    This paper advances a model, called the expected opportunity loss model, for curriculum evaluation. This decision-making technique utilizes subjective data by ranking courses according to their expected contributions to the primary objective of the total program. The model also utilizes objective data in the form of component costs, and differs…

  2. The Global Economic Cost of Osteoarthritis: How the UK Compares

    Directory of Open Access Journals (Sweden)

    A. Chen

    2012-01-01

    Full Text Available Aims. To examine all relevant literature on the economic costs of osteoarthritis in the UK, and to compare such costs globally. Methods. A search of MEDLINE was performed. The search was expanded beyond peer-reviewed journals into publications by the department of health, national orthopaedic associations, national authorities and registries, and arthritis charities. Results. No UK studies were identified in the literature search. 3 European, 6 North American, and 2 Asian studies were reviewed. Significant variation in direct and indirect costs were seen in these studies. Costs for topical and oral NSAIDs were estimated to be £19.2 million and £25.65 million, respectively. Cost of hip and knee replacements was estimated to exceed £850 million, arthroscopic surgery for osteoarthritis was estimated to be £1.34 million. Indirect costs from OA caused a loss of economic production over £3.2 billion, £43 million was spent on community services and £215 million on social services for osteoarthritis. Conclusions. While estimates of economic costs can be made using information from non-published data, there remains a lack of original research looking at the direct or indirect costs of osteoarthritis in the UK. Differing methodology in calculating costs from overseas studies makes direct comparison with the UK difficult.

  3. Digital Identifier Systems: Comparative Evaluation

    Directory of Open Access Journals (Sweden)

    Hamid Reza Khedmatgozar

    2015-02-01

    Full Text Available Identifier is one of the main elements in identifying an object in digital environment. Digital identifier systems were developed followed by a lot of problems such as violation of persistency and uniqueness of physical identifiers and URL in digital environment. These identifiers try to guarantee uniqueness and persistency of hostnames by using indirect names for Domain Name System (DNS. The main objective of this research is to identify qualified digital identifier system among other systems. To achieve the research objective, researchers have considered two major steps: first, identifying main criteria for distinguishing digital identifier based on literature review and focus group interview; and second, performing a comparative evaluation on common identifier systems in the world. Findings of first step demonstrated seven main criteria in three domains for distinguishing digital identifier systems: identifier uniqueness and persistency in the identifier features domain, digital identification, digital uniqueness, digital persistency and digital actionability in the digital coverage domain, and globality in the comprehensiveness of scope domain. In the second step, results of the comparative evaluation on common identifier systems indicated that six identifier systems, included, DOI, Handle, UCI, URN, ARK and PURL, are appropriate choices for using as a digital identifier system. Also, according to these results, three identification systems Including NBN, MARIAM and ISNI were identified as suitable choices for digital identification in certain specialized fields. According to many benefits of using these identifiers in important applied fields, such as, digital content chains and networks integration, digital right management, cross referencing, digital libraries and citation analysis, results of this study can help digital environment experts to diagnose digital identifier and their effective use in applied fields.

  4. Technical Evaluation Report 52: Audio/ Videoconferencing Packages: High cost

    Directory of Open Access Journals (Sweden)

    Urel Sawyers

    2005-11-01

    Full Text Available This report compares two integrated course delivery packages: Centra 6 and WebEx. Both applications feature asynchronous and synchronous audio communications for online education and training. They are relatively costly products, and provide useful comparisons with the two less expensive products to be evaluated in the following report #53. The criteria used in the current evaluation include capacity, interactivity features, integration with learning management systems, technical specifications, and cost. The report ends with a short analysis of the currently emerging audio-conferencing software, Google Talk.

  5. Comparative analysis of the efficiencies of two low cost adsorbents ...

    African Journals Online (AJOL)

    Comparative analysis of the efficiencies of two low cost adsorbents in the removal of Cr(VI) ... African Journal of Environmental Science and Technology ... Generally, the result showed an increase in adsorption by Cr(VI) with increase in mass ...

  6. Methods for the comparative evaluation of pharmaceuticals

    Directory of Open Access Journals (Sweden)

    Busse, Reinhard

    2005-11-01

    countries made post-licensing evaluation of pharmaceuticals a requirement for reimbursement or pricing decisions. Typically an explicitly designated drug review body is involved. In all eleven countries included (Austria, Australia, Canada, Switzerland, Finland, France, the Netherlands, Norway, New Zealand, Sweden, and the United Kingdom a drug's therapeutic benefit in comparison to treatment alternatives is leading the evaluation. A medicine is classified as a therapeutic improvement if it demonstrates an improved benefit-/risk-profile compared to treatment alternatives. However, evidence of superiority to a relevant degree is requested. Health related quality of life is considered as the most appropriate criterion for a drug's added value from patients' perspective. Review bodies in Australia, New Zealand, and the United Kingdom have committed themselves to include this outcome measure whenever possible. Pharmacological or innovative characteristics (e.g. administration route, dosage regime, new acting principle and other advantages (e.g. taste, appearance are considered in about half of the countries. However, in most cases these aspects rank as second line criteria for a drug's added value. All countries except France and Switzerland perform a comparative pharmacoeconomic evaluation to analyse costs caused by a drug intervention in relation to its benefit (preferably by cost utility analysis. However, the question if a medicine is cost effective in relation to treatment alternatives is answered in a political and social context. A range of remarkably varying criteria are considered. Countries agree that randomised controlled head-to-head trials (head-to-head RCT with a high degree of internal and external validity provide the most reliable and least biased evidence of a drug's relative treatment effects (as do systematic reviews and meta-analyses of these RCT. Final outcome parameters reflecting long-term treatment objectives (mortality, morbidity, quality of life are

  7. Life-Cycle-Cost Evaluation on Degradation Diagnosis for Cables

    Science.gov (United States)

    Shimakage, Toyonari; Wu, Kai; Kato, Takeyoshi; Okamoto, Tatsuki; Suzuoki, Yasuo

    Degradation diagnosis is aimed at preventing unexpected failure and extending the service life of electric power apparatuses. It is, however, necessary to investigate the economic feasibility of degradation diagnosis, because the life-cycle cost of cable maintenance changes with the diagnostic parameters such as diagnosis cost, diagnosis interval and replacement criterion. In this paper, based on the actual data of water-tree degradation, we proposed a method of life-cycle-cost evaluation and evaluated the economic effect of degradation diagnosis. We also discussed the economic feasibility of practical nondestructive diagnosis of 6.6 kV XLPE cable, i. e. DC leakage current measurement and residual charge measurement, and compared the economic effects of these methods. As a result, the residual charge measurement is economically feasible and has higher effectiveness than the DC leakage current measurement.

  8. Perceptual costs for motion transparency evaluated by two performance measures.

    Science.gov (United States)

    Suzuki, Naoto; Watanabe, Osamu

    2009-08-01

    Transparency perception is recognized as one of the important phenomena to understand the computational mechanism of early visual system. Transparency perception indicates that a simple theory reconstructing a single-valued field of a visual attribute, such as an optical-flow field, cannot model the neural mechanism for the human visual system and raises a fundamental issue of how visual attributes are represented and detected in the brain. It is considered that one of the important cues to reveal the neural encoding mechanism for overlapping surfaces is the perceptual cost in transparency perception. It has been known that the perceptual performance in motion transparency is worse than that expected from single motion perception. This perceptual "cost" would reflect the encoding strategy for transparent motions. Here we present a systematic study comparing the perceptual costs in motion transparency evaluated by two performance measures. The result showed that the properties of the perceptual costs varied with the performance measures. The perceptual cost evaluated by the motion detection threshold became smaller as a directional difference between overlapping motions increased, whereas the cost examined with the precision of directional judgments became worse. A computational analysis suggests that these contradictory results cannot be explained by a simple population coding model for motion directions.

  9. The Costs of Higher Education: An Essay on the Comparative Financing of Universities. Special Studies in Comparative Education No. 23.

    Science.gov (United States)

    Johnstone, D. Bruce

    The paper uses data from the United States and several other industrialized nations to evaluate the costs of post-secondary education. Discussed are: variations on the concept of higher educational costs; three cost issues (how much higher education, the unit costs of higher education, and sharing the costs); higher education costs and social…

  10. Cost, Power Consumption and Performance Evaluation of Metro Networks

    OpenAIRE

    Bianco, Andrea; Bonald, Thomas; Cuda, Davide; Indre, Raluca-Maria

    2013-01-01

    International audience; We provide models for evaluating the performance, cost and power consumption of different architectures suitable for a metropolitan area network (MAN). We then apply these models to compare today's SONET/SDH metro rings with different alternatives envisaged for next-generation MAN: an Ethernet-carrier grade ring, an optical hub-based architecture and an optical time-slotted WDM ring. Our results indicate that the optical architectures are likely to decrease power consu...

  11. Evaluation of Distribution Network Customer Outage Costs

    Science.gov (United States)

    Zemīte, Laila; Gerhards, Jānis

    2009-01-01

    Customer outage cost criteria are considered, collected and analyzed outage costs in Latvia distribution network, as well as distribution network outage elimination structure, the most common outage causes, are proposed outage costs estimation model. Finally the discussion of results of expected customer outage costs and interrupted energy assessment rate calculation results in Latvia distribution network in 2007 are presented, based on customers' mean value of incomes, outcomes and profitability.

  12. Tonsillectomy compared to acute tonsillitis in children: a comparison study of societal costs.

    Science.gov (United States)

    Leupe, P; Hox, V; Debruyne, F; Schrooten, W; Claes, N V; Lemkens, N; Lemkens, P

    2012-01-01

    Tonsillectomy is one of the most commonly performed surgical procedures in children; its main indications are recurrent episodes of acute tonsillitis and adenotonsillar hypertrophy. The effectiveness of tonsillectomy for severe recurrent tonsillitis is generally accepted; however its socio-economic cost is less well investigated. This study aims to determine and compare the societal cost of a tonsillectomy and a severe throat infection. The costs for both tonsillectomy and severe throat infection were evaluated. Costs of the surgical procedure and hospital stay were calculated based on resource use and personnel input at the participating hospital. The cost of work-related disability for both treatments was measured based on a questionnaire filled in by 275 parents of children undergoing a tonsillectomy. Data from two Belgian institutions (NIS and FOD) were used to calculate the cost of parents' absenteeism. An episode of acute tonsillitis in the child results in a longer period of parents' work absenteeism (mean of 3.1 +/- 0.3 days) compared to tonsillectomy (2.2 +/- 0.2 days). The cost of economic productivity loss amounts to 613 Euros (NIS) or 759 Euros (FOD) for acute tonsillitis and 435 Euros (NIS) or 539 Euros (FOD) for a tonsillectomy. The medical costs linked to the surgical procedure at the local department correspond to 535 Euros and for an acute tonsillitis to 46 Euros. From societal perspective, a tonsillectomy costs the equivalent of 1.4 times the cost of a severe throat infection. This indicates that in children suffering from recurrent acute tonsillitis, watchful waiting results in a higher cost compared to tonsillectomy, given the cumulative costs of parents' absenteeism.

  13. Hospitalization costs of severe bacterial pneumonia in children: comparative analysis considering different costing methods.

    Science.gov (United States)

    Nunes, Sheila Elke Araujo; Minamisava, Ruth; Vieira, Maria Aparecida da Silva; Itria, Alexander; Pessoa, Vicente Porfirio; Andrade, Ana Lúcia Sampaio Sgambatti de; Toscano, Cristiana Maria

    2017-01-01

    To determine and compare hospitalization costs of bacterial community-acquired pneumonia cases via different costing methods under the Brazilian Public Unified Health System perspective. Cost-of-illness study based on primary data collected from a sample of 59 children aged between 28 days and 35 months and hospitalized due to bacterial pneumonia. Direct medical and non-medical costs were considered and three costing methods employed: micro-costing based on medical record review, micro-costing based on therapeutic guidelines and gross-costing based on the Brazilian Public Unified Health System reimbursement rates. Costs estimates obtained via different methods were compared using the Friedman test. Cost estimates of inpatient cases of severe pneumonia amounted to R$ 780,70/$Int. 858.7 (medical record review), R$ 641,90/$Int. 706.90 (therapeutic guidelines) and R$ 594,80/$Int. 654.28 (Brazilian Public Unified Health System reimbursement rates). Costs estimated via micro-costing (medical record review or therapeutic guidelines) did not differ significantly (p=0.405), while estimates based on reimbursement rates were significantly lower compared to estimates based on therapeutic guidelines (pSistema Único de Saúde. Estudo de custo, com coleta de dados primários de uma amostra de 59 crianças com 28 dias a 35 meses de idade hospitalizadas por pneumonia bacteriana. Foram considerados custos diretos médicos e não médicos. Três metodologias de custeio foram utilizadas: microcusteio por revisão de prontuários, microcusteio considerando diretriz terapêutica e macrocusteio por ressarcimento do Sistema Único de Saúde. Os custos estimados pelas diferentes metodologias foram comparados utilizando o teste de Friedman. Os custos hospitalares de crianças com pneumonia grave foram R$ 780,70 ($Int. 858.7) por revisão de prontuários, R$ 641,90 ($Int. 706.90) por diretriz terapêutica e R$ 594,80 ($Int. 654.28) por ressarcimento do Sistema Único de Sa

  14. Comparative evaluation of the efficiency of low-cost adsorbents and ligninolytic fungi to remove a combination of xenoestrogens and pesticides from a landfill leachate and abate its phytotoxicity.

    Science.gov (United States)

    Loffredo, Elisabetta; Castellana, Giancarlo

    2015-01-01

    In this study, two widely available low-cost adsorbents, almond shells and a green compost, and two ligninolytic fungi, Pleurotus ostreatus and Stereum hirsutum, were used to remove organic contaminants from a landfill leachate (LLe) and abate its phytotoxicity. The methodology adopted was based on the occurrence of two simultaneous processes, such as adsorption and bioremoval. The leachate was artificially contaminated with a mixture of the xenoestrogens bisphenol A (BPA), ethynilestadiol (EE2) and 4-n-nonylphenol (NP), the herbicide linuron and the insecticide dimethoate at concentrations of 10, 1, 1, 10 and 10 mg L(-1), respectively. Three adsorption substrates were prepared: potato dextrose agar alone or the same incorporating each adsorbent. The substrates were either not inoculated or inoculated with each fungus, separately, before to be superimposed on LLe. After 2 months, the residual amount of each contaminant, the electrical conductivity, the pH and the content of total phenols were measured in treated LLe. Germination assays using lettuce, ryegrass and radish were performed to evaluate LLe phytotoxicity. The combination substrate+P. ostreatus showed the best results with average removals of 88, 96, 99, 58 and 46% for BPA, EE2, NP, linuron and dimethoate, respectively. The same treatment considerably reduced the phenol content in LLe compared to no treatment. The combination substrate+S. hirsutum produced average removals of 39, 71, 100, 61 and 32% for BPA, EE2, NP, linuron and dimethoate, respectively. Also uninoculated substrates showed relevant adsorption capacities towards the five contaminants. Most treatments significantly reduced LLe phytotoxicity, especially on lettuce. The best results were obtained with the treatment compost+S. hirsutum, which produced root and shoot lengths and seedling biomass of lettuce, respectively, 2.3, 3.3, and 1.9 times those measured in untreated LLe. In general, germination results were negatively correlated with LLe

  15. A cluster randomised trial, cost-effectiveness analysis and psychosocial evaluation of insulin pump therapy compared with multiple injections during flexible intensive insulin therapy for type 1 diabetes: the REPOSE Trial.

    Science.gov (United States)

    Heller, Simon; White, David; Lee, Ellen; Lawton, Julia; Pollard, Daniel; Waugh, Norman; Amiel, Stephanie; Barnard, Katharine; Beckwith, Anita; Brennan, Alan; Campbell, Michael; Cooper, Cindy; Dimairo, Munyaradzi; Dixon, Simon; Elliott, Jackie; Evans, Mark; Green, Fiona; Hackney, Gemma; Hammond, Peter; Hallowell, Nina; Jaap, Alan; Kennon, Brian; Kirkham, Jackie; Lindsay, Robert; Mansell, Peter; Papaioannou, Diana; Rankin, David; Royle, Pamela; Smithson, W Henry; Taylor, Carolin

    2017-04-01

    Insulin is generally administered to people with type 1 diabetes mellitus (T1DM) using multiple daily injections (MDIs), but can also be delivered using infusion pumps. In the UK, pumps are recommended for patients with the greatest need and adult use is less than in comparable countries. Previous trials have been small, of short duration and have failed to control for training in insulin adjustment. To assess the clinical effectiveness and cost-effectiveness of pump therapy compared with MDI for adults with T1DM, with both groups receiving equivalent structured training in flexible insulin therapy. Pragmatic, multicentre, open-label, parallel-group cluster randomised controlled trial, including economic and psychosocial evaluations. After participants were assigned a group training course, courses were randomly allocated in pairs to either pump or MDI. Eight secondary care diabetes centres in the UK. Adults with T1DM for > 12 months, willing to undertake intensive insulin therapy, with no preference for pump or MDI, or a clinical indication for pumps. Pump or MDI structured training in flexible insulin therapy, followed up for 2 years. MDI participants used insulin analogues. Pump participants used a Medtronic Paradigm(®) Veo(TM) (Medtronic, Watford, UK) with insulin aspart (NovoRapid, Novo Nordisk, Gatwick, UK). Primary outcome - change in glycated haemoglobin (HbA1c) at 2 years in participants whose baseline HbA1c was ≥ 7.5% (58 mmol/mol). Key secondary outcome - proportion of participants with HbA1c ≤ 7.5% at 2 years. Other outcomes at 6, 12 and 24 months - moderate and severe hypoglycaemia; insulin dose; body weight; proteinuria; diabetic ketoacidosis; quality of life (QoL); fear of hypoglycaemia; treatment satisfaction; emotional well-being; qualitative interviews with participants and staff (2 weeks), and participants (6 months); and ICERs in trial and modelled estimates of cost-effectiveness. We randomised 46 courses comprising 317 participants

  16. Cost of Quality Evaluation Methodologies Handbook

    Science.gov (United States)

    1988-07-28

    manu- 2-7 ... . ., I I facturing inefficiency, and foster quality and productivity improvement." MIL-STD-1520C Paragraph 5.7.4 Nonconformance costs...1979 ALFORD REX E 126. QALITX COSTO - WNZR T STT PhR III QUALITY 40-42 1979 ALFORD REX E 127.QUALITY COST8 - WHZE _W START, PART QUALITY 36-37 1979

  17. Time-driven activity based costing: a comparative study with the activity based costing

    Directory of Open Access Journals (Sweden)

    Marina Battistella Luna

    2017-06-01

    Full Text Available The activity-based costing (ABC emerged in the 1980s to meet the new necessities of cost information facing companies, the result of continuous changes in the business environment. In the 2000s, a new costing method, known as time-driven activity-based costing (TDABC was introduced in order to simplify the ABC. This paper compares these methods in order to provide information to assist managers to decide which of these methods better suits the reality of their companies. Therefore, they were analyzed based on information obtained through a systematic search in the Scopus and Web of Knowledge databases, as well as papers from the annals of the Congresso Brasileiro de Custos, Congresso de Controladoria e Contabilidade da USP and Encontro Nacional de Engenharia de Produção (considering scientific papers published between 2004 and 2016. From this analysis, in most cases it was concluded that TDABC is a simpler and more practical option than ABC. However, it was also apparent that managers, before choosing a particular method, must verify whether the conditions that enable its applicability exist.

  18. SPS and alternative technologies cost and performance evaluations

    Science.gov (United States)

    Samsa, M. E.

    1980-01-01

    Cost estimates for production of the electrical energy needed in the early twenty-first century are provided. Costs and performance of the Satellite Power System are compared with alternative methods of producing electrical energy.

  19. Comparative evaluation of CVD diamond technologies

    Energy Technology Data Exchange (ETDEWEB)

    Anthony, T.R. [General Electric Corporate Research & Development Center, Schenectady, NY (United States)

    1993-01-01

    Chemical vapor deposition (CVD) of diamonds occurs from hydrogen-hydrocarbon gas mixtures in the presence of atomic hydrogen at subatmospheric pressures. Most CVD methods are based on different means of generating and transporting atomic hydrogen in a particular system. Evaluation of these different techniques involves their capital costs, material costs, energy costs, labor costs and the type and quality of diamond that they produce. Currently, there is no universal agreement on which is the best technique and technique selection has been largely driven by the professional background of the user as well as the particular application of interest. This article discusses the criteria for evaluating a process for low-pressure deposition of diamond. Next, a brief history of low-pressure diamond synthesis is reviewed. Several specific processes are addressed, including the hot filament process, hot filament electron-assisted chemical vapor deposition, and plasma generation of atomic hydrogen by glow discharge, microwave discharge, low pressure radio frequency discharge, high pressure DC discharge, high pressure microwave discharge jets, high pressure RF discharge, and high and low pressure flames. Other types of diamond deposition methods are also evaluated. 101 refs., 15 figs.

  20. Staff Draft Report. Comparative Cost of California Central Station Electricity Generation Technologies.

    Energy Technology Data Exchange (ETDEWEB)

    Badr, Magdy; Benjamin, Richard

    2003-02-11

    This Energy Commission staff draft report presents preliminary levelized cost estimates for several generic central-station electricity generation technologies. California has traditionally adopted energy policies that balance the goals of supporting economic development, improving environmental quality and promoting resource diversity. In order to be effective, such policies must be based on comprehensive and timely gathering of information. With this goal in mind, the purpose of the report is to provide comparative levelized cost estimates for a set of renewable (e.g., solar) and nonrenewable (e.g., natural gas-fired) central-station electricity generation resources, based on each technology's operation and capital cost. Decision-makers and others can use this information to compare the generic cost to build specific technology. These costs are not site specific. If a developer builds a specific power plant at a specific location, the cost of siting that plant at that specific location must be considered. The Energy Commission staff also identifies the type of fuel used by each technology and a description of the manner in which the technology operates in the generation system. The target audiences of this report are both policy-makers and anyone wishing to understand some of the fundamental attributes that are generally considered when evaluating the cost of building and operating different electricity generation technology resources. These costs do not reflect the total cost to consumers of adding these technologies to a resources portfolio. These technology characterizations do not capture all of the system, environmental or other relevant attributes that would typically be needed by a portfolio manager to conduct a comprehensive ''comparative value analysis''. A portfolio analysis will vary depending on the particular criteria and measurement goals of each study. For example, some form of firm capacity is typically needed with wind

  1. Evaluation of energy and cost savings in mobile Cloud RAN

    DEFF Research Database (Denmark)

    Checko, Aleksandra; Christiansen, Henrik Lehrmann; Berger, Michael Stübert

    2013-01-01

    The load in mobile networks is subject to variations during the day, due to user mobility and varying network average usage. Therefore, the traditional or Distributed Radio Access Network (D-RAN) architecture, where the BaseBand processing Units (BBUs) are assigned statically to a number of cells......, is sub optimal, comparing to a novel, cloud based architecture called Cloud Radio Access Network (C-RAN). In C-RAN a group of cells shares processing resources, and hence benefit from statistical multiplexing gain is expected. In this paper, the energy and cost savings in C-RAN are evaluated numerically...

  2. Evaluation of Cost Models and Needs & Gaps Analysis

    DEFF Research Database (Denmark)

    Kejser, Ulla Bøgvad

    2014-01-01

    his report ’D3.1—Evaluation of Cost Models and Needs & Gaps Analysis’ provides an analysis of existing research related to the economics of digital curation and cost & benefit modelling. It reports upon the investigation of how well current models and tools meet stakeholders’ needs for calculating...... andcomparing financial information. Based on this evaluation, it aims to point out gaps that need to be bridged in order to increase the uptake of cost & benefit modelling and good practices that will enable costing and comparison of the costs of alternative scenarios—which in turn provides a starting point...... for amore efficient use of resources for digital curation. To facilitate and clarify the model evaluation the report first outlines a basic terminology and a generaldescription of the characteristics of cost and benefit models.The report then describes how the ten current and emerging cost and benefit...

  3. COMPARATIVE ANALYSIS FOR THE PRACTICAL PRACTICE OF COST CALCULATION

    Directory of Open Access Journals (Sweden)

    Veronika Fenyves

    2015-07-01

    Full Text Available Basic topic of our treatise is to introduce the system of cost calculation. Our reason for choice of this topic is that, in the economic environment of today, it is very important for a production company to have the most possible accurate knowledge about costs of the activity. This informational demand emerges in case of more and more managing entities since the cost cutback is often the only tool for retaining the competitiveness – of course, within certain frameworks. There is a frequent question among the corporate owners and management: “How could our costs be cut – even if only to a small extent?” One of the devices is the moderation of the activity costs, in order to do this it is essential to know how much the production of the unit of product costs for the company, that is to say, how many its first cost is. Our goal is to aim the attention at values and importance of the management information system as well as information obtained during determination of the cost, the differences in results of the individual cost calculation methods and the reasons of differences. In addition, our intention was to know and acquaint a complex cost calculation procedure in depth during which we endeavoured to form a system theory of a kind.

  4. A comparative analysis of the costs of administration of an OSCE (objective structured clinical examination).

    Science.gov (United States)

    Cusimano, M D; Cohen, R; Tucker, W; Murnaghan, J; Kodama, R; Reznick, R

    1994-07-01

    The objective structured clinical examination (OSCE) has become an accepted technique for the evaluation of clinical competence in medicine. Although advances have been made in our knowledge of the psychometric aspects of the OSCE, extremely little has been written about feasibility and cost issues. Given the current economic imperative to control costs and the extremely scant literature on the costs of developing and administering an examination in medicine, the authors felt it timely and relevant to explore issues related to the cost of the OSCE. In 1991-92 and in 1992-93, costs and time requirements to implement and administer a structured oral (SO) examination and a six-station OSCE for a surgical clerkship at the University of Toronto Faculty of Medicine were gathered by review of invoices, interviews with those involved, and perusal of diaries kept by staff. To develop and administer the six-station OSCE, 327.5 hours of staff and faculty time were required for each rotation of surgical clerks (8.2 hours per student). The SO examination required 110 hours of staff and faculty time (2.75 hours per student). Direct expenses for the OSCE amounted to U.S. $6.90 per student per station, compared with no direct expense for the SO examination. The OSCE was more time-consuming and more expensive in human and material costs than the SO examination. However, costs of the OSCE can be substantially reduced from approximately U.S. $35 to U.S. ! per student per station if test developers, standardized patients, support staff, and examiners can donate their time. The authors compare the costs and time requirements of their OSCE with those of other OSCEs reported in the literature, and they provide guidelines to assist educators in deciding whether the costs of an OSCE are justifiable in the educators' individual settings.

  5. Comparing Cost-Effectiveness of HIV Testing Strategies: Targeted and Routine Testing in Washington, DC.

    Directory of Open Access Journals (Sweden)

    Amanda D Castel

    Full Text Available Routine HIV testing is an essential approach to identifying undiagnosed infections, linking people to care and treatment, and preventing new infections. In Washington, DC, where HIV prevalence is 2.4%, a combination of routine and targeted testing approaches has been implemented since 2006.We sought to evaluate the cost effectiveness of the District of Columbia (DC Department of Health's routine and targeted HIV testing implementation strategies. We collected HIV testing data from 3 types of DC Department of Health-funded testing sites (clinics, hospitals, and community-based organizations; collected testing and labor costs; and calculated effectiveness measures including cost per new diagnosis and cost per averted transmission.Compared to routine testing, targeted testing resulted in higher positivity rates (1.33% vs. 0.44%. Routine testing averted 34.30 transmissions per year compared to targeted testing at 17.78. The cost per new diagnosis was lower for targeted testing ($2,467 vs. $7,753 per new diagnosis as was the cost per transmission averted ($33,160 vs. $104,205. When stratified by testing site, both testing approaches were most cost effective in averting new transmissions when conducted by community based organizations ($25,037 routine; $33,123 targeted compared to hospitals or clinics.While routine testing identified more newly diagnosed infections and averted more infections than targeted testing, targeted testing is more cost effective per diagnosis and per transmission averted overall. Given the high HIV prevalence in DC, the DC Department of Health's implementation strategy should continue to encourage routine testing implementation with emphasis on a combined testing strategy among community-based organizations.

  6. Comparação dos gastos com material para reparação de perfurações de córnea com cola de cianoacrilato e sutura de córnea Comparative cost evaluation in corneal perforation repair with cyanoacrylate adhesive versus corneal suture

    Directory of Open Access Journals (Sweden)

    Emerson Lioji Ueda

    2004-02-01

    Full Text Available OBJETIVO: Avaliação comparativa de custos de reparação de pequenas perfurações oculares utilizando a técnica da cola de cianoacrilato Super Bonder® (2-metil-cianoacrilato comparada à técnica de sutura de córnea. MÉTODOS: A fim de avaliar comparativamente os custos do uso da técnica de cola de cianoacrilato com a técnica de sutura de córnea, realizou-se análise dos materiais usados em ambas técnicas. RESULTADOS: A análise de custos comparativos entre o uso da técnica de cola de cianoacrilato em pequenas perfurações, versus a técnica de sutura de córnea demonstrou menor gasto com uso do adesivo. CONCLUSÃO: A utilização da técnica de cola de cianoacrilato, para reparação de perfuração de córnea, apresentou custos menores quando comparada com a técnica de sutura de córnea.PURPOSE: The aim of this study was performing a comparative evaluation of cost in small ocular perforation repair using cyanoacrylate adhesive technique Super BonderTM (methyl-2-cyanoacrylate as compared with corneal suture technique. METHODS: In order to compare evaluations of cost a cost analysis in "reais" (R$ was conducted for both techniques according to the materials used in cyanoacrylate glue technique and the corneal suture. RESULTS: The analysis of comparative cost of the cyanoacrylate adhesive technique in small perforations versus corneal suture showed a lower cost of the former. CONCLUSION: Lower cost was found for the cyanoacrylate glue technique for corneal perforation repair when compared to the corneal suture technique.

  7. Heliostat production evaluation and cost analysis

    Energy Technology Data Exchange (ETDEWEB)

    Britt, J. F.; Shulte, C. W.; Davey, H. L.

    1979-12-01

    The primary objective of this study is to provide a factory cost for the production of heliostats in terms of 1979 dollars. Factory cost is defined as the sum of all direct labor, direct material and burden expenses that are incurred in the manufacture of a heliostat, and its packaging for shipment. Transportation, installation, taxes other than plant real taxes, profit, selling expenses, and all other profit and loss items are not included. Two production volumes are considered, 25,000 heliostat units per year and 250,000 heliostat units per year. The study concluded that the factory cost to manufacture heliostats is $95.99/m/sup 2/ at 25,000 units per year and $67.95/m/sup 2/ at 250,000 units per year. The Policy Analysis Branch of the Solar Energy Research Institute estimates that this implies an installed price of $122.12/m/sup 2/ at the 25,000 unit-per-year volume.

  8. Comparing five alternative methods of breast reconstruction surgery: a cost-effectiveness analysis.

    Science.gov (United States)

    Grover, Ritwik; Padula, William V; Van Vliet, Michael; Ridgway, Emily B

    2013-11-01

    The purpose of this study was to assess the cost-effectiveness of five standardized procedures for breast reconstruction to delineate the best reconstructive approach in postmastectomy patients in the settings of nonirradiated and irradiated chest walls. A decision tree was used to model five breast reconstruction procedures from the provider perspective to evaluate cost-effectiveness. Procedures included autologous flaps with pedicled tissue, autologous flaps with free tissue, latissimus dorsi flaps with breast implants, expanders with implant exchange, and immediate implant placement. All methods were compared with a "do-nothing" alternative. Data for model parameters were collected through a systematic review, and patient health utilities were calculated from an ad hoc survey of reconstructive surgeons. Results were measured in cost (2011 U.S. dollars) per quality-adjusted life-year. Univariate sensitivity analyses and Bayesian multivariate probabilistic sensitivity analysis were conducted. Pedicled autologous tissue and free autologous tissue reconstruction were cost-effective compared with the do-nothing alternative. Pedicled autologous tissue was the slightly more cost-effective of the two. The other procedures were not found to be cost-effective. The results were robust to a number of sensitivity analyses, although the margin between pedicled and free autologous tissue reconstruction is small and affected by some parameter values. Autologous pedicled tissue was slightly more cost-effective than free tissue reconstruction in irradiated and nonirradiated patients. Implant-based techniques were not cost-effective. This is in agreement with the growing trend at academic institutions to encourage autologous tissue reconstruction because of its natural recreation of the breast contour, suppleness, and resiliency in the setting of irradiated recipient beds.

  9. Cost-utility of enoxaparin compared with unfractionated heparin in unstable coronary artery disease

    Directory of Open Access Journals (Sweden)

    Milne Ruairidh

    2001-10-01

    Full Text Available Abstract Background Low molecular weight heparins hold several advantages over unfractionated heparin including convenience of administration. Enoxaparin is one such heparin licensed in the UK for use in unstable coronary artery disease (unstable stable angina and non-Q wave myocardial infarction. In these patients, two large randomised controlled trials and their meta-analysis showed small benefits for enoxaparin over unfractionated heparin at 30–43 days and potentially at one year. We found no relevant published full economic evaluations, only cost studies, one of which was conducted in the UK. The other studies, from the US, Canada and France, are difficult to interpret since their resource use and costs may not reflect UK practice. Methods We aimed to compare the benefits and costs of short-term treatment (two to eight days with enoxaparin and unfractionated heparin in unstable coronary artery disease. We used published data sources to estimate the incremental cost per quality adjusted life year (QALY, adopting a NHS perspective and using 1998 prices. Results The base case was a 0.013 QALY gain and net cost saving of £317 per person treated with enoxaparin instead of unfractionated heparin. All but one sensitivity analysis showed net savings and QALY gains, the exception (the worst case being a cost per QALY of £3,305. Best cases were a £495 saving and 0.013 QALY gain, or a £317 saving and 0.014 QALY gain per person. Conclusions Enoxaparin appears cost saving compared with unfractionated heparin in patients with unstable coronary artery disease. However, cost implications depend on local revascularisation practice.

  10. Comparing Cost Of New Supply Chain Designs Under Uncertainty

    DEFF Research Database (Denmark)

    Wæhrens, Brian Vejrum; Kristensen, Jesper; Asmussen, Jesper Normann

    2016-01-01

    Companies pursuing improvements to their global supply chain (SC) are challenged with unravelling the true cost of operating with their supply chain design (SCD). This challenge is further intensified as SCs are faced with increasing uncertainty. To rectify this it is investigated how Cost...... Accounting, Operational Modelling and SCM inform decision making for new SCDs. Through four embedded cases, a gap is found between the practice of a global OEM and literature. Results shows complications when assessing SCDs due to limited understanding of the internal activity costs, supply chain dynamics...

  11. Cost minimization of generation, storage, and new loads, comparing costs with and without externalities

    DEFF Research Database (Denmark)

    Noel, Lance Douglas; Brodie, Joseph; Kempton, Willett

    2017-01-01

    G) technology, and building heat) are modeled within the PJM Interconnection. The corresponding electric systems are then operated and constrained to meet the load every hour over four years. The total cost of each energy system is calculated, both with and without externalities, to find the least...... cost energy systems. Using today’s costs of conventional and renewable electricity and without adding any externalities, the cost-minimum system includes no renewable generation, but does include EVs. When externalities are included, however, the most cost-effective to system covers 50% of the electric...... load with renewable energy and runs reliably without need for either new conventional generation or purpose-built storage. The three novel energy policy implications of this research are: (1) using today’s cost of renewable electricity and estimates of externalities, it is cost effective to implement...

  12. Cost utility analysis of sildenafil compared with papaverine-phentolamine injections

    NARCIS (Netherlands)

    E.A. Stolk (Elly); M. Caffa; E.J. Meuleman; F.F.H. Rutten (Frans); J.J. van Busschbach (Jan)

    2000-01-01

    textabstractOBJECTIVE: To compare the cost effectiveness of sildenafil and papaverine-phentolamine injections for treating erectile dysfunction. DESIGN: Cost utility analysis comparing treatment with sildenafil (allowing a switch to injection therapy) and treatment with

  13. EVALUATION OF CORROSION COST OF CRUDE OIL PROCESSING INDUSTRY

    Directory of Open Access Journals (Sweden)

    ADESANYA A.O.

    2012-08-01

    Full Text Available Crude oil production industry as the hub of Nigeria Economy is not immune to the global financial meltdown being experienced world over which have resulted in a continual fall of oil price. This has necessitated the need to reduce cost of production. One of the major costs of production is corrosion cost, hence, its evaluation. This research work outlined the basic principles of corrosion prevention, monitoring and inspection and attempted to describe ways in which these measures may be adopted in the context of oil production. A wide range of facilities are used in crude oil production making it difficult to evaluate precisely the extent of corrosion and its cost implication. In this study, cost of corrosion per barrel was determined and the annualized value of corrosion cost was also determined using the principles of engineering economy and results analyzed using descriptive statistics. The results showed that among the corrosion prevention methods identified, the use of chemical treatment gave the highest cost contribution (81% of the total cost of prevention while coating added 19%. Cleaning pigging and cathodic protection gave no cost. The contribution of corrosion maintenance methods are 60% for repairs and 40% for replacement. Also among the corrosion monitoring and inspection identified, NDT gave the highest cost contribution of 41% of the total cost, followed by coating survey (34%. Cathodic protection survey and crude analysis gives the lowest cost contribution of 19% and 6% respectively. Corrosion control cost per barrel was found to be 77 cent/barrel. The significance of this cost was not much due to high price of crude oil in the international market. But the effect of corrosion in crude oil processing takes its toll on crude oil production (i.e. deferment.

  14. Cost evaluation of clinical laboratory in Taiwan's National Health System by using activity-based costing.

    Science.gov (United States)

    Su, Bin-Guang; Chen, Shao-Fen; Yeh, Shu-Hsing; Shih, Po-Wen; Lin, Ching-Chiang

    2016-11-01

    To cope with the government's policies to reduce medical costs, Taiwan's healthcare service providers are striving to survive by pursuing profit maximization through cost control. This article aimed to present the results of cost evaluation using activity-based costing performed in the laboratory in order to throw light on the differences between costs and the payment system of National Health Insurance (NHI). This study analyzed the data of costs and income of the clinical laboratory. Direct costs belong to their respective sections of the department. The department's shared costs, including public expenses and administrative assigned costs, were allocated to the department's respective sections. A simple regression equation was created to predict profit and loss, and evaluate the department's break-even point, fixed cost, and contribution margin ratio. In clinical chemistry and seroimmunology sections, the cost per test was lower than the NHI payment and their major laboratory tests had revenues with the profitability ratio of 8.7%, while the other sections had a higher cost per test than the NHI payment and their major tests were in deficit. The study found a simple linear regression model as follows: "Balance=-84,995+0.543×income (R2=0.544)". In order to avoid deficit, laboratories are suggested to increase test volumes, enhance laboratory test specialization, and become marginal scale. A hospital could integrate with regional medical institutions through alliances or OEM methods to increase volumes to reach marginal scale and reduce laboratory costs, enhancing the level and quality of laboratory medicine.

  15. Comparing tools for Service Quality Evaluation

    OpenAIRE

    Franceschini, Fiorenzo

    1998-01-01

    Service quality evaluation is one of the main issues that have recently drawn managers' and researchers' attention. The definition of an evaluation standard not dependent on any particular service context has determined the popularity of many different quality tools. In this paper we show a comparative analysis of the affected tools that are widely used. These are summarized in an orientation map. Moreover we present some results of an experiment carried out with two of the major quality tool...

  16. comparative cost and strength analysis of cement and aggregate ...

    African Journals Online (AJOL)

    2012-07-02

    Jul 2, 2012 ... Nigerian Journal of Technology (NIJOTECH) ... groundnut husk ash, palm oil fuel ash, bone powder ash, acha husk ash and bambara groundnut ... study suggests that; the cost of construction and concrete production can be reduced if cement .... coarse aggregate for light trafficked roads and 10% as par-.

  17. Cost evaluations of radiotherapy: What do we know? An ESTRO-HERO analysis.

    Science.gov (United States)

    Defourny, Noémie; Dunscombe, Peter; Perrier, Lionel; Grau, Cai; Lievens, Yolande

    2016-12-01

    Although economic evidence is becoming mandatory to support health care decision-making, challenges remain in generating high quality cost data, especially for complex and rapidly evolving treatment modalities, such as radiotherapy. The overall aim of this systematic literature review was to critically analyse the type and quality of radiotherapy cost information available in cost calculation studies, from the health care provider's perspective, published since 1981. A selection process, based on strict and explicit criteria, yielded 52 articles. In spite of meeting our criteria these studies displayed large heterogeneity in scope, costing method, inputs and outputs. The limited use of conventional costing methodologies along with insufficient information on resource inputs hampered comparability across studies. A consistent picture of radiotherapy costs, based on methodologically sound costing studies, has yet to emerge. These results call for developing a well-defined and generally accepted cost methodology for performing economic evaluation studies in radiotherapy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Evaluation of Cost Models and Needs & Gaps Analysis

    DEFF Research Database (Denmark)

    Kejser, Ulla Bøgvad

    2014-01-01

    his report ’D3.1—Evaluation of Cost Models and Needs & Gaps Analysis’ provides an analysis of existing research related to the economics of digital curation and cost & benefit modelling. It reports upon the investigation of how well current models and tools meet stakeholders’ needs for calculating...... for amore efficient use of resources for digital curation. To facilitate and clarify the model evaluation the report first outlines a basic terminology and a generaldescription of the characteristics of cost and benefit models.The report then describes how the ten current and emerging cost and benefit...... they breakdown costs. This is followed by an in depth analysis of stakeholders’ needs for financial information derived from the 4C project stakeholder consultation.The stakeholders’ needs analysis indicated that models should:• support accounting, but more importantly they should enable budgeting• be able...

  19. Early‐Stage Capital Cost Estimation of Biorefinery Processes: A Comparative Study of Heuristic Techniques

    Science.gov (United States)

    Couturier, Jean‐Luc; Kokossis, Antonis; Dubois, Jean‐Luc

    2016-01-01

    Abstract Biorefineries offer a promising alternative to fossil‐based processing industries and have undergone rapid development in recent years. Limited financial resources and stringent company budgets necessitate quick capital estimation of pioneering biorefinery projects at the early stages of their conception to screen process alternatives, decide on project viability, and allocate resources to the most promising cases. Biorefineries are capital‐intensive projects that involve state‐of‐the‐art technologies for which there is no prior experience or sufficient historical data. This work reviews existing rapid cost estimation practices, which can be used by researchers with no previous cost estimating experience. It also comprises a comparative study of six cost methods on three well‐documented biorefinery processes to evaluate their accuracy and precision. The results illustrate discrepancies among the methods because their extrapolation on biorefinery data often violates inherent assumptions. This study recommends the most appropriate rapid cost methods and urges the development of an improved early‐stage capital cost estimation tool suitable for biorefinery processes. PMID:27484398

  20. Early-Stage Capital Cost Estimation of Biorefinery Processes: A Comparative Study of Heuristic Techniques.

    Science.gov (United States)

    Tsagkari, Mirela; Couturier, Jean-Luc; Kokossis, Antonis; Dubois, Jean-Luc

    2016-09-08

    Biorefineries offer a promising alternative to fossil-based processing industries and have undergone rapid development in recent years. Limited financial resources and stringent company budgets necessitate quick capital estimation of pioneering biorefinery projects at the early stages of their conception to screen process alternatives, decide on project viability, and allocate resources to the most promising cases. Biorefineries are capital-intensive projects that involve state-of-the-art technologies for which there is no prior experience or sufficient historical data. This work reviews existing rapid cost estimation practices, which can be used by researchers with no previous cost estimating experience. It also comprises a comparative study of six cost methods on three well-documented biorefinery processes to evaluate their accuracy and precision. The results illustrate discrepancies among the methods because their extrapolation on biorefinery data often violates inherent assumptions. This study recommends the most appropriate rapid cost methods and urges the development of an improved early-stage capital cost estimation tool suitable for biorefinery processes. © 2015 The Authors. Published by Wiley-VCH Verlag GmbH & Co. KGaA.

  1. Cost evaluation of CO2 sequestration by aqueous mineral carbonation

    Energy Technology Data Exchange (ETDEWEB)

    Huijgen, W.J.J. [Energy Research Centre of The Netherlands, P.O. Box 1, 1755 ZG Petten (Netherlands); Comans, R.N.J. [Wageningen University, Department of Soil Quality, P.O. Box 8005, 6700 EC Wageningen (Netherlands); Witkamp, G.J. [Delft University of Technology, Laboratory for Process Equipment, Leeghwaterstraat 44, 2628 CA Delft (Netherlands)

    2007-05-15

    A cost evaluation of CO2 sequestration by aqueous mineral carbonation has been made using either wollastonite (CaSiO3) or steel slag as feedstock. First, the process was simulated to determine the properties of the streams as well as the power and heat consumption of the process equipment. Second, a basic design was made for the major process equipment, and total investment costs were estimated with the help of the publicly available literature and a factorial cost estimation method. Finally, the sequestration costs were determined on the basis of the depreciation of investments and variable and fixed operating costs. Estimated costs are 102 and 77 euro/ton CO2 net avoided for wollastonite and steel slag, respectively. For wollastonite, the major costs are associated with the feedstock and the electricity consumption for grinding and compression (54 and 26 euro/ton CO2 avoided, respectively). A sensitivity analysis showed that additional influential parameters in the sequestration costs include the liquid-to-solid ratio in the carbonation reactor and the possible value of the carbonated product. The sequestration costs for steel slag are significantly lower due to the absence of costs for the feedstock. Although various options for potential cost reduction have been identified, CO2 sequestration by current aqueous carbonation processes seems expensive relative to other CO2 storage technologies. The permanent and inherently safe sequestration of CO2 by mineral carbonation may justify higher costs, but further cost reductions are required, particularly in view of (current) prices of CO2 emission rights. Niche applications of mineral carbonation with a solid residue such as steel slag as feedstock and/or a useful carbonated product hold the best prospects for an economically feasible CO2 sequestration process.

  2. Project JADE. Comparative cost analysis for different deposition methods; Projekt JADE. Jaemfoerande kostnadsanalys mellan olika deponeringsmetoder

    Energy Technology Data Exchange (ETDEWEB)

    Ageskog, L. [SWECO VBB VIAK AB, Stockholm (Sweden)

    2001-08-01

    Within the SKB Deep Repository Project, a study called JADE (Comparison of Deposition Methods) has been performed with the purpose of systematically evaluating different deposition methods The study has encompassed the areas of technology, long term performance and safety, and costs. The alternative methods studied are all within the frame of the so-called KBS-3 concept. The present report deals with the comparison regarding costs. The following deposition methods have been studied and compared: deposition in vertical holes (KBS-3 V), single canister deposition in horizontal holes (KBS-3 H) and serial canister deposition in medium long holes (MLH). KBS-3 V constitutes the reference concept for current development and planing activities within SKB. The cost calculations have been performed according to a method called 'the Successive Principle'. The same method is currently used by SKB in the cost analyses reported to the authorities on a yearly basis (the so-called PLAN analyses). The method covers uncertainties of various kinds and presents data in a statistical manner, providing means for a result interpretation in terms of probabilities. Beside the methodology, also technical and cost data have been derived from the PLAN works, mostly from the report PLAN 97, which was forwarded to the authorities in June 1997. Hence, all cost data in the present study refer to price level January 1997. The findings of the present study are compared with the reference method KBS 3 V. (The report also includes comparisons between alternatives within each one of the three principal methods.)

  3. Evaluation of the Total Cost of Ownership of Fuel Cell-Powered Material Handling Equipment

    Energy Technology Data Exchange (ETDEWEB)

    Ramsden, T.

    2013-04-01

    This report discusses an analysis of the total cost of ownership of fuel cell-powered and traditional battery-powered material handling equipment (MHE, or more typically 'forklifts'). A number of fuel cell MHE deployments have received funding support from the federal government. Using data from these government co-funded deployments, DOE's National Renewable Energy Laboratory (NREL) has been evaluating the performance of fuel cells in material handling applications. NREL has assessed the total cost of ownership of fuel cell MHE and compared it to the cost of ownership of traditional battery-powered MHE. As part of its cost of ownership assessment, NREL looked at a range of costs associated with MHE operation, including the capital costs of battery and fuel cell systems, the cost of supporting infrastructure, maintenance costs, warehouse space costs, and labor costs. Considering all these costs, NREL found that fuel cell MHE can have a lower overall cost of ownership than comparable battery-powered MHE.

  4. Evaluating Training: Return on Investment and Cost-Benefit Analysis.

    Science.gov (United States)

    Munoz, Maria D.; Munoz, Marco A.

    Training interventions can be evaluated by calculating return on investment (ROI) and cost-benefit analysis. The four-level model proposed by Kirkpatrick is the dominant evaluation model used. Calculating ROI has been a critical issue for trainers and executives, but only a few organizations have implemented the process that is considered as…

  5. Comparative cost estimates of five coal utilization processes

    Energy Technology Data Exchange (ETDEWEB)

    1979-01-01

    Detailed capital and operating cost estimates were prepared for the generation of electric power in a new, net 500 MW (e), coal-burning facility by five alternative processes: conventional boiler with no control of SO/sub 2/ emissions, atmospheric fluidized bed steam generator (AFB), conventional boiler equipped with a limestone FGD system, conventional boiler equipped with magnesia FGD system, and coal beneficiation followed by a conventional boiler quipped with limestone FGD for part of the flue gas stream. For a coal containing 3.5% sulfur, meeting SO/sub 2/ emission limits of 1.2 pounds per million Btu fired was most economical with the limestone FGD system. This result was unchanged for a coal containing 5% sulfur; however, for 2% sulfur, limestone FGD and AFB were competitive methods of controlling SO/sub 2/ emissions. Brief consideration of 90% reduction of SO/sub 2/ emissions led to the choice of limestone FGD as the most economical method. Byproduct credit for the sulfuric acid produced in regenerating the magnesia could make that system competitive with the limestone FGD system, depending upon local markets. The cost of sludge fixation and disposal would make limestone FGD noneconomic in many situations, if these steps are necessary.

  6. Petroleum Refinery Hydrogen Production Unit: Exergy and Production Cost Evaluation

    Directory of Open Access Journals (Sweden)

    Silvio de Oliveira Júnior

    2008-12-01

    Full Text Available Some specific processes are required to obtain pure hydrogen and the most usual one is natural gas reforming, where natural gas reacts with superheated steam producing H2, CO, CO2 and H2O. This paper presents the exergy and production costs evaluation of a complete hydrogen production unit of a petroleum refinery. The hydrogen production unit analysed in this paper has to supply 550,000 Nm3 of hydrogen per day to purify diesel oil. Based on a synthesis plant of the hydrogen production unit, the exergy efficiency of each component and of the overall plant are calculated. The hydrogen production cost is determined by means of a thermoeconomic analysis in which the equality cost partition method is employed, including capital and operational costs, in order to determine the production cost of hydrogen and other products of the plant.

  7. A cost-effectiveness analysis comparing different strategies to implement noninvasive prenatal testing into a Down syndrome screening program.

    Science.gov (United States)

    Ayres, Alice C; Whitty, Jennifer A; Ellwood, David A

    2014-10-01

    Currently, noninvasive prenatal testing (NIPT) is only recommended in high-risk women following conventional Down syndrome (DS) screening, and it has not yet been included in the Australian DS screening program. To evaluate the cost-effectiveness of different strategies of NIPT for DS screening in comparison with current practice. A decision-analytic approach modelled a theoretical cohort of 300,000 singleton pregnancies. The strategies compared were the following: current practice, NIPT as a second-tier investigation, NIPT only in women >35 years, NIPT only in women >40 years and NIPT for all women. The direct costs (low and high estimates) were derived using both health system costs and patient out-of-pocket expenses. The number of DS cases detected and procedure-related losses (PRL) were compared between strategies. The incremental cost per case detected was the primary measure of cost-effectiveness. Universal NIPT costs an additional $134,636,832 compared with current practice, but detects 123 more DS cases (at an incremental cost of $1,094,608 per case) and avoids 90 PRL. NIPT for women >40 years was the most cost-effective strategy, costing an incremental $81,199 per additional DS case detected and avoiding 95 PRL. The cost of NIPT needs to decrease significantly if it is to replace current practice on a purely cost-effectiveness basis. However, it may be beneficial to use NIPT as first-line screening in selected high-risk patients. Further evaluation is needed to consider the longer-term costs and benefits of screening. © 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  8. Evaluation of the cost of atrial fibrillation during emergency hospitalization.

    Science.gov (United States)

    Pirson, Magali; Di Pierdomenico, Lionel; Gusman, Julie; Baré, Benoît; Fontaine, David; Motte, Serge

    2013-10-01

    The number of hospitalizations for atrial fibrillation has increased dramatically. This increase, in the number of hospital stays will continue, given the growth projections based on epidemiological data, and will contribute to significantly increase expenses for the social security system.The objective of this study was to evaluate the length of hospital stay, the average cost borne by social security, and the types of hospital stay expenditures for patients admitted through the emergency department for atrial fibrillation. Patients were identified by using the minimal clinical summaries of seven general hospitals in Belgium in 2008. Only hospitalized patients having as primary diagnosis code ICD-9-CM 42731 'atrial fibrillation'were selected for this study. Hospital billing files were analysed in order to isolate the costs borne by social security. Outliers were isolated in order not to have results influenced by patients having an atypical length of stay. Results show that the mean length of stay was 8.6 days and the mean cost charged to social security was euro 3,066.02 per hospital stay.The mean cost of care was strongly associated with the degree of severity index related to the APR-DRG. Approximately 85% of the total cost was related to the cost of hospital days and medical procedures with medical imaging and laboratory tests being the two main cost inductors. 18% of patients had cardioversion during their hospital stay, including 4% who had only that treatment. 19% of patients used amiodarone. Flecainide and propafenone were also used, but less frequently. The mean cost of care for AF patients admitted via the emergency department is strongly associated with the degree of severity. Approximately 85% of the total cost is related to the cost of hospital days and medical procedures. Hypertension is the most common secondary diagnosis. An optimal treatment of this risk factor could help to reduce the risk of atrial fibrillation, and thereby reduce the morbidity

  9. EVALUATION OF FORWARDER WOOD EXTRACTION COST OF OPERATION

    Directory of Open Access Journals (Sweden)

    Larissa Nunes dos Santos

    2016-03-01

    Full Text Available The objective of this study was to determine the costs of the activity of timber extraction done by forwarders until approximately 30,000 work hours. We used 7 John Deere forwarders, model 1710D with 160 kW engine power. A database provided by a forestry company located in the state of Minas Gerais was used, containing all the information necessary for calculating the operating cost of the machines and for the subsequent sensitivity analysis. The operating cost was obtained by the sum of the fixed and variable costs. For the sensitivity analysis a variation ± 20% of the most representative elements of the total cost of the machine was performed. The result obtained for the average operating cost of the forwarder was US$ 147.80 h-1. Costs for repairs and maintenance, labor, fuel, and depreciation represented approximately 90% of the total cost of the machine. A 10% reduction in their values resulted in a savings of approximately 9% in all years evaluated.

  10. Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe

    Science.gov (United States)

    Mangenah, Collin; Mavhu, Webster; Hatzold, Karin; Biddle, Andrea K; Ncube, Getrude; Mugurungi, Owen; Ticklay, Ismail; Cowan, Frances M; Thirumurthy, Harsha

    2016-01-01

    ABSTRACT Background: The 14 countries that are scaling up voluntary male medical circumcision (VMMC) for HIV prevention are also considering early infant male circumcision (EIMC) to ensure longer-term reductions in HIV incidence. The cost of implementing EIMC is an important factor in scale-up decisions. We conducted a comparative cost analysis of EIMC performed by nurse-midwives and doctors using the AccuCirc device in Zimbabwe. Methods: Between August 2013 and July 2014, nurse-midwives performed EIMC on 500 male infants using AccuCirc in a field trial. We analyzed the overall unit cost and identified key cost drivers of EIMC performed by nurse-midwives and compared these with costing data previously collected during a randomized noninferiority comparison trial of 2 devices (AccuCirc and the Mogen clamp) in which doctors performed EIMC. We assessed direct costs (consumable and nonconsumable supplies, device, personnel, associated staff training, and waste management costs) and indirect costs (capital and support personnel costs). We performed one-way sensitivity analyses to assess cost changes when we varied key component costs. Results: The unit costs of EIMC performed by nurse-midwives and doctors in vertical programs were US$38.87 and US$49.77, respectively. Key cost drivers of EIMC were consumable supplies, personnel costs, and the device price. In this cost analysis, major cost drivers that explained the differences between EIMC performed by nurse-midwives and doctors were personnel and training costs, both of which were lower for nurse-midwives. Conclusions: EIMC unit costs were lower when performed by nurse-midwives compared with doctors. To minimize costs, countries planning to scale up EIMC should consider using nurse-midwives, who are in greater supply than doctors and are the main providers at the primary health care level, where most infants are born. PMID:27413085

  11. A noticeable difference? Productivity costs related to paid and unpaid work in economic evaluations on expensive drugs.

    Science.gov (United States)

    Krol, Marieke; Papenburg, Jocé; Tan, Siok Swan; Brouwer, Werner; Hakkaart, Leona

    2016-05-01

    Productivity costs can strongly impact cost-effectiveness outcomes. This study investigated the impact in the context of expensive hospital drugs. This study aimed to: (1) investigate the effect of productivity costs on cost-effectiveness outcomes, (2) determine whether economic evaluations of expensive drugs commonly include productivity costs related to paid and unpaid work, and (3) explore potential reasons for excluding productivity costs from the economic evaluation. We conducted a systematic literature review to identify economic evaluations of 33 expensive drugs. We analysed whether evaluations included productivity costs and whether inclusion or exclusion was related to the study population's age, health and national health economic guidelines. The impact on cost-effectiveness outcomes was assessed in studies that included productivity costs. Of 249 identified economic evaluations of expensive drugs, 22 (9 %) included productivity costs related to paid work. One study included unpaid productivity. Mostly, productivity cost exclusion could not be explained by the study population's age and health status, but national guidelines appeared influential. Productivity costs proved often highly influential. This study indicates that productivity costs in economic evaluations of expensive hospital drugs are commonly and inconsistently ignored in economic evaluations. This warrants caution in interpreting and comparing the results of these evaluations.

  12. Panel 1 - comparative evaluation of deposition technologies

    Energy Technology Data Exchange (ETDEWEB)

    Fenske, G.R.; Stodolsky, F. [Argonne National Lab., IL (United States); Benson, D.K.; Pitts, R.J. [National Renewable Energy Lab., Golden, CO (United States); Bhat, D.G. [GTE Valenite Corp., Troy, MI (United States); Yulin Chen [Allison Gas Turbine Division, GM, Indianapolis, IN (United States); Gat, R.; Sunkara, M.K. [Case Western Reserve Univ., Cleveland, OH (United States); Kelly, M. [Stanford Univ., CA (United States); Lawler, J.E. [Univ. of Wisconsin, Madison (United States); Nagle, D.C. [Martin Marietta Labs., Baltimore, MD (United States); Outka, D. [Sandia National Laboratories, Livermore, CA (United States); Revankar, G.S. [Deere & Co., Moline, IL (United States); Subramaniam, V.V. [Ohio State Univ., Columbus (United States); Wilbur, P.J. [Colorado State Univ., Fort Collins (United States); Mingshow Wong [Northwestern Univ., Evanston, IL (United States); Woolam, W.E. [Southwest Research Inst., Arlington, VA (United States)

    1993-01-01

    This working group attempted to evaluate/compare the different types of deposition techniques currently under investigation for depositing diamond and diamond-like carbon films. A table lists the broad types of techniques that were considered for depositing diamond and diamond-like carbon films. After some discussion, it was agreed that any evaluation of the various techniques would be dependent on the end application. Thus the next action was to list the different areas where diamond and DLC films could find applications in transportation. These application areas are listed in a table. The table intentionally does not go into great detail on applications because that subject is dealt with specifically by Panel No. 4 - Applications To Transportation. The next action concentrated on identifying critical issues or limitations that need to be considered in evaluating the different processes. An attempt was then made to rank different broad categories of deposition techniques currently available or under development based on the four application areas and the limitations. These rankings/evaluations are given for diamond and DLC techniques. Finally, the working group tried to identify critical development and research issues that need to be incorporated into developing a long-term program that focuses on diamond/DLC coatings for transportation needs. 5 tabs.

  13. Evaluation of solar sludge drying alternatives by costs and area requirements.

    Science.gov (United States)

    Kurt, Mayıs; Aksoy, Ayşegül; Sanin, F Dilek

    2015-10-01

    Thermal drying is a common method to reach above 90% dry solids content (DS) in sludge. However, thermal drying requires high amount of energy and can be expensive. A greenhouse solar dryer (GSD) can be a cost-effective substitute if the drying performance, which is typically 70% DS, can be increased by additional heat. In this study feasibility of GSD supported with solar panels is evaluated as an alternative to thermal dryers to reach 90% DS. Evaluations are based on capital and O&M costs as well as area requirements for 37 wastewater treatment plants (WWTPs) with various sludge production rates. Costs for the supported GSD system are compared to that of conventional and co-generation thermal dryers. To calculate the optimal costs associated with the drying system, an optimization model was developed in which area limitation was a constraint. Results showed that total cost was minimum when the DS in the GSD (DS(m,i)) was equal to the maximum attainable value (70% DS). On average, 58% of the total cost and 38% of total required area were associated with the GSD. Variations in costs for 37 WWTPs were due to differences in initial DS (DS(i,i)) and sludge production rates, indicating the importance of dewatering to lower drying costs. For large plants, GSD supported with solar panels provided savings in total costs especially in long term when compared to conventional and co-generation thermal dryers.

  14. A comparative cost analysis of an integrated military telemental health-care service.

    Science.gov (United States)

    Grady, Brian J

    2002-01-01

    The National Naval Medical Center, Bethesda, Maryland, integrated telemental health care into its primary behavioral health-care outreach service in 1998. To date, there have been over 1,800 telemental health visits, and the service encounters approximately 100 visits per month at this time. The objective of this study was to compare and contrast the costs to the beneficiary, the medical system, and the military organization as a whole via one of the four methods currently employed to access mental health care from remotely located military medical clinics. The four methods include local access via the military's civilian health maintenance organization (HMO) network, patient travel to the military treatment facility, military mental health specialists' travel to the remote clinic (circuit riding) and TeleMental Healthcare (TMH). Interactive video conferencing, phone, electronic mail, and facsimile were used to provide telemental health care from a military treatment facility to a remote military medical clinic. The costs of health-care services, equipment, patient travel, lost work time, and communications were tabulated and evaluated. While the purpose of providing telemental healthcare services was to improve access to mental health care for our beneficiaries at remote military medical clinics, it became apparent that this could be done at comparable or reduced costs.

  15. A Comparative Analysis of the Costs of Administration of an OSCE.

    Science.gov (United States)

    Cusimano, Michael D.; And Others

    1994-01-01

    A study compared the costs of a six-station structured oral examination and an objective structured clinical examination (OSCE) for a surgery clerkship, assessing both faculty and materials costs. The OSCE was found to be more time consuming and expensive. Cost-cutting measures and guidelines to assist medical schools in selecting test type are…

  16. Comparing the Cost-Effectiveness of Simulation Modalities: A Case Study of Peripheral Intravenous Catheterization Training

    Science.gov (United States)

    Isaranuwatchai, Wanrudee; Brydges, Ryan; Carnahan, Heather; Backstein, David; Dubrowski, Adam

    2014-01-01

    While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three…

  17. Comparative Evaluation of Software Features and Performances.

    Science.gov (United States)

    Cecconi, Daniela

    2016-01-01

    Analysis of two-dimensional gel images is a crucial step for the determination of changes in the protein expression, but at present, it still represents one of the bottlenecks in 2-DE studies. Over the years, different commercial and academic software packages have been developed for the analysis of 2-DE images. Each of these shows different advantageous characteristics in terms of quality of analysis. In this chapter, the characteristics of the different commercial software packages are compared in order to evaluate their main features and performances.

  18. Cervical spine evaluation in urban trauma centers: lowering institutional costs and complications through helical CT scan.

    Science.gov (United States)

    Grogan, Eric L; Morris, John A; Dittus, Robert S; Moore, Derek E; Poulose, Benjamin K; Diaz, Jose J; Speroff, Theodore

    2005-02-01

    In the evaluation of the cervical spine (c-spine), helical CT scan has higher sensitivity and specificity than plain radiographs in the moderate- and high-risk trauma population, but is more costly. We hypothesize that institutional costs associated with missed injuries make helical CT scan the least costly approach. A cost-minimization study was performed using decision analysis examining helical CT scan versus radiographic evaluation of the c-spine. Parameter estimates were obtained from the literature for probability of c-spine injury, probability of paralysis after missed injury, plain film sensitivity and specificity, CT scan sensitivity and specificity, and settlement cost of missed injuries resulting in paralysis. Institutional costs of CT scan and plain radiography were used. Sensitivity analyses tested robustness of strategy preference, accounted for parameter variability, and determined threshold values for individual parameters on strategy preference. C-spine evaluation with helical CT scan has an expected cost of US 554 dollars per patient compared with US 2,142 dollars for plain films. CT scan is the least costly alternative if threshold values exceed US 58,180 dollars for institutional settlement costs, 0.9% for probability of c-spine fracture, and 1.7% for probability of paralysis. Plain films are least costly if CT scan costs surpass US 1,918 dollars or plain film sensitivity exceeds 90%. Helical CT scan is the preferred initial screening test for detection of cervical spine fractures among moderate- to high-risk patients seen in urban trauma centers, reducing the incidence of paralysis resulting from false-negative imaging studies and institutional costs, when settlement costs are taken into account.

  19. Surgical hand rubbing compared with surgical hand scrubbing: comparison of efficacy and costs.

    Science.gov (United States)

    Tavolacci, M P; Pitrou, I; Merle, V; Haghighat, S; Thillard, D; Czernichow, P

    2006-05-01

    The aim of this study was to compare the efficacy of surgical hand rubbing (SHR) with the efficacy of surgical hand scrubbing (SHS), and to determine the costs of both techniques for surgical hand disinfection. A review of studies reported in the literature that compared the efficacy of SHS and SHR was performed using MEDLINE. The costs of SHR and SHS were estimated based on standard hospital costs. The literature showed that SHR had immediate efficacy that was similar to that of SHS, but SHR had a more lasting effect. SHR reduced costs by 67%. In conclusion, SHR is a cost-effective alternative to SHS.

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

    OpenAIRE

    1985-01-01

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

  1. Cost Evaluation of CO2 Sequestration by Aqueous Mineral Carbonation

    NARCIS (Netherlands)

    Huijgen, W.J.J.; Comans, R.N.J.; Witkamp, G.J.

    2007-01-01

    A cost evaluation of CO2 sequestration by aqueous mineral carbonation has been made using either wollastonite (CaSiO3) or steel slag as feedstock. First, the process was simulated to determine the properties of the streams as well as the power and heat consumption of the process equipment. Second, a

  2. 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.

  3. Cost Evaluation of CO2 Sequestration by Aqueous Mineral Carbonation

    NARCIS (Netherlands)

    Huijgen, W.J.J.; Comans, R.N.J.; Witkamp, G.J.

    2007-01-01

    A cost evaluation of CO2 sequestration by aqueous mineral carbonation has been made using either wollastonite (CaSiO3) or steel slag as feedstock. First, the process was simulated to determine the properties of the streams as well as the power and heat consumption of the process equipment. Second, a

  4. A multicentre comparative evaluation of catheter valves.

    Science.gov (United States)

    Fader, M; Pettersson, L; Brooks, R; Dean, G; Wells, M; Cottenden, A; Malone-Lee, J

    Catheter valves are an alternative to leg bags for urine drainage, but no studies have yet been published which have compared the performance of different valves. This study was undertaken to evaluate the performance of the seven catheter valves available on the UK market in April 1996. The study was carried out by the Continence Products Evaluation (CPE) Network funded by the Medical Devices Agency (Department of Health). Each valve type was tested for 1 week by 19-36 cognitively unimpaired and manually dextrous subjects recruited from 11 test centres. At the end of each week, subjects completed an evaluation form (based on a three-point rating scale) to record product performance. The same catheter valves were also tested for ease of opening/closing by 33 subjects (mostly catheter users) who had some manual impairment. Performance scores varied widely between products. It was found that, to be successful, a valve needs to be easy to manipulate, leak-free, comfortable and inconspicuous. Prescribers need to be aware of the strengths and limitations of different valves for appropriate product selection.

  5. Social welfare and the Affordable Care Act: is it ever optimal to set aside comparative cost?

    Science.gov (United States)

    Mortimer, Duncan; Peacock, Stuart

    2012-10-01

    The creation of the Patient-Centered Outcomes Research Institute (PCORI) under the Affordable Care Act has set comparative effectiveness research (CER) at centre stage of US health care reform. Comparative cost analysis has remained marginalised and it now appears unlikely that the PCORI will require comparative cost data to be collected as an essential component of CER. In this paper, we review the literature to identify ethical and distributional objectives that might motivate calls to set priorities without regard to comparative cost. We then present argument and evidence to consider whether there is any plausible set of objectives and constraints against which priorities can be set without reference to comparative cost. We conclude that - to set aside comparative cost even after accounting for ethical and distributional constraints - would be truly to act as if money is no object.

  6. Accuracy evaluation of a lower-cost and four higher-cost laser scanners.

    Science.gov (United States)

    Campanelli, Valentina; Howell, Stephen M; Hull, Maury L

    2016-01-04

    Knowing the accuracy of laser scanners is imperative to select the best scanner to generate bone models. However, errors stated by manufacturers may not apply to bones. The three objectives of this study were to determine: 1) whether the overall error stated by the manufacturers of five laser scanners was different from the root mean squared error (RMSE) computed by scanning a gage block; 2) the repeatability of 3D models generated by the laser scanners when scanning a complex freeform surface such as a distal femur and whether this differed from the repeatability when scanning a gage block; 3) whether the errors for one lower-cost laser scanner are comparable to those of four higher-cost laser scanners. The RMSEs in scanning the gage block were 2 to 52µm lower than the overall errors stated by the manufacturers. The repeatability in scanning the bovine femur 10 times was significantly worse than that in scanning the gage block 10 times. The precision of the lower-cost laser scanner was comparable to that of the higher-cost laser scanners, but the bias was an order of magnitude greater. The contributions of this study are that 1) the overall errors stated by the manufacturers are an upper bound when simple geometric objects like a gage block are scanned, 2) the repeatability is worse on average three times when scanning a complex freeform surface compared to scanning the gage block, and 3) the main difference between the lower-cost and the higher-cost laser scanners is the bias.

  7. A systematic comparative evaluation of biclustering techniques.

    Science.gov (United States)

    Padilha, Victor A; Campello, Ricardo J G B

    2017-01-23

    Biclustering techniques are capable of simultaneously clustering rows and columns of a data matrix. These techniques became very popular for the analysis of gene expression data, since a gene can take part of multiple biological pathways which in turn can be active only under specific experimental conditions. Several biclustering algorithms have been developed in the past recent years. In order to provide guidance regarding their choice, a few comparative studies were conducted and reported in the literature. In these studies, however, the performances of the methods were evaluated through external measures that have more recently been shown to have undesirable properties. Furthermore, they considered a limited number of algorithms and datasets. We conducted a broader comparative study involving seventeen algorithms, which were run on three synthetic data collections and two real data collections with a more representative number of datasets. For the experiments with synthetic data, five different experimental scenarios were studied: different levels of noise, different numbers of implanted biclusters, different levels of symmetric bicluster overlap, different levels of asymmetric bicluster overlap and different bicluster sizes, for which the results were assessed with more suitable external measures. For the experiments with real datasets, the results were assessed by gene set enrichment and clustering accuracy. We observed that each algorithm achieved satisfactory results in part of the biclustering tasks in which they were investigated. The choice of the best algorithm for some application thus depends on the task at hand and the types of patterns that one wants to detect.

  8. [Comparative evaluation of health services outcomes].

    Science.gov (United States)

    Agabiti, Nera; Davoli, Marina; Fusco, Danilo; Stafoggia, Massimo; Perucci, Carlo A

    2011-01-01

    This introductory guide represents an operative tool to conduct epidemiological studies in the area of comparative outcomes evaluation. It is based on the experience of epidemiological research in this field conducted in Italy within national (BPAC-Esiti del bypass aortocoronarico, Progetto mattoni outcome, Progetto Progressi) or regional (P.Re.Val.E. Programma Regionale di Valutazione degli Esiti, Lazio) health care outcomes projects and the National outcome programme. This guide is aimed to all those interested in conducting or interpreting health care outcomes studies within different levels of the Italian NHS. It gives an introductory description of the operative steps to build outcome indicators and to perform comparative analyses, with the general objective of measuring and promoting improvement in health care. A specific emphasis is given to the use of routinely collected health care databases that have found widespread use for epidemiological purposes. This guide has two parts: part A includes an introduction and comments on critical methodological points, part B shows three example of epidemiological studies (A. Complications after cholecystectomy: comparison between two surgical techniques, B. 30-day mortality after acute myocardial infarction: comparison among hospitals, C. 30-day mortality after acute myocardial infarction: comparison between time periods). The online version of this guide is organised as a hypertext as practical instrument of appraisal.

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

    Science.gov (United States)

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

    2005-10-01

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

  10. Comparing systems for costing hospital treatments. The case of stable angina pectoris.

    Science.gov (United States)

    Larsen, Jytte; Skjoldborg, Ulla Slothuus

    2004-03-01

    This paper demonstrates the basic properties in the systems most commonly considered for costing treatments in the Danish hospitals. The differences between the traditional charge system, the DRG system and the ABC system are analysed, and difficulties encountered in comparing these systems are discussed. A sample of patients diagnosed with stable angina pectoris (SAP) at Odense University Hospital was used to compare the three systems when costing an entire treatment path, costing single hospitalisations and studying the effects of length of stay. Furthermore, it is illustrated that the main idea behind each system is reflected in how the systems over- or underestimate costs. Implications when managing the hospitals, particularly reimbursement, are discussed.

  11. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

    Directory of Open Access Journals (Sweden)

    V. V. Omel'yanovskiy

    2011-01-01

    Full Text Available Aim. To evaluate clinical and cost effectiveness of different reperfusion strategies in myocardial infarction with ST segment elevation (STEMI, including pre-hospital thrombolysis with tenecteplase.  Material and methods. Methods of cost-effectiveness analysis and economic modeling were used to calculate the costs of reperfusion in STEMI, expected number of life gains, the cost of life gains depending on reperfusion strategy (no reperfusion, percutaneous coronary intervention (PCI, prehospital thrombolysis, hospital thrombolysis.  Results. In accordance to analysis results and from economic point of view, the most effective strategy is primary PCI in patients within "therapeutic window" and pre-hospital thrombolysis in the remaining patients with STEMI. More complex strategy of patients flow control with patient division into groups of primary PCI, pre-hospital thrombolysis and hospital thrombolysis lead to decrease in reperfusion costs efficacy.  Conclusion. The reperfusion model with primary PCI in the first 120 minutes after STEMI symptoms onset, and pre-hospital thrombolysis with bolus thrombolytic administration, when PCI is not possible in this period, is the most effective economically and in respect on mortality reduction in patients with STEMI.

  12. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

    Directory of Open Access Journals (Sweden)

    V. V. Omel'yanovskiy

    2016-01-01

    Full Text Available Aim. To evaluate clinical and cost effectiveness of different reperfusion strategies in myocardial infarction with ST segment elevation (STEMI, including pre-hospital thrombolysis with tenecteplase.  Material and methods. Methods of cost-effectiveness analysis and economic modeling were used to calculate the costs of reperfusion in STEMI, expected number of life gains, the cost of life gains depending on reperfusion strategy (no reperfusion, percutaneous coronary intervention (PCI, prehospital thrombolysis, hospital thrombolysis.  Results. In accordance to analysis results and from economic point of view, the most effective strategy is primary PCI in patients within "therapeutic window" and pre-hospital thrombolysis in the remaining patients with STEMI. More complex strategy of patients flow control with patient division into groups of primary PCI, pre-hospital thrombolysis and hospital thrombolysis lead to decrease in reperfusion costs efficacy.  Conclusion. The reperfusion model with primary PCI in the first 120 minutes after STEMI symptoms onset, and pre-hospital thrombolysis with bolus thrombolytic administration, when PCI is not possible in this period, is the most effective economically and in respect on mortality reduction in patients with STEMI.

  13. Comparing the net cost of CSP-TES to PV deployed with battery storage

    Science.gov (United States)

    Jorgenson, Jennie; Mehos, Mark; Denholm, Paul

    2016-05-01

    Concentrated solar power with thermal energy storage (CSP-TES) is a unique source of renewable energy in that its energy can be shifted over time and it can provide the electricity system with dependable generation capacity. In this study, we provide a framework to determine if the benefits of CSP-TES (shiftable energy and the ability to provide firm capacity) exceed the benefits of PV and firm capacity sources such as long-duration battery storage or conventional natural gas combustion turbines (CTs). The results of this study using current capital cost estimates indicate that a combination of PV and conventional gas CTs provides a lower net cost compared to CSP-TES and PV with batteries. Some configurations of CSP-TES have a lower net cost than PV with batteries for even the lowest battery cost estimate. Using projected capital cost targets, however, some configurations of CSP-TES have a lower net cost than PV with either option for even the lowest battery cost estimate. The net cost of CSP-TES varies with configuration, and lower solar multiples coupled with less storage are more attractive at current cost levels, due to high component costs. However, higher solar multiples show a lower net cost using projected future costs for heliostats and thermal storage materials.

  14. Comparing the Net Cost of CSP-TES to PV Deployed with Battery Storage

    Energy Technology Data Exchange (ETDEWEB)

    Jorgenson, Jennie; Mehos, Mark; Denholm, Paul

    2016-05-31

    Concentrated solar power with thermal energy storage (CSP-TES) is a unique source of renewable energy in that its energy can be shifted over time and it can provide the electricity system with dependable generation capacity. In this study, we provide a framework to determine if the benefits of CSP-TES (shiftable energy and the ability to provide firm capacity) exceed the benefits of PV and firm capacity sources such as long-duration battery storage or conventional natural gas combustion turbines (CTs). The results of this study using current capital cost estimates indicate that a combination of PV and conventional gas CTs provides a lower net cost compared to CSP-TES and PV with batteries. Some configurations of CSP-TES have a lower net cost than PV with batteries for even the lowest battery cost estimate. Using projected capital cost targets, however, some configurations of CSP-TES have a lower net cost than PV with either option for even the lowest battery cost estimate. The net cost of CSP-TES varies with configuration, and lower solar multiples coupled with less storage are more attractive at current cost levels, due to high component costs. However, higher solar multiples show a lower net cost using projected future costs for heliostats and thermal storage materials.

  15. Comparative evaluation of antimicrobials for textile applications.

    Science.gov (United States)

    Windler, Lena; Height, Murray; Nowack, Bernd

    2013-03-01

    Many antimicrobial technologies are available for textiles. They may be used in many different textile applications to prevent the growth of microorganisms. Due to the biological activity of the antimicrobial compounds, the assessment of the safety of these substances is an ongoing subject of research and regulatory scrutiny. This review aims to give an overview on the main compounds used today for antimicrobial textile functionalization. Based on an evaluation of scientific publications, market data as well as regulatory documents, the potential effects of antimicrobials on the environment and on human health were considered and also life cycle perspectives were taken into account. The characteristics of each compound were summarized according to technical, environmental and human health criteria. Triclosan, silane quaternary ammonium compounds, zinc pyrithione and silver-based compounds are the main antimicrobials used in textiles. The synthetic organic compounds dominate the antimicrobials market on a weight basis. On the technical side the application rates of the antimicrobials used to functionalize a textile product are an important parameter with treatments requiring lower dosage rates offering clear benefits in terms of less active substance required to achieve the functionality. The durability of the antimicrobial treatment has a strong influence on the potential for release and subsequent environmental effects. In terms of environmental criteria, all compounds were rated similarly in effective removal in wastewater treatment processes. The extent of published information about environmental behavior for each compound varies, limiting the possibility for an in-depth comparison of all textile-relevant parameters across the antimicrobials. Nevertheless the comparative evaluation showed that each antimicrobial technology has specific risks and benefits that should be taken into account in evaluating the suitability of different antimicrobial products. The

  16. Development and evaluation of cost-sensitive universum-SVM.

    Science.gov (United States)

    Dhar, Sauptik; Cherkassky, Vladimir

    2015-04-01

    Many machine learning applications involve analysis of high-dimensional data, where the number of input features is larger than/comparable to the number of data samples. Standard classification methods may not be sufficient for such data, and this provides motivation for nonstandard learning settings. One such new learning methodology is called learning through contradiction or Universum-support vector machine (U-SVM). Recent studies have shown U-SVM to be quite effective for sparse high-dimensional data sets. However, all these earlier studies have used balanced data sets with equal misclassification costs. This paper extends the U-SVM formulation to problems with different misclassification costs, and presents practical conditions for the effectiveness of this cost-sensitive U-SVM. Several empirical comparisons are presented to validate the proposed approach.

  17. Evaluating the cost-effectiveness of preventive zinc supplementation

    OpenAIRE

    Fink, Günther; Heitner, Jesse

    2014-01-01

    Background Even though the WHO currently recommends zinc for diarrhea management, no consensus has been reached with respect to routine distribution of zinc for preventive reasons. We reviewed the health impact of preventive zinc interventions, and evaluated the relative cost effectiveness of currently feasible interventions. Methods Using the latest relative risk estimates reported in the literature, we parameterized a health impact model, and calculated the expected benefits of zinc supplem...

  18. Evaluating the cost-effectiveness of preventive zinc supplementation

    OpenAIRE

    Fink, Günther; Heitner, Jesse

    2014-01-01

    Background: Even though the WHO currently recommends zinc for diarrhea management, no consensus has been reached with respect to routine distribution of zinc for preventive reasons. We reviewed the health impact of preventive zinc interventions, and evaluated the relative cost effectiveness of currently feasible interventions. Methods: Using the latest relative risk estimates reported in the literature, we parameterized a health impact model, and calculated the expected benefits of zinc suppl...

  19. Cost Effective Evaluation of Companies’ Storytelling on the Web

    OpenAIRE

    Clemmensen, Torkil; Vendelø, Morten

    2004-01-01

    In this paper we present a cost effective and simple procedure for evaluating company web sites. Our assumption is that such sites are places for companies’ self-presentation and that customers are readers of these texts. Web site texts with narrative qualities, e.g. scenes, actors, acts, initiate the customers’ imagination and narrative mind and hence their decision making. These ideas are investigated in a qualitative study of two companies’ self-presentation as future work places for stude...

  20. Cost Effective Evaluation of Companies’ Storytelling on the Web

    OpenAIRE

    Clemmensen, Torkil; Vendelø, Morten

    2004-01-01

    Abstract: In this paper we present a cost effective and simple procedure for evaluating company web sites. Our assumption is that such sites are places for companies’ self-presentation and that customers are readers of these texts. Web site texts with narrative qualities, e.g. scenes, actors, acts, initiate the customers’ imagination and narrative mind and hence their decision making. These ideas are investigated in a qualitative study of two companies’ self-presentation as future work places...

  1. A study of the comparability of Naval activity motor vehicle costs

    OpenAIRE

    Simmons, Gregory Scott.

    1993-01-01

    Approved for public release; distribution is unlimited. This thesis reports on a study conducted to determine the feasibility of using a sampling technique within the Department of the Navy to compare in- house motor vehicle costs with the costs that would be incurred were the General Services Administration or a civilian fleet management contractor employed to meet the Navy's motor vehicle needs. Such cost comparison studies are required by the Consolidated Omnibus Budget Reconciliation A...

  2. Treatment Costs for Pediatrics Acute Lymphoblastic Leukemia; Comparing Clinical Expenditures in Developed and Developing Countries: a Review Article

    Directory of Open Access Journals (Sweden)

    Hadi Hayati

    2016-12-01

    Full Text Available Background                                               Pediatric acute lymphoblastic leukemia (ALL is the most common, yet curable childhood malignancy within the pediatric cancers; but in most developed and developing countries cost of cancer treatment in children with ALL is high. So, we specified the range of expenses for the treatment of pediatric cancer and compared the results in developed and developing countries.Materials and MethodsTo evaluate treatment costs in childhood ALL, a review was taken place through published papers during the years 2000 to 2015. We searched multiple well known databases such as Medline, Scopus, ISI Web of Science and Google Scholar on January 2015 with "cost effectiveness", "cost utility", "cost minimization", "cost analysis", "economic evaluation", "childhood", "acute lymphoblastic leukemia", and "ALL" as our keywords.ResultsRegarding the reviewed evidence the essential result was that the total costs for treatment of pediatrics ALL in developing countries such as Asian countries were considerably lower than the costs reported from high income countries in Europe and North America. So different protocols were performed to treat ALL and this matter was significant due to the different durations of hospitalization.ConclusionAccording to the results, the total costs for treatment of pediatrics ALL in developing countries were considerably lower than the costs reported from high income countries.

  3. Superbugs: should antimicrobial resistance be included as a cost in economic evaluation?

    Science.gov (United States)

    Coast, J; Smith, R D; Millar, M R

    1996-01-01

    This paper argues that increasing resistance to antimicrobials is an important social externality that has not been captured at the level of economic appraisal. The paper explicitly considers reasons why the externality of antimicrobial resistance has not generally been included as a cost in economic evaluations comparing management strategies for infectious diseases. Four reasons are considered: first, that the absolute cost of antimicrobial resistance is too small to be worth including; second, that there is an implicit discounting of the costs of antimicrobial resistance on the basis of time preference which makes the cost too small to be worth including; third, that there is an implicit discounting of the costs of antimicrobial resistance on the basis of uncertainty which makes the cost too small to be worth including; and fourth, that the costs are too difficult to measure. Although there does not appear to be methodological justification for excluding the costs of antimicrobial resistance, it seems likely that, because of the practical difficulties associated with measuring these costs, they will continue to be ignored. The paper concludes with a discussion of the applicability of standard policy responses used to deal with externalities in other areas of welfare economics.

  4. Comparative Life Cycle Cost Analysis of Hardening Options for Critical Loads

    Directory of Open Access Journals (Sweden)

    Sungmin Park

    2016-07-01

    Full Text Available In order to determine the most cost effective alternative among hardening options of power systems, the direct monetary benefits should be evaluated above all other things. Therefore, this paper presents a life-cycle cost model which describes total monetary costs experienced in annual time increments during the project with consideration for the time value of money. In addition, to minimize the risks associated with estimated cost errors due to uncertainties of input data, the stochastic input data are considered. Using the Monte Carlo method, the probabilities and cost ranges in the case studies can be predicted, in turn resulting in better decisions in the selection of hardening options which are cost effective.

  5. Investigation into life-cycle costing as a comparative analysis approach of energy systems

    CSIR Research Space (South Africa)

    Mokheseng, B

    2010-08-31

    Full Text Available production because it is too expensive compared with coal-based electricity. Statements such as these are made because the initial capital costs (procurement costs) are often used as the primary (and sometimes only) criterion for project, equipment or system...

  6. Comparing the social costs of biofuels and fossil fuels: A case study of Vietnam

    NARCIS (Netherlands)

    Thanh, le L.; Ierland, van E.C.; Zhu, X.; Wesseler, J.H.H.; Ngo, G.

    2013-01-01

    Biofuel substitution for fossil fuels has been recommended in the literature and promoted in many countries; however, there are concerns about its economic viability. In this paper we focus on the cost-effectiveness of fuels, i.e., we compare the social costs of biofuels and fossil fuels for a

  7. Comparing the social costs of biofuels and fossil fuels: A case study of Vietnam

    NARCIS (Netherlands)

    Thanh, le L.; Ierland, van E.C.; Zhu, X.; Wesseler, J.H.H.; Ngo, G.

    2013-01-01

    Biofuel substitution for fossil fuels has been recommended in the literature and promoted in many countries; however, there are concerns about its economic viability. In this paper we focus on the cost-effectiveness of fuels, i.e., we compare the social costs of biofuels and fossil fuels for a funct

  8. Targeted Therapies Compared to Dacarbazine for Treatment of BRAFV600E Metastatic Melanoma: A Cost-Effectiveness Analysis

    Directory of Open Access Journals (Sweden)

    Vanessa Shih

    2015-01-01

    Full Text Available Purpose. Two BRAFV600E targeted therapies, dabrafenib and vemurafenib, have received US approval for treatment of metastatic melanoma in BRAFV600E patients, a mutation that affects ~50% of patients. We evaluated the cost-effectiveness of BRAF inhibitors and traditional chemotherapy for treatment of metastatic melanoma. Methods. A Markov model was developed using a societal perspective. Transition probabilities were derived from two Phase III registration trials comparing each BRAF inhibitor against dacarbazine. Costs were obtained from literature, national databases, and Medicare fee schedules. Utilities were obtained from published literature. Deterministic and probabilistic sensitivity analyses were run to test the impact of uncertainties. Results. The incremental cost-effectiveness ratio of dabrafenib was $149,035/QALY compared to dacarbazine. Vemurafenib was dominated by dabrafenib. Probabilistic sensitivity analysis showed that, at a willingness-to-pay (WTP threshold of ≤$100,000/QALY, dacarbazine was the optimal treatment in ~85% of simulations. At a WTP threshold of ≥$150,000/QALY, dabrafenib was the optimal treatment. Conclusion. Compared with dacarbazine, dabrafenib and vemurafenib were not cost-effective at a willingness-to-pay threshold of $100,000/QALY. Dabrafenib is more efficient compared to vemurafenib. With few treatment options, dabrafenib is an option for qualifying patients if the overall cost of dabrafenib is reduced to $30,000–$31,000 or a WTP threshold of ≥$150,000/QALY is considered. More comparative data is needed.

  9. Comparing the cost-effectiveness of simulation modalities: a case study of peripheral intravenous catheterization training.

    Science.gov (United States)

    Isaranuwatchai, Wanrudee; Brydges, Ryan; Carnahan, Heather; Backstein, David; Dubrowski, Adam

    2014-05-01

    While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three simulation-based programs. Medical students (n = 15 per group) practiced in one of three 2-h intravenous catheterization skills training programs: low-fidelity (virtual reality), high-fidelity (mannequin), or progressive (consisting of virtual reality, task trainer, and mannequin simulator). One week later, all performed a transfer test on a hybrid simulation (standardized patient with a task trainer). We used a net benefit regression model to identify the most cost-effective training program via paired comparisons. We also created a cost-effectiveness acceptability curve to visually represent the probability that one program is more cost-effective when compared to its comparator at various 'willingness-to-pay' values. We conducted separate analyses for implementation and total costs. The results showed that the progressive program had the highest total cost (p willingness-to-pay value, the progressive training program was generally most educationally- and cost-effective. Our analyses suggest that a progressive program that strategically combines simulation modalities provides a cost-effective solution. More generally, we have introduced how a cost-effectiveness analysis may be applied to simulation training; a method that medical educators may use to investment decisions (e.g., purchasing cost-effective and educationally sound simulators).

  10. A cost-effectiveness model of genetic testing for the evaluation of families with hypertrophic cardiomyopathy.

    Science.gov (United States)

    Ingles, Jodie; McGaughran, Julie; Scuffham, Paul A; Atherton, John; Semsarian, Christopher

    2012-04-01

    Traditional management of families with hypertrophic cardiomyopathy (HCM) involves periodic lifetime clinical screening of family members, an approach that does not identify all gene carriers owing to incomplete penetrance and significant clinical heterogeneity. Limitations in availability and cost have meant genetic testing is not part of routine clinical management for many HCM families. To determine the cost-effectiveness of the addition of genetic testing to HCM family management, compared with clinical screening alone. A probabilistic Markov decision model was used to determine cost per quality-adjusted life-year and cost for each life-year gained when genetic testing is included in the management of Australian families with HCM, compared with the conventional approach of periodic clinical screening alone. The incremental cost-effectiveness ratio (ICER) was $A785 (£510 or €587) per quality-adjusted life-year gained, and $A12 720 (£8261 or €9509) per additional life-year gained making genetic testing a very cost-effective strategy. Sensitivity analyses showed that the cost of proband genetic testing was an important variable. As the cost of proband genetic testing decreased, the ICER decreased and was cost saving when the cost fell below $A248 (£161 or €185). In addition, the mutation identification rate was also important in reducing the overall ICER, although even at the upper limits, the ICER still fell well within accepted willingness to pay bounds. The addition of genetic testing to the management of HCM families is cost-effective in comparison with the conventional approach of regular clinical screening. This has important implications for the evaluation of families with HCM, and suggests that all should have access to specialised cardiac genetic clinics that can offer genetic testing.

  11. Tracheostomy versus mandibular distraction osteogenesis in infants with Robin sequence: a comparative cost analysis.

    Science.gov (United States)

    Paes, Emma C; Fouché, James J; Muradin, Marvick S M; Speleman, Lucienne; Kon, Moshe; Breugem, Corstiaan C

    2014-03-01

    Many treatments have been described for infants with Robin sequence and severe respiratory distress, but there have not been many comparative studies of outcome and cost-effectiveness. The aim of this study was to compare the cost and complications of two common interventions - mandibular distraction osteogenesis and tracheostomy. Nine patients with isolated Robin sequence (mandibular distraction osteogenesis, n=5, and tracheostomy, n=4) were included in the analyses. Predetermined costs and complications were obtained retrospectively from medical records and by questionnaires to the parents over a 12-month period. Overall direct costs (admission to hospital, diagnostics, surgery, and homecare) were 3 times higher for tracheostomy (€105.523 compared with €33.482, p=0.02). Overall indirect costs (absence from work) were almost 5 times higher (€2.543 compared with €543, p=0.02). There was a threefold increase in overall total cost/patient (both direct and indirect) for tracheostomy (€108.057 compared with 34.016, p=0.02) and 4 times more complications were encountered. This study shows that mandibular distraction osteogenesis in infants diagnosed with Robin sequence costs significantly less and results in fewer complications than tracheostomy, and this contributes to our current knowledge about the ideal approach for infants with Robin sequence and might provide a basis for institutional protocols in the future.

  12. Economics of mycotoxins: evaluating costs to society and cost-effectiveness of interventions.

    Science.gov (United States)

    2012-01-01

    The economic impacts of mycotoxins to human society can be thought of in two ways: (i) the direct market costs associated with lost trade or reduced revenues due to contaminated food or feed, and (ii) the human health losses from adverse effects associated with mycotoxin consumption. Losses related to markets occur within systems in which mycotoxins are being monitored in the food and feed supply. Food that has mycotoxin levels above a particular maximum allowable level is either rejected outright for sale or sold at a lower price for a different use. Such transactions can take place at local levels or at the level of trade among countries. Sometimes this can result in heavy economic losses for food producers, but the benefit of such monitoring systems is a lower risk of mycotoxins in the food supply. Losses related to health occur when mycotoxins are present in food at levels that can cause illness. In developed countries, such losses are often measured in terms of cost of illness; around the world, such losses are more frequently measured in terms of disability-adjusted life years (DALYs). It is also useful to assess the economics of interventions to reduce mycotoxins and their attendant health effects; the relative effectiveness of public health interventions can be assessed by estimating quality-adjusted life years (QALYs) associated with each intervention. Cost-effectiveness assessment can be conducted to compare the cost of implementing the intervention with the resulting benefits, in terms of either improved markets or improved human health. Aside from cost-effectiveness, however, it is also important to assess the technical feasibility of interventions, particularly in low-income countries, where funds and infrastructures are limited.

  13. Welfare costs in patients with rheumatoid arthritis and their partners compared with matched controls

    DEFF Research Database (Denmark)

    Løppenthin, Katrine; Esbensen, Bente Appel; Østergaard, Mikkel

    2017-01-01

    subjects, i.e., treatment (€346 vs. €211), hospitalization (€1261 vs. €778), and medication use (€654 vs. €393). The costs associated with the patients were present 11 years before diagnosis of RA (€1592) compared with control subjects (€1172). Furthermore, income from employment was lower for patients...... (€14,023) than for control subjects (€17,196). Being a partner to a patient with RA was associated with high total welfare costs. This register-based study shows that RA has significant welfare costs for patients, their partners, and society. The differences in total health costs exist up to 11 years......Rheumatoid arthritis (RA) is a chronic autoimmune disease with significant morbidity, mortality, and costs for the individual patient and for society. The purpose of this study was to examine welfare costs in patients with RA including their partners before and after initial diagnosis. Data were...

  14. Nanoparticle risk management and cost evaluation: a general framework

    Energy Technology Data Exchange (ETDEWEB)

    Fleury, Dominique; Metz, Sebastien; Bouillard, Jacques X; Brignon, Jean-Marc [INERIS, Parc Technologique Alata BP2 - 60550 Verneuil-en-Halatte (France); Bomfim, Joao A S, E-mail: dominique.fleury@ineris.fr [Centro Ricerche Plast-optica (CRP), Via Jacopo Linussio 1 - 33020 Amaro (Italy)

    2011-07-06

    Industrial production of nano-objects has been growing fast during the last decade and a wide range of products containing nanoparticles (NPs) is proposed to the public in various markets (automotive, electronics, textiles...). The issues encountered in monitoring the presence of nano-objects in any media cause a major difficulty for controlling the risk associated to the production stage. It is therefore very difficult to assess the efficiency of prevention and mitigation solutions, which potentially leads to overestimate the level of the protection barriers that are recommended. The extra costs in adding nano-objects to the process, especially that of nanosafety, must be estimated and optimized to ensure the competitiveness of the future production lines and associated products. The risk management and cost evaluation methods presented herein have been designed for application in a pilot production line of injection-moulded nanocomposites.

  15. Nanoparticle risk management and cost evaluation: a general framework

    Science.gov (United States)

    Fleury, Dominique; Bomfim, João A. S.; Metz, Sébastien; Bouillard, Jacques X.; Brignon, Jean-Marc

    2011-07-01

    Industrial production of nano-objects has been growing fast during the last decade and a wide range of products containing nanoparticles (NPs) is proposed to the public in various markets (automotive, electronics, textiles...). The issues encountered in monitoring the presence of nano-objects in any media cause a major difficulty for controlling the risk associated to the production stage. It is therefore very difficult to assess the efficiency of prevention and mitigation solutions, which potentially leads to overestimate the level of the protection barriers that are recommended. The extra costs in adding nano-objects to the process, especially that of nanosafety, must be estimated and optimized to ensure the competitiveness of the future production lines and associated products. The risk management and cost evaluation methods presented herein have been designed for application in a pilot production line of injection-moulded nanocomposites.

  16. Comparing the Mass, Energy, and Cost Effects of Lightweighting in Conventional and Electric Passenger Vehicles

    Directory of Open Access Journals (Sweden)

    Johannes Hofer

    2014-09-01

    Full Text Available In this work the effect of weight reduction using advanced lightweight materials on the mass, energy use, and cost of conventional and battery electric passenger vehicles is compared. Analytic vehicle simulation is coupled with cost assessment to find the optimal degree of weight reduction minimizing manufacturing and total costs. The results show a strong secondary weight and cost saving potential for the battery electric vehicles, but a higher sensitivity of vehicle energy use to mass reduction for the conventional vehicle. Generally, light weighting has the potential to lower vehicle costs, however, the results are very sensitive to parameters affecting lifetime fuel costs for conventional and battery costs for electric vehicles. Based on current technology cost estimates it is shown that the optimal amount of primary mass reduction minimizing total costs is similar for conventional and electric vehicles and ranges from 22% to 39%, depending on vehicle range and overall use patterns. The difference between the optimal solutions minimizing manufacturing versus total costs is higher for conventional than battery electric vehicles.

  17. The cost of post-abortion care in developing countries: a comparative analysis of four studies.

    Science.gov (United States)

    Vlassoff, Michael; Singh, Susheela; Onda, Tsuyoshi

    2016-10-01

    Over the last five years, comprehensive national surveys of the cost of post-abortion care (PAC) to national health systems have been undertaken in Ethiopia, Uganda, Rwanda and Colombia using a specially developed costing methodology-the Post-abortion Care Costing Methodology (PACCM). The objective of this study is to expand the research findings of these four studies, making use of their extensive datasets. These studies offer the most complete and consistent estimates of the cost of PAC to date, and comparing their findings not only provides generalizable implications for health policies and programs, but also allows an assessment of the PACCM methodology. We find that the labor cost component varies widely: in Ethiopia and Colombia doctors spend about 30-60% more time with PAC patients than do nurses; in Uganda and Rwanda an opposite pattern is found. Labor costs range from I$42.80 in Uganda to I$301.30 in Colombia. The cost of drugs and supplies does not vary greatly, ranging from I$79 in Colombia to I$115 in Rwanda. Capital and overhead costs are substantial amounting to 52-68% of total PAC costs. Total costs per PAC case vary from I$334 in Rwanda to I$972 in Colombia. The financial burden of PAC is considerable: the expense of treating each PAC case is equivalent to around 35% of annual per capita income in Uganda, 29% in Rwanda and 11% in Colombia. Providing modern methods of contraception to women with an unmet need would cost just a fraction of the average expenditure on PAC: one year of modern contraceptive services and supplies cost only 3-12% of the average cost of treating a PAC patient. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

  18. Evaluation of activity-based costing versus resource-based relative value costing.

    Science.gov (United States)

    Berlin, Mark F; Smith, Tommy H

    2004-01-01

    Activity-based costing (ABC) and relative value units costing (RVU) are two approaches that a practice manager can use to determine the cost of physician services. Each costing approach has features that provide distinction as well as differentiation in the cost estimates that are estimated. This paper will provide cost estimates under each approach along with cost estimates under a hybrid approach that merges features from each costing approach known as the ABC-RVU costing technique. A comparison of the results will be provided.

  19. Transmission avoided cost: a new parameter to evaluate the economic competitiveness of generations plants projects

    Energy Technology Data Exchange (ETDEWEB)

    Ramos, D.S. [Companhia Energetica de Sao Paulo, SP (Brazil); Albuquerque, J.C.R.; Rosenblat, J. [ELETROBRAS, Rio de Janeiro, RJ (Brazil)

    1994-12-31

    The paper presents a new formulation that makes feasible a composition of long run production marginal costs with the long run transmission marginal costs, including the costs related to the interconnection EHV networks and that related to the voltage levels below. The goal top be attained is to have available a more adequate parameter in order to compare production cost related to a plant, that will be connected to a certain voltage level network, to the cost related supplying the sam,e amount of energy from the bulk power system which will be represented by the marginal costs up to the voltage level under consideration. This procedure brings to light the Transmission Avoided Costs concepts, that are stressed throughout the text. The proposed methodology is now being used, in the brazilian Power Sector, as a rule of thumb in order to guide planning decisions about the schedule of new plants that have installed capacity below 30 MW. For plants with higher capacity, the transmission avoided costs are evaluated for each specific case, simulating the system behavior without the quoted hydroelectric plant. This paper focuses, an an application example, the case of the Canoas Hydroelectric Project, recently included in the Generation Expansion Reference Plan after a detailed analysis supported by the methodology described here. (author) 7 refs., 3 tabs.

  20. Optimization and comparative evaluation of nucleic acids extraction protocols

    Directory of Open Access Journals (Sweden)

    Lucian Negura

    2011-12-01

    Full Text Available Modern molecular applications have grown the need of biobanks, which contain DNA and RNA of high purety, quality, and quantity. Nucleic acid extraction methods have widely variate and evolve in time, from methods using toxic reagents to enzymatic protocols, and furthermore to DNA or RNA-binding polymers, separating membranes or highly eulogized commercially kits. In order to establish a constant, reproducible and ergonomic system in generating biobanks, we compared different available methods for the extraction of genomic DNA and total RNA, from peripheram blood or solid tumoral tissues. We evaluated the cost/effectiveness and time consumption of each method, tracking RNA/DNA quantity, quality and integrity. We imagined a “E-ratio” value to define these parameters, and a “NA- estimation” to integrate “E-ratio” with quality and integrity data.

  1. Comparative evaluation of surface and downhole steam-generation techniques

    Science.gov (United States)

    Hart, C.

    The application of heat to reservoirs containing high API gravity oils can substantially improve recovery. Although steam injection is currently the principal thermal recovery method, heat transmission losses associated with delivery of the steam from the surface generators to the oil bearing formation has limited conventional steam injection to shallow reservoirs. The objective of the Department of Energy's Project DEEP STEAM is to develop the technology required to economically produce heavy oil from deep reservoirs. The tasks included in this effort are the development and evaluation of thermally efficient delivery systems and downhole steam generation systems. The technical and economic performance of conventional surface steam drives, which are strongly influenced by heat losses are compared. The selection of a preferred technology based upon either total efficiency or cost is found to be strongly influenced by reservoir depth, steam mass flow rate, and sandface steam quality.

  2. A comparative cost analysis of picture archiving and communications systems (PACS versus conventional radiology in the private sector

    Directory of Open Access Journals (Sweden)

    Indres Moodley

    2015-03-01

    Full Text Available Background: Radiology is rapidly advancing, with a global transition to digital imaging technology to improve productivity and enhance communication. The major challenge confronting radiology practices is to demonstrate cost savings and productivity gains when a picture archiving and communication system (PACS is established.Aim: To undertake an incremental cost analysis of PACS compared with conventional radiology to determine productivity gains, if any, at two private hospitals in Durban.Method: An incremental cost analysis for chest radiographs, computed tomography and magnetic resonance imaging brain scans with and without contrast were performed. The overall incremental cost for PACS in comparison with a conventional radiology site was determined. The net present value was also determined to evaluate the capital budgeting requirements for both systems.Results: The incremental cost of both capital and the radiology information system for installing PACS shows an expected increase. The incremental PACS image cost shows a reduction.Conclusion: The study provides a benchmark for the cost incurred when implementing PACS. It also provides a decision framework for radiology departments that plan to introduce PACS and helps to determine the feasibility of its introduction.

  3. Comparative study on medical utilization and costs of chronic obstructive pulmonary disease with good lung function

    Directory of Open Access Journals (Sweden)

    Lim JU

    2017-09-01

    Full Text Available Jeong Uk Lim,1 Kyungjoo Kim,2 Sang Hyun Kim,3 Myung Goo Lee,4 Sang Yeub Lee,5 Kwang Ha Yoo,6 Sang Haak Lee,1 Ki-Suck Jung,7 Chin Kook Rhee,2 Yong Il Hwang7 1Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, St Paul’s Hospital, 2Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 3Big Data Division, Health Insurance Review and Assessment Service, Wonju, 4Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, 5Department of Internal Medicine, Korea University, Anam Hospital, 6Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, 7Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Republic of Korea Introduction: Patients with mild to moderate chronic obstructive pulmonary disease (COPD are underdiagnosed and undertreated due to the asymptomatic nature of the disease. Previous studies on patients with mild COPD have focused on symptomatic patients. Therefore, in this study, we evaluated the treatment status of patients with early COPD in Korea.Materials and methods: We compared hospital visits, medical costs per person, and COPD medication use by patients with COPD screened from the general population and COPD cohort patients. Patients with COPD aged ≥40 years with the value of forced expiratory volume in 1 s (FEV1 ≥60% were selected from the 2007 to 2012 Korea National Health and Nutrition Examination Survey (KNHANES data. Data including the number of outpatient clinic visits, admission to hospitals, COPD-related medications, and medical

  4. At what price? A cost-effectiveness analysis comparing trial of labour after previous Caesarean versus elective repeat Caesarean delivery.

    LENUS (Irish Health Repository)

    Fawsitt, Christopher G

    2013-01-01

    Elective repeat caesarean delivery (ERCD) rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland.

  5. Cost-effectiveness of cardiotocography plus ST analysis of the fetal electrocardiogram compared with cardiotocography only.

    Science.gov (United States)

    Vijgen, Sylvia M C; Westerhuis, Michelle E M H; Opmeer, Brent C; Visser, Gerard H A; Moons, Karl G M; Porath, Martina M; Oei, Guid S; Van Geijn, Herman P; Bolte, Antoinette C; Willekes, Christine; Nijhuis, Jan G; Van Beek, Erik; Graziosi, Giuseppe C M; Schuitemaker, Nico W E; Van Lith, Jan M M; Van Den Akker, Eline S A; Drogtrop, Addy P; Van Dessel, Hendrikus J H M; Rijnders, Robbert J P; Oosterbaan, Herman P; Mol, Ben Willem J; Kwee, Anneke

    2011-07-01

    To assess the cost-effectiveness of addition of ST analysis of the fetal electrocardiogram (ECG; STAN) to cardiotocography (CTG) for fetal surveillance during labor compared with CTG only. Cost-effectiveness analysis based on a randomized clinical trial on ST analysis of the fetal ECG. Obstetric departments of three academic and six general hospitals in The Netherlands. Population. Laboring women with a singleton high-risk pregnancy, a fetus in cephalic presentation, a gestational age >36 weeks and an indication for internal electronic fetal monitoring. A trial-based cost-effectiveness analysis was performed from a health-care provider perspective. Primary health outcome was the incidence of metabolic acidosis measured in the umbilical artery. Direct medical costs were estimated from start of labor to childbirth. Cost-effectiveness was expressed as costs to prevent one case of metabolic acidosis. The incidence of metabolic acidosis was 0.7% in the ST-analysis group and 1.0% in the CTG-only group (relative risk 0.70; 95% confidence interval 0.38-1.28). Per delivery, the mean costs per patient of CTG plus ST analysis (n= 2 827) were €1,345 vs. €1,316 for CTG only (n= 2 840), with a mean difference of €29 (95% confidence interval -€9 to €77) until childbirth. The incremental costs of ST analysis to prevent one case of metabolic acidosis were €9 667. The additional costs of monitoring by ST analysis of the fetal ECG are very limited when compared with monitoring by CTG only and very low compared with the total costs of delivery. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

  6. Evaluation of APACHE II for cost containment and quality assurance.

    Science.gov (United States)

    Civetta, J M; Hudson-Civetta, J A; Nelson, L D

    1990-01-01

    APACHE II (an acronym formed from acute physiology score and chronic health evaluation) has been proposed to limit intensive care unit (ICU) admissions ('cost containment') and to judge outcome ('quality assurance') of surgical patients. To judge its performance, a 6-month study of 372 surgical ICU patients was performed. When patients were divided by mean duration of stay, mortality rates rose from 1% (short stay) to 19% (long stay) (p less than 0.001) for patients with APACHE II scores less than 10, but decreased from 94% (short stay) to 60% (long stay) (p less than 0.01) for patients with APACHE II scores more than 24. Exclusion of patients by high or low APACHE scores would 'save' 6% of ICU days but risk increasing morbidity, hospital costs, and deaths. Grouped APACHE II scores did not correlate with total hospital charges (r = 0.05, p = 0.89) or ICU days used (r = 0.42, p = 0.17). Grouping by APACHE II score and duration of ICU stay showed neither symmetry nor uniformity of mortality rates. Surgical patients would not be well served by APACHE II for quality assurance or cost containment. PMID:2396881

  7. Who Should Bear the Cost of Convenience? A Cost-effectiveness Analysis Comparing External Beam and Brachytherapy Radiotherapy Techniques for Early Stage Breast Cancer.

    Science.gov (United States)

    McGuffin, M; Merino, T; Keller, B; Pignol, J-P

    2017-03-01

    Standard treatment for early breast cancer includes whole breast irradiation (WBI) after breast-conserving surgery. Recently, accelerated partial breast irradiation (APBI) has been proposed for well-selected patients. A cost and cost-effectiveness analysis was carried out comparing WBI with two APBI techniques. An activity-based costing method was used to determine the treatment cost from a societal perspective of WBI, high dose rate brachytherapy (HDR) and permanent breast seed implants (PBSI). A Markov model comparing the three techniques was developed with downstream costs, utilities and probabilities adapted from the literature. Sensitivity analyses were carried out for a wide range of variables, including treatment costs, patient costs, utilities and probability of developing recurrences. Overall, HDR was the most expensive ($14 400), followed by PBSI ($8700), with WBI proving the least expensive ($6200). The least costly method to the health care system was WBI, whereas PBSI and HDR were less costly for the patient. Under cost-effectiveness analyses, downstream costs added about $10 000 to the total societal cost of the treatment. As the outcomes are very similar between techniques, WBI dominated under cost-effectiveness analyses. WBI was found to be the most cost-effective radiotherapy technique for early breast cancer. However, both APBI techniques were less costly to the patient. Although innovation may increase costs for the health care system it can provide cost savings for the patient in addition to convenience. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  8. Information Literacy Skills: Comparing and Evaluating Databases

    Science.gov (United States)

    Grismore, Brian A.

    2012-01-01

    The purpose of this database comparison is to express the importance of teaching information literacy skills and to apply those skills to commonly used Internet-based research tools. This paper includes a comparison and evaluation of three databases (ProQuest, ERIC, and Google Scholar). It includes strengths and weaknesses of each database based…

  9. Cost Effective Evaluation of Companies' Storytelling on the Web

    DEFF Research Database (Denmark)

    Clemmensen, Torkil; Vendelø, Morten Thanning

    2004-01-01

    Abstract: In this paper we present a cost effective and simple procedure for evaluating company web sites. Our assumption is that such sites are places for companies' self-presentation and that customers are readers of these texts. Web site texts with narrative qualities, e.g. scenes, actors, acts......, initiate the customers' imagination and narrative mind and hence their decision making. These ideas are investigated in a qualitative study of two companies' self-presentation as future work places for students. The results demonstrate that the students choose the company that has a web site with rich...... narrative qualities above the company that has a web site with good graphical appearance, but poor narrative qualities. In conclusion, we suggest that user centred evaluation of commercial web sites by using the suggested method can pay attention to deep, narrative structures in both the company's self...

  10. Cost-of-illness studies: a guide to critical evaluation.

    Science.gov (United States)

    Larg, Allison; Moss, John R

    2011-08-01

    Cost-of-illness (COI) studies aim to assess the economic burden of health problems on the population overall, and they are conducted for an ever widening range of health conditions and geographical settings. While they attract much interest from public health advocates and healthcare policy makers, inconsistencies in the way in which they are conducted and a lack of transparency in reporting have made interpretation difficult, and have ostensibly limited their usefulness. Yet there is surprisingly little in the literature to assist the non-expert in critically evaluating these studies. This article aims to provide non-expert readers with a straightforward guide to understanding and evaluating traditional COI studies. The intention is to equip a general audience with an understanding of the most important issues that influence the validity of a COI study, and the ability to recognize the most common limitations in such work.

  11. High-temperature superconducting transformer performance, cost, and market evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Dirks, J.A.; Dagle, J.E.; DeSteese, J.G.; Huber, H.D.; Smith, S.A.; Currie, J.W. [Pacific Northwest Lab., Richland, WA (United States); Merrick, S.B. [Westinghouse Hanford Co., Richland, WA (United States); Williams, T.A. [National Renewable Energy Lab., Golden, CO (United States)

    1993-09-01

    Recent laboratory breakthroughs in high-temperature superconducting (HTS) materials have stimulated both the scientific community and general public with questions regarding how these materials can be used in practical applications. While there are obvious benefits from using HTS materials (most notably the potential for reduced energy losses in the conductors), a number of issues (such as overall system energy losses, cost, and reliability) may limit applications of HTS equipment, even if the well known materials problems are solved. This study examined the future application potential of HTS materials to power transformers. This study effort was part of a US Department of Energy (DOE) Office of Energy Storage and Distribution (OESD) research program, Superconductivity Technology for Electric Power Systems (STEPS). The study took a systems perspective to gain insights to help guide DOE in managing research designed to realize the vision of HTS applications. Specific objectives of the study were as follows: to develop an understanding of the fundamental HTS transformer design issues that can provide guidance for developing practical devices of interest to the electric utility industry; to identify electric utility requirements for HTS transformers and to evaluate the potential for developing a commercial market; to evaluate the market potential and national benefits for HTS transformers that could be achieved by a successful HTS development program; to develop an integrated systems analysis framework, which can be used to support R&D planning by DOE, by identifying how various HTS materials characteristics impact the performance, cost, and national benefits of the HTS application.

  12. Comparative analysis for various redox flow batteries chemistries using a cost performance model

    Energy Technology Data Exchange (ETDEWEB)

    Crawford, Aladsair J.; Viswanathan, Vilayanur V.; Stephenson, David E.; Wang, Wei; Thomsen, Edwin C.; Reed, David M.; Li, Bin; Balducci, Patrick J.; Kintner-Meyer, Michael CW; Sprenkle, Vincent L.

    2015-10-20

    A robust performance-based cost model is developed for all-vanadium, iron-vanadium and iron chromium redox flow batteries. Systems aspects such as shunt current losses, pumping losses and thermal management are accounted for. The objective function, set to minimize system cost, allows determination of stack design and operating parameters such as current density, flow rate and depth of discharge (DOD). Component costs obtained from vendors are used to calculate system costs for various time frames. A 2 kW stack data was used to estimate unit energy costs and compared with model estimates for the same size electrodes. The tool has been shared with the redox flow battery community to both validate their stack data and guide future direction.

  13. Cost-efficient evaluation of ambulance services for community ...

    African Journals Online (AJOL)

    PROMOTING ACCESS TO AFRICAN RESEARCH. AFRICAN ... The annual operational cost was Kshs. 70,328,627 (USD 717,639.05). ... The supply barriers were transport costs, operational costs and in-efficient signage on roads for direction.

  14. 24 CFR Appendix to Part 971 - Methodology of Comparing Cost of Public Housing With Cost of Tenant-Based Assistance

    Science.gov (United States)

    2010-04-01

    ... occupied unit basis. The costs shall be expressed in current dollar terms for the period for which the most... the current per-unit operating cost of the development, then the plan should detail how the... operating costs are lower than current operating costs, the current per-unit operating costs of...

  15. Comparative evaluation of aqueous humor viscosity.

    Science.gov (United States)

    Davis, Kyshia; Carter, Renee; Tully, Thomas; Negulescu, Ioan; Storey, Eric

    2015-01-01

    To evaluate aqueous humor viscosity in the raptor, dog, cat, and horse, with a primary focus on the barred owl (Strix varia). Twenty-six raptors, ten dogs, three cats, and one horse. Animals were euthanized for reasons unrelated to this study. Immediately, after horizontal and vertical corneal dimensions were measured, and anterior chamber paracentesis was performed to quantify anterior chamber volume and obtain aqueous humor samples for viscosity analysis. Dynamic aqueous humor viscosity was measured using a dynamic shear rheometer (AR 1000 TA Instruments, New Castle, DE, USA) at 20 °C. Statistical analysis included descriptive statistics, unpaired t-tests, and Tukey's test to evaluate the mean ± standard deviation for corneal diameter, anterior chamber volume, and aqueous humor viscosity amongst groups and calculation of Spearman's coefficient for correlation analyses. The mean aqueous humor viscosity in the barred owl was 14.1 centipoise (cP) ± 9, cat 4.4 cP ± 0.2, and dog 2.9 cP ± 1.3. The aqueous humor viscosity for the horse was 1 cP. Of the animals evaluated in this study, the raptor aqueous humor was the most viscous. The aqueous humor of the barred owl is significantly more viscous than the dog (P humor viscosity of the raptor, dog, cat, and horse can be successfully determined using a dynamic shear rheometer. © 2014 American College of Veterinary Ophthalmologists.

  16. Blood pressure reduction, persistence and costs in the evaluation of antihypertensive drug treatment – a review

    Directory of Open Access Journals (Sweden)

    Hasford Joerg

    2009-03-01

    Full Text Available Abstract Background Blood pressure lowering drugs are usually evaluated in short term trials determining the absolute blood pressure reduction during trough and the duration of the antihypertensive effect after single or multiple dosing. A lack of persistence with treatment has however been shown to be linked to a worse cardiovascular prognosis. This review explores the blood pressure reduction and persistence with treatment of antihypertensive drugs and the cost consequences of poor persistence with pharmaceutical interventions in arterial hypertension. Methods We have searched the literature for data on blood pressure lowering effects of different antihypertensive drug classes and agents, on persistence with treatment, and on related costs. Persistence was measured as patients' medication possession rate. Results are presented in the form of a systematic review. Results Angiotensin II receptor blocker (ARBs have a competitive blood pressure lowering efficacy compared with ACE-inhibitors (ACEi and calcium channel blockers (CCBs, beta-blockers (BBs and diuretics. 8 studies describing the persistence with treatment were identified. Patients were more persistent on ARBs than on ACEi and CCBs, BBs and diuretics. Thus the product of blood pressure lowering and persistence was higher on ARBs than on any other drug class. Although the price per tablet of more recently developed drugs (ACEi, ARBs is higher than that of older ones (diuretics and BBs, the newer drugs result in a more favourable cost to effect ratio when direct drug costs and indirect costs are also considered. Conclusion To evaluate drugs for the treatment of hypertension several key variables including the blood pressure lowering effect, side effects, compliance/persistence with treatment, as well as drug costs and direct and indirect costs of medical care have to be considered. ARBs, while nominally more expensive when drug costs are considered only, provide substantial cost savings

  17. A cost-effectiveness analysis comparing a clinical decision rule versus usual care to risk stratify children for intraabdominal injury after blunt torso trauma.

    Science.gov (United States)

    Nishijima, Daniel K; Yang, Zhuo; Clark, John A; Kuppermann, Nathan; Holmes, James F; Melnikow, Joy

    2013-11-01

    Recently a clinical decision rule (CDR) to identify children at very low risk for intraabdominal injury needing acute intervention (IAI) following blunt torso trauma was developed. Potential benefits of a CDR include more appropriate abdominal computed tomography (CT) use and decreased hospital costs. The objective of this study was to compare the cost-effectiveness of implementing the CDR compared to usual care for the evaluation of children with blunt torso trauma. The hypothesis was that compared to usual care, implementation of the CDR would result in lower CT use and hospital costs. A cost-effectiveness decision analytic model was constructed comparing the costs and outcomes of implementation of the CDR to usual care in the evaluation of children with blunt torso trauma. Probabilities from a multicenter cohort study of children with blunt torso trauma were derived; estimated costs were based on those at the study coordinating site. Outcome measures included missed IAI, number of abdominal CT scans, total costs, and incremental cost-effectiveness ratios. Sensitivity analyses varying imputed probabilities, costs, and scenarios were conducted. Using a hypothetical cohort of 1,000 children with blunt torso trauma, the base case model projected that the implementation of the CDR would result in 0.50 additional missed IAIs, a total cost savings of $54,527, and 104 fewer abdominal CT scans compared to usual care. The usual care strategy would cost $108,110 to prevent missing one additional IAI. Findings were robust under multiple sensitivity analyses. Compared to usual care, implementation of the CDR in the evaluation of children with blunt torso trauma would reduce hospital costs and abdominal CT imaging, with a slight increase in the risk of missed intraabdominal IAI. © 2013 by the Society for Academic Emergency Medicine.

  18. Cost of wind energy: comparing distant wind resources to local resources in the midwestern United States.

    Science.gov (United States)

    Hoppock, David C; Patiño-Echeverri, Dalia

    2010-11-15

    The best wind sites in the United States are often located far from electricity demand centers and lack transmission access. Local sites that have lower quality wind resources but do not require as much power transmission capacity are an alternative to distant wind resources. In this paper, we explore the trade-offs between developing new wind generation at local sites and installing wind farms at remote sites. We first examine the general relationship between the high capital costs required for local wind development and the relatively lower capital costs required to install a wind farm capable of generating the same electrical output at a remote site,with the results representing the maximum amount an investor should be willing to pay for transmission access. We suggest that this analysis can be used as a first step in comparing potential wind resources to meet a state renewable portfolio standard (RPS). To illustrate, we compare the cost of local wind (∼50 km from the load) to the cost of distant wind requiring new transmission (∼550-750 km from the load) to meet the Illinois RPS. We find that local, lower capacity factor wind sites are the lowest cost option for meeting the Illinois RPS if new long distance transmission is required to access distant, higher capacity factor wind resources. If higher capacity wind sites can be connected to the existing grid at minimal cost, in many cases they will have lower costs.

  19. Cost-effectiveness of radiotherapy during surgery compared with external radiation therapy in the treatment of women with breast cancer

    Directory of Open Access Journals (Sweden)

    Hedie Mosalanezhad

    2016-04-01

    Full Text Available Introduction: Intraoperative radiation therapy device (IORT is one of the several options for partial breast irradiation. IORT is sent to the tumor bed during surgery and can be replaced with conventional standard therapy (EBRT. The aim of this study was to evaluate the safety and effectiveness of IORT machine compared with EBRT and to determine the dominant option in terms of the cost-effectiveness. Method: This study was conducted in two phases; the first phase was a comprehensive review of the electronic databases search that was extracted after extraction and selection of the articles used in this article on effectiveness outcomes. Data collection form was completed by professionals and experts to estimate the cost of treatment, intraoperative radiotherapy and radiotherapy cost when using external radiation therapy process; direct costs were considered from the perspective of service provider and they were calculated in the second phase to determine the option of cost-effective ICER. Excel software was used for data analysis and sensitivity analysis was performed to determine the strength of the results of cost-effectiveness. Results:18 studies were selected but only 8 of them were shown to have acceptable quality. The consequences like “rate of cancer recurrence”, “seroma”, “necrosis”, “toxic”, “skin disorders and delayed wound healing” and “spread the pain” were among the consequences used in the selected articles. The total costs for each patient during a course of treatment for EBRT and IORT were estimated 1398 and $5337.5, respectively. During the analysis, cost-effectiveness of the consequences of cancer recurrence, seroma, necrosis and skin disorders and delayed wound healing ICER was calculated. And IORT was found to be the dominant supplier in all cases. Also, in terms of implications of toxicity and prevalence of pain, IORT had a lower cost and better effectiveness and consequently the result was more cost

  20. Low-cost portable TRNG, implementation and evaluation

    Directory of Open Access Journals (Sweden)

    Fermevc Igor

    2016-01-01

    Full Text Available This paper will show one of many possible hardware implementations of random sequence generators and give a short survey on existing work related to techniques used for producing true random bits. By using cheap electronic components found in every specialized store such as 8-bit RISC microcontroler, double analogue comparator chip and USB to RS232 interface integrated circuit, we were able to produce a low cost, higly portable device that outputs random sequences with excellent statistical characteristics and high entropy. The source of randomness is a mix of techniques such as electronic noise, phase noise and oscillator jitter. The device in question has a built-in debiasing algorithm similar to [1] and a security mechanism that protects the end user by constantly monitoring the quality of digitized noise signal. Finaly, we will show the results of comparative analysis of data acquired from our device and „random.org“ online service.

  1. Preliminary evaluation of the lifecycle costs and market barriers of reflective pavements

    Energy Technology Data Exchange (ETDEWEB)

    Ting, M.; Koomey, J.G.; Pomerantz, M.

    2001-11-21

    The objective of this study is to evaluate the life cycle costs and market barriers associated with using reflective paving materials in streets and parking lots as a way to reduce the urban heat island effect. We calculated and compared the life cycle costs of conventional asphalt concrete (AC) pavements to those of other existing pavement technologies with higher reflectivity-portland cement concrete (PCC), porous pavements, resin pavements, AC pavements using light-colored chip seals, and AC pavements using light-colored asphalt emulsion additives. We found that for streets and parking lots, PCC can provide a cost-effective alternative to conventional AC when severely damaged pavements must be completely reconstructed. We also found that rehabilitating damaged AC streets and intersections with thin overlays of PCC (ultra-thin white topping) can often provide a cost-effective alternative to standard rehabilitation techniques using conventional AC. Chip sealing is a common maintenance treatment for low-volume streets which, when applied using light-colored chips, could provide a reflective pavement surface. If the incremental cost of using light-colored chips is low, this chip sealing method could also be cost-effective, but the incremental costs of light-colored chips are as of yet uncertain and expected to vary. Porous pavements were found to have higher life cycle costs than conventional AC in parking lots, but several cost-saving features of porous pavements fell outside the boundaries of this study. Resin pavements were found to be only slightly more expensive than conventional AC, but the uncertainties in the cost and performance data were large. The use of light-colored additives in asphalt emulsion seal coats for parking lot pavements was found to be significantly more expensive than conventional AC, reflecting its current niche market of decorative applications. We also proposed two additional approaches to increasing the reflectivity of conventional AC

  2. Comparative efficiency research (COMER): meta-analysis of cost-effectiveness studies.

    Science.gov (United States)

    Crespo, Carlos; Monleon, Antonio; Díaz, Walter; Ríos, Martín

    2014-12-22

    The aim of this study was to create a new meta-analysis method for cost-effectiveness studies using comparative efficiency research (COMER). We built a new score named total incremental net benefit (TINB), with inverse variance weighting of incremental net benefits (INB). This permits determination of whether an alternative is cost-effective, given a specific threshold (TINB > 0 test). Before validation of the model, the structure of dependence between costs and quality-adjusted life years (QoL) was analysed using copula distributions. The goodness-of-fit of a Spanish prospective observational study (n = 498) was analysed using the Independent, Gaussian, T, Gumbel, Clayton, Frank and Placket copulas. Validation was carried out by simulating a copula distribution with log-normal distribution for costs and gamma distribution for disutilities. Hypothetical cohorts were created by varying the sample size (n: 15-500) and assuming three scenarios (1-cost-effective; 2-non-cost-effective; 3-dominant). The COMER result was compared to the theoretical result according to the incremental cost-effectiveness ratio (ICER) and the INB, assuming a margin of error of 2,000 and 500 monetary units, respectively. The Frank copula with positive dependence (-0.4279) showed a goodness-of-fit sufficient to represent costs and QoL (p-values 0.524 and 0.808). The theoretical INB was within the 95% confidence interval of the TINB, based on 15 individuals with a probability > 80% for scenarios 1 and 2, and > 90% for scenario 3. The TINB > 0 test with 15 individuals showed p-values of 0.0105 (SD: 0.0411) for scenario 1, 0.613 (SD: 0.265) for scenario 2 and < 0.0001 for scenario 3. COMER is a valid tool for combining cost-effectiveness studies and may be of use to health decision makers.

  3. Spacesuit and Space Vehicle Comparative Ergonomic Evaluation

    Science.gov (United States)

    England, Scott; Benson, Elizabeth; Cowley, Matthew; Harvill, Lauren; Blackledge, Christopher; Perez, Esau; Rajulu, Sudhakar

    2011-01-01

    With the advent of the latest manned spaceflight objectives, a series of prototype launch and reentry spacesuit architectures were evaluated for eventual down selection by NASA based on the performance of a set of designated tasks. A consolidated approach was taken to testing, concurrently collecting suit mobility data, seat-suit-vehicle interface clearances and movement strategies within the volume of a Multi-Purpose Crew Vehicle mockup. To achieve the objectives of the test, a requirement was set forth to maintain high mockup fidelity while using advanced motion capture technologies. These seemingly mutually exclusive goals were accommodated with the construction of an optically transparent and fully adjustable frame mockup. The mockup was constructed such that it could be dimensionally validated rapidly with the motion capture system. This paper will describe the method used to create a motion capture compatible space vehicle mockup, the consolidated approach for evaluating spacesuits in action, as well as the various methods for generating hardware requirements for an entire population from the resulting complex data set using a limited number of test subjects. Kinematics, hardware clearance, suited anthropometry, and subjective feedback data were recorded on fifteen unsuited and five suited subjects. Unsuited subjects were selected chiefly by anthropometry, in an attempt to find subjects who fell within predefined criteria for medium male, large male and small female subjects. The suited subjects were selected as a subset of the unsuited subjects and tested in both unpressurized and pressurized conditions. Since the prototype spacesuits were fabricated in a single size to accommodate an approximately average sized male, the findings from the suit testing were systematically extrapolated to the extremes of the population to anticipate likely problem areas. This extrapolation was achieved by first performing population analysis through a comparison of suited

  4. Comparative Evaluation of Mobile Forensic Tools

    Directory of Open Access Journals (Sweden)

    Oluwafemi Osho

    2016-01-01

    Full Text Available Mobile technology, over the years, has improved tremendously in sophistication and functionality. Today, there are mobile phones, known as smartphones, that can perform virtually most functions associated with personal computers. This has translated to increase in the adoption of mobile technology. Consequently, there has been an increase in the number of attacks against and with the aid of this technology. Mobile phones will often contain data that are needed as evidence in a court of law. And, therefore, the need to be able to acquire and present this data in an admissible form cannot be overemphasized. This requires the right forensic tools. This is the focus of this study. We evaluated the ability of four forensic tools to extract data, with emphasis on deleted data, from Android phones. Our results show that AccessData FTK Imager and EnCase performed better than MOBILedit Forensic and Oxygen Forensic Suite at acquiring deleted data. The conclusion is that, finding a forensic tool or toolkit that is virtually applicable across all mobile device platforms and operating systems is currently infeasible.

  5. Evaluating, Comparing, and Interpreting Protein Domain Hierarchies

    Science.gov (United States)

    2014-01-01

    Abstract Arranging protein domain sequences hierarchically into evolutionarily divergent subgroups is important for investigating evolutionary history, for speeding up web-based similarity searches, for identifying sequence determinants of protein function, and for genome annotation. However, whether or not a particular hierarchy is optimal is often unclear, and independently constructed hierarchies for the same domain can often differ significantly. This article describes methods for statistically evaluating specific aspects of a hierarchy, for probing the criteria underlying its construction and for direct comparisons between hierarchies. Information theoretical notions are used to quantify the contributions of specific hierarchical features to the underlying statistical model. Such features include subhierarchies, sequence subgroups, individual sequences, and subgroup-associated signature patterns. Underlying properties are graphically displayed in plots of each specific feature's contributions, in heat maps of pattern residue conservation, in “contrast alignments,” and through cross-mapping of subgroups between hierarchies. Together, these approaches provide a deeper understanding of protein domain functional divergence, reveal uncertainties caused by inconsistent patterns of sequence conservation, and help resolve conflicts between competing hierarchies. PMID:24559108

  6. Cost-effectiveness of rivaroxaban compared with enoxaparin plus a vitamin K antagonist for the treatment of venous thromboembolism.

    Science.gov (United States)

    Lefebvre, Patrick; Coleman, Craig I; Bookhart, Brahim K; Wang, Si-Tien; Mody, Samir H; Tran, Kevin N; Zhuo, Daisy Y; Huynh, Lynn; Nutescu, Edith A

    2014-01-01

    Venous thromboembolism (VTE), comprised of deep vein thrombosis (DVT) and pulmonary embolism (PE), is commonly treated with a low-molecular-weight heparin such as enoxaparin plus a vitamin K antagonist (VKA) to prevent recurrence. Administration of enoxaparin + VKA is hampered by complexities of laboratory monitoring and frequent dose adjustments. Rivaroxaban, an orally administered anticoagulant, has been compared with enoxaparin + VKA in the EINSTEIN trials. The objective was to evaluate the cost-effectiveness of rivaroxaban compared with enoxaparin + VKA as anticoagulation treatment for acute, symptomatic, objectively-confirmed DVT or PE. A Markov model was built to evaluate the costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios associated with rivaroxaban compared to enoxaparin + VKA in adult patients treated for acute DVT or PE. All patients entered the model in the 'on-treatment' state upon commencement of oral rivaroxaban or enoxaparin + VKA for 3, 6, or 12 months. Transition probabilities were obtained from the EINSTEIN trials during treatment and published literature after treatment. A 3-month cycle length, US payer perspective ($2012), 5-year time horizon and a 3% annual discount rate were used. Treatment with rivaroxaban cost $2,448 per-patient less and was associated with 0.0058 more QALYs compared with enoxaparin + VKA, making it a dominant economic strategy. Upon one-way sensitivity analysis, the model's results were sensitive to the reduction in index VTE hospitalization length-of-stay associated with rivaroxaban compared with enoxaparin + VKA. At a willingness-to-pay threshold of $50,000/QALY, probabilistic sensitivity analysis showed rivaroxaban to be cost-effective compared with enoxaparin + VKA approximately 76% of the time. The model did not account for the benefits associated with an oral and minimally invasive administration of rivaroxaban. 'Real-world' applicability is limited

  7. Comparative cost analysis of inpatient integrative medicine-Results of a pilot study.

    Science.gov (United States)

    Ostermann, Thomas; Lauche, Romy; Cramer, Holger; Dobos, Gustav

    2017-06-01

    Costs of integrative treatment alone and in comparison with other treatment approaches have scarcely been reported in the past. This study presents results of a comparative cost analysis of an inpatient integrative medicine treatment costs. Data from 2006 for inpatients referred to a Department of Integrative Medicine in Germany were used. Case-related treatment costs were calculated, and transformed into Casemix-Indices and revenues per DRG. Costs were compared between departments at the same hospital and between different hospitals using univariate statistics and Chi-Square tests. In total 1253 inpatients (81.4% female, 61.1±14.4years) were included in the current analysis. Most patients were treated for diseases of the musculoskeletal system (57.2%), followed by diseases of the digestive system (11.4%), and diseases of the nervous system (10.4%). The department received an additional payment for most of the patients (88.0%), which led to an effective appreciation of 10.8% per case compared to the standardized Casemix-Index. In-house comparisons with other departments found the department in close vicinity to the departments of Internal medicine with regards to CMI and mean revenue, however the Patient Clinical Complexity Level was significantly lower in the Integrative medicine department. The interhospital comparison revealed comparable Casemix-Index and DRG-revenue, however the additional payment increased the mean revenue significantly. Modern integrative in-patient treatment is mostly cost-equivalent to conventional treatment. Cost effectiveness studies should be considered to further investigate the potential of integrative in patient treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Cost-effective cloud computing: a case study using the comparative genomics tool, roundup.

    Science.gov (United States)

    Kudtarkar, Parul; Deluca, Todd F; Fusaro, Vincent A; Tonellato, Peter J; Wall, Dennis P

    2010-12-22

    Comparative genomics resources, such as ortholog detection tools and repositories are rapidly increasing in scale and complexity. Cloud computing is an emerging technological paradigm that enables researchers to dynamically build a dedicated virtual cluster and may represent a valuable alternative for large computational tools in bioinformatics. In the present manuscript, we optimize the computation of a large-scale comparative genomics resource-Roundup-using cloud computing, describe the proper operating principles required to achieve computational efficiency on the cloud, and detail important procedures for improving cost-effectiveness to ensure maximal computation at minimal costs. Utilizing the comparative genomics tool, Roundup, as a case study, we computed orthologs among 902 fully sequenced genomes on Amazon's Elastic Compute Cloud. For managing the ortholog processes, we designed a strategy to deploy the web service, Elastic MapReduce, and maximize the use of the cloud while simultaneously minimizing costs. Specifically, we created a model to estimate cloud runtime based on the size and complexity of the genomes being compared that determines in advance the optimal order of the jobs to be submitted. We computed orthologous relationships for 245,323 genome-to-genome comparisons on Amazon's computing cloud, a computation that required just over 200 hours and cost $8,000 USD, at least 40% less than expected under a strategy in which genome comparisons were submitted to the cloud randomly with respect to runtime. Our cost savings projections were based on a model that not only demonstrates the optimal strategy for deploying RSD to the cloud, but also finds the optimal cluster size to minimize waste and maximize usage. Our cost-reduction model is readily adaptable for other comparative genomics tools and potentially of significant benefit to labs seeking to take advantage of the cloud as an alternative to local computing infrastructure.

  9. Natural dyes versus lysochrome dyes in cheiloscopy: A comparative evaluation

    Directory of Open Access Journals (Sweden)

    Narendra Nath Singh

    2010-01-01

    Full Text Available Cheiloscopy is the study of lip prints. Lip prints are genotypically determined and are unique, and stable. At the site of crime, lip prints can be either visible or latent. To develop lip prints for study purpose various chemicals such as lysochrome dyes, fluorescent dyes, etc. are available which are very expensive. Vermilion (Sindoor used by married Indian women and indigo dye (fabric whitener are readily available, naturally derived, and cost-effective reagents available in India. Objective: To compare the efficacy of sudan black, vermilion, and indigo in developing visible and latent lip prints made on bone china cup, satin fabric, and cotton fabric. Materials and Methods: Out of 45 Volunteers 15 lip prints were made on bone China cup 15 lip prints on Satin fabric and 15 on Cotton fabric. Sudan black, vermilion and indigo were applied on visible and latent lip prints and graded as good (+,+, fair (+, and poor (- and statistically evaluated. Results: The vermilion and indigo dye gives comparable results to that of sudan black for developing visible and latent lip prints.

  10. Depression in working adults: comparing the costs and health outcomes of working when ill.

    Directory of Open Access Journals (Sweden)

    Fiona Cocker

    Full Text Available OBJECTIVE: Working through a depressive illness can improve mental health but also carries risks and costs from reduced concentration, fatigue, and poor on-the-job performance. However, evidence-based recommendations for managing work attendance decisions, which benefit individuals and employers, are lacking. Therefore, this study has compared the costs and health outcomes of short-term absenteeism versus working while ill ("presenteeism" amongst employed Australians reporting lifetime major depression. METHODS: Cohort simulation using state-transition Markov models simulated movement of a hypothetical cohort of workers, reporting lifetime major depression, between health states over one- and five-years according to probabilities derived from a quality epidemiological data source and existing clinical literature. Model outcomes were health service and employment-related costs, and quality-adjusted-life-years (QALYs, captured for absenteeism relative to presenteeism, and stratified by occupation (blue versus white-collar. RESULTS: Per employee with depression, absenteeism produced higher mean costs than presenteeism over one- and five-years ($42,573/5-years for absenteeism, $37,791/5-years for presenteeism. However, overlapping confidence intervals rendered differences non-significant. Employment-related costs (lost productive time, job turnover, and antidepressant medication and service use costs of absenteeism and presenteeism were significantly higher for white-collar workers. Health outcomes differed for absenteeism versus presenteeism amongst white-collar workers only. CONCLUSIONS: Costs and health outcomes for absenteeism and presenteeism were not significantly different; service use costs excepted. Significant variation by occupation type was identified. These findings provide the first occupation-specific cost evidence which can be used by clinicians, employees, and employers to review their management of depression-related work

  11. Cost-effectiveness of hepatitis B vaccination using HEPLISAV™ in selected adult populations compared to Engerix-B® vaccine.

    Science.gov (United States)

    Kuan, Renee Kim; Janssen, Robert; Heyward, William; Bennett, Sean; Nordyke, Robert

    2013-08-20

    HEPLISAV™ is an adult hepatitis B vaccine that requires fewer doses over a shorter period of time and elicits higher and earlier seroprotection compared to Engerix-B to reduce the risk of hepatitis B infection. The objective of this analysis was to evaluate the cost-effectiveness of vaccination with HEPLISAV vs. Engerix-B(®) to prevent hepatitis B infection in select populations. Markov models were developed for the following populations: diabetics, patients with chronic or end stage kidney disease, healthcare workers and international travelers to countries with high HBV infection prevalence. Hepatitis B disease progression was modeled using 11 health states: seroprotected, susceptible, acute infection, chronic infection, fulminant hepatic failure, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, liver transplant, post-transplant care, and death. Seroprotection rates were obtained from two phase 3 clinical trials comparing HEPLISAV with Engerix-B and ranged across various populations from 89-96% for HEPLISAV and 62-81% for Engerix-B. Higher vaccination completion rates were assumed for HEPLISAV compared with Engerix-B given that fewer doses of HEPLISAV are required in a shorter period of time to achieve seroprotection for the evaluated populations. Each cycle length after the first year in the model was 1-year. All future costs and benefits were discounted at 3%. A lifetime analysis and a U.S. payer perspective were used. HEPLISAV has a favorable cost-effectiveness profile with incremental cost effectiveness ratios rates, and seroprotection rates were the sensitive variables in the models. HEPLISAV is a cost-effective option to provide high rates of seroprotection and early seroprotection across a range of populations from health care workers to patients with chronic or end stage kidney disease. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Revisiting rose: comparing the benefits and costs of population-wide and targeted interventions.

    Science.gov (United States)

    Ahern, Jennifer; Jones, Matthew R; Bakshis, Erin; Galea, Sandro

    2008-12-01

    Geoffrey Rose's two principal approaches to public health intervention are (1) targeted strategies focusing on individuals at a personal increased risk of disease and (2) population-wide approaches focusing on the whole population. Beyond his discussion of the strengths and weaknesses of these approaches, there is no empiric work examining the conditions under which one of these approaches may be better than the other. This article uses mathematical simulations to model the benefits and costs of the two approaches, varying the cut points for treatment, effect magnitudes, and costs of the interventions. These techniques then were applied to the specific example of an intervention on blood pressure to reduce cardiovascular disease. In the general simulation (using an inverse logit risk curve), lower costs of intervention, treating people with risk factor values at or above where the slope on the risk curve is at its steepest (for targeted interventions), and interventions with larger effects on reducing the risk factor (for population-wide interventions) provided benefit/cost advantages. In the specific blood pressure intervention example, lower-cost population-wide interventions had better benefit/cost ratios, but some targeted treatments with lower cutoffs prevented more absolute cases of disease. These simulations empirically evaluate some of Rose's original arguments. They can be replicated for particular interventions being considered and may be useful in helping public health decision makers assess potential intervention strategies.

  13. Economic cost evaluation on the viability of offshore wind turbine farms in Nigeria

    Directory of Open Access Journals (Sweden)

    S.O. Effiom

    2016-11-01

    Full Text Available The paper presents an economic cost evaluation on the feasibility of offshore wind turbine (OWT farms development in Nigeria, using a 500 MW OWT farm as an incident study. A developed model was used to evaluate the economic cost of the OWTs at different phases of the project. Additionally, the effect of the cost drivers at the changed phases of the OWTs was studied correspondingly. Results obtained showed that over 50% of the OWT project cost emanated from CAPEX while a value less than 50% came from OPEX. However, further analysis indicates at maximum power of 4 MW a 4.95% diminution in LCOE. For comparable power rating (PR between 5⩽PR⩽6MW, a 2.7% reduction in LCOE exists. Cost stability was apparent at a growth of WTs between 300⩽WT⩽500 MW. The study also observed a decrease in LCOE for all development stages of the OWT while a decrease in the CMS detectability was considered marginal. Subsequently, it can be inferred that Nigeria has the potential for OWT farm expansion. However, the demonstrated model was appropriate for handling preliminary variations in OWT studies.

  14. Cost-effectiveness of apixaban compared with warfarin for stroke prevention in atrial fibrillation.

    Directory of Open Access Journals (Sweden)

    Soyon Lee

    Full Text Available BACKGROUND: Apixaban was shown to be superior to adjusted-dose warfarin in preventing stroke or systemic embolism in patients with atrial fibrillation (AF and at least one additional risk factor for stroke, and associated with reduced rates of hemorrhage. We sought to determine the cost-effectiveness of using apixaban for stroke prevention. METHODS: Based on the results from the Apixaban Versus Warfarin in Patients with Atrial Fibrillation (ARISTOTLE trial and other published studies, we constructed a Markov model to evaluate the cost-effectiveness of apixaban versus warfarin from the Medicare perspective. The base-case analysis assumed a cohort of 65-year-old patients with a CHADS(2 score of 2.1 and no contraindication to oral anticoagulation. We utilized a 2-week cycle length and a lifetime time horizon. Outcome measures included costs in 2012 US$, quality-adjusted life-years (QALYs, life years saved and incremental cost-effectiveness ratios. RESULTS: Under base case conditions, quality adjusted life expectancy was 10.69 and 11.16 years for warfarin and apixaban, respectively. Total costs were $94,941 for warfarin and $86,007 for apixaban, demonstrating apixaban to be a dominant economic strategy. Upon one-way sensitivity analysis, these results were sensitive to variability in the drug cost of apixaban and various intracranial hemorrhage related variables. In Monte Carlo simulation, apixaban was a dominant strategy in 57% of 10,000 simulations and cost-effective in 98% at a willingness-to-pay threshold of $50,000 per QALY. CONCLUSIONS: In patients with AF and at least one additional risk factor for stroke and a baseline risk of ICH risk of about 0.8%, treatment with apixaban may be a cost-effective alternative to warfarin.

  15. [Evaluating cost/equity in the Colombian health system, 1998-2005].

    Science.gov (United States)

    Eslava-Schmalbach, Javier; Barón, Gilberto; Gaitán-Duarte, Hernando; Alfonso, Helman; Agudelo, Carlos; Sánchez, Carolina

    2008-01-01

    An economic analysis of cost-equity (from society's viewpoint) for evaluating the impact of Law 100/93 in Colombia between 1998 and 2005. An economic analysis compared costs and equity in health in Colombia between 1998 and 2005. Data was taken from the Colombian Statistics' Administration Department ( Departamento Administrativo Nacional de Estadistica - DANE) and from national demographic and health surveys carried out in 2000 and 2005. Information regarding costs was taken from the National Health Accounts' System. Inequity in Health was considered in line with the Inequity in Health Index (IHI). Incremental and average cost-equity analysis covered three sub-periods; 1998-1999 (during which time per capita gross internal product became reduced in Colombia ), 2000-2001 (during which time total health expense became reduced) and 2001 -2005. An unstable tendency for inequity in health becoming reduced during the period was revealed. There was an inverse relationship between IHI and public health spending and a direct relationship between out-of-pocket spending on health and equity in health (Spearman, p<0.05). The second period had the best incremental cost-equity ratio. Fluctuations in IHI and marginal cost-equity during the periods being analysed suggested that health spending depended on equity in health in Colombia during the period being studied.

  16. Integral municipal wastes management. Cost evaluation; Gestion integral de residuos urbanos. Evaluacion de rendimientos y costes de la recogida selectiva (Parte II)

    Energy Technology Data Exchange (ETDEWEB)

    Baldasano, J. M.; Ginestar, X.; Perez, C.; Gasso, S.

    2002-07-01

    The Spanish National Plan for Municipal Solid Waste (PNRU 2002-2006) includes an integrated waste management model that arranges the waste management options in order of priority: minimization, reuse, recycling (including composting and biomethanisation), energy recovery and final disposal. This paper makes an evaluation of the cost increases of the MSW separate collection for recycling compared to the traditional collection system. The first part of this paper include a description of the different possibilities to carry out the separate collection in terms of materials (containers and collectors), human resources and performances, as well as a comparison between its unitary costs. This second part contains a total cost evaluation and specially focuses on the organic matter and refuse separate collection comparing the lateral load system and the back load system in three temporal scenarios from 2001 to 2006. (Author)

  17. A Comparative Analysis of the Costs of Substitute Care and Family Based Services. Monograph 2.

    Science.gov (United States)

    Hutchinson, Janet

    Family based services attempt to maintain and strengthen the client family and prevent family dissolution and the placement of a child or several children in substitute care. This study compared programs that serve children and their families in their home. Variances in program costs were attributed to differences in number of casework hours per…

  18. The cost of dental implants as compared to that of conventional strategies

    NARCIS (Netherlands)

    van der Wijk, P; Bouma, J; van Waas, MAJ; van Oort, RP; Rutten, FFH

    1998-01-01

    The effectiveness of dental implants is widely studied, especially in terms of their clinical outcomes. However, from the policymaker's point of view, variables other than safety and efficacy such as the costs and effectiveness of dental implants as compared to other treatment alternatives, are

  19. A comparative assessment of the financial costs and carbon benefits of REDD+ strategies in Southeast Asia

    Science.gov (United States)

    Graham, Victoria; Laurance, Susan G.; Grech, Alana; McGregor, Andrew; Venter, Oscar

    2016-11-01

    REDD+ holds potential for mitigating emissions from tropical forest loss by providing financial incentives for carbon stored in forests, but its economic viability is under scrutiny. The primary narrative raised in the literature is that REDD+ will be of limited utility for reducing forest carbon loss in Southeast Asia, while the level of finance committed falls short of profits from alternative land-use activities in the region, including large-scale timber and oil palm operations. Here we assess the financial costs and carbon benefits of various REDD+ strategies deployed in the region. We find the cost of reducing emissions ranges from 9 to 75 per tonne of avoided carbon emissions. The strategies focused on reducing forest degradation and promoting forest regrowth are the most cost-effective ways of reducing emissions and used in over 60% of REDD+ projects. By comparing the financial costs and carbon benefits of a broader range of strategies than previously assessed, we highlight the variation between different strategies and draw attention to opportunities where REDD+ can achieve maximum carbon benefits cost-effectively. These findings have broad policy implications for Southeast Asia. Until carbon finance escalates, emissions reductions can be maximized from reforestation, reduced-impact logging and investing in improved management of protected areas. Targeting cost-efficient opportunities for REDD+ is important to improve the efficiency of national REDD+ policy, which in-turn fosters greater financial and political support for the scheme.

  20. Activity-based costing evaluation of [F-18]-fludeoxyglucose production

    NARCIS (Netherlands)

    Krug, Bruno; Van Zanten, Annie; Pirson, Anne-Sophie; Crott, Ralph; Borght, Thierry Vander

    2008-01-01

    Introduction As healthcare expenses are escalating in many countries, the sector faces a new challenge of becoming more cost efficient. There is an urgent need for more accurate data on the costs of healthcare procedures. The cost of Positron Emission Tomography (PET) with [F-18]-fludeoxyglucose (F-

  1. Activity-based costing evaluation of [F-18]-fludeoxyglucose production

    NARCIS (Netherlands)

    Krug, Bruno; Van Zanten, Annie; Pirson, Anne-Sophie; Crott, Ralph; Borght, Thierry Vander

    2008-01-01

    Introduction As healthcare expenses are escalating in many countries, the sector faces a new challenge of becoming more cost efficient. There is an urgent need for more accurate data on the costs of healthcare procedures. The cost of Positron Emission Tomography (PET) with [F-18]-fludeoxyglucose (F-

  2. [Percutaneous closure of patent ductus arteriosus: results and costs compared to surgical closure].

    Science.gov (United States)

    Vieu, T; Beaurain, S; Angel, C; Leriche, H; Petit, J; Conso, J F; Planché, C; Losay, J

    1995-10-01

    The comparison of the clinical results and costs of the two methods of closure of patient ductus arteriosus was undertaken in two comparable groups of 40 patients treated in the same period in the same hospital. After transcatheter closure there was a 9% residual shunt rate at 3 years, the 2 patients with a residual continuous murmur being operated secondarily. The only complication was severe haemolysis which regressed after transcatheter ablation of the prosthesis. After surgical closure, there were no residual shunt. Some postoperative complications were observed in 20% of cases, usually benign (ventilatory problems, dysphonia or urinary infection), but occasionally more serious (peroperative lesion of the pulmonary artery). Morbidity, inherent to the technique of closure, was very different and much less in catheter closure. The average cost (daily cost x average length of hospital stay) was much less with transcatheter closure 38,558 francs versus 11,240 francs. On the other hand, the direct cost of transcatheter closure was greater than that of surgery: 32,798 francs versus 20,903 francs, the difference being related to the actual price of the prosthesis. The authors conclude that the 3 year results of transcatheter closure of patent ductus arterious make this technique a reasonable therapeutic alternative to surgery. From the safety point of view, the two techniques are comparable bu patient confort is greater with transcatheter closure for an increase in cost of the initial procedure which should decrease in relation to the types and prices of the prosthesis used.

  3. Comparing the assets of uninsured households to cost sharing under high-deductible health plans.

    Science.gov (United States)

    Jacobs, Paul D; Claxton, Gary

    2008-01-01

    Financial assets are relevant when one is assessing whether high-deductible plans, which require greater up-front cost sharing, are worthwhile for the uninsured. We show that uninsured households have less financial assets compared to the insured; at lower income levels, their net financial assets may even be negative. Although lower premiums may increase the ability of the uninsured to buy some coverage, high out-of-pocket liability may leave families exposed to costs that they cannot meet. Paying premiums for a policy that exposes the uninsured to unaffordable medical bills may be viewed as an uneconomical use of their limited assets.

  4. Coping with Costly Bid Evaluation in Online Reverse Auctions for IT Services

    NARCIS (Netherlands)

    U.L. Radkevitch (Uladzimir); H.W.G.M. van Heck (Eric); O.R. Koppius (Otto)

    2008-01-01

    textabstractOnline markets have dramatically decreased costs of search and communication for buyers. By contrast, costs of evaluating purchasing alternatives have become critical due to an overwhelming range of available options. When high, evaluation costs can offset potential gains from

  5. Coping with Costly Bid Evaluation in Online Reverse Auctions for IT Services

    NARCIS (Netherlands)

    U.L. Radkevitch (Uladzimir); H.W.G.M. van Heck (Eric); O.R. Koppius (Otto)

    2008-01-01

    textabstractOnline markets have dramatically decreased costs of search and communication for buyers. By contrast, costs of evaluating purchasing alternatives have become critical due to an overwhelming range of available options. When high, evaluation costs can offset potential gains from transactio

  6. The cost effectiveness of lung transplantation compared with that of heart and liver transplantation in the Netherlands

    NARCIS (Netherlands)

    Ouwens, JP; van Enckevort, PJ; TenVergert, EM; Bonsel, GJ; van der Bij, W; Haagsma, EB; Rutten, FFH; Slooff, MJH; Koeter, GH

    This study was performed to assess the main reasons for the unfavorable cost effectiveness of lung transplantation compared with that of heart and liver transplantation. Costs, effects, and cost-effectiveness ratios of Dutch lung, heart, and liver transplantation programs were compared. The data are

  7. Comparative analysis of individuals with and without chiropractic coverage: patient characteristics, utilization, and costs.

    Science.gov (United States)

    Legorreta, Antonio P; Metz, R Douglas; Nelson, Craig F; Ray, Saurabh; Chernicoff, Helen Oster; Dinubile, Nicholas A

    2004-10-11

    Back pain accounts for more than $100 billion in annual US health care costs and is the second leading cause of physician visits and hospitalizations. This study ascertains the effect of systematic access to chiropractic care on the overall and neuromusculoskeletal-specific consumption of health care resources within a large managed-care system. A 4-year retrospective claims data analysis comparing more than 700 000 health plan members with an additional chiropractic coverage benefit and 1 million members of the same health plan without the chiropractic benefit. Members with chiropractic insurance coverage, compared with those without coverage, had lower annual total health care expenditures ($1463 vs $1671 per member per year, P<.001). Having chiropractic coverage was associated with a 1.6% decrease (P = .001) in total annual health care costs at the health plan level. Back pain patients with chiropractic coverage, compared with those without coverage, had lower utilization (per 1000 episodes) of plain radiographs (17.5 vs 22.7, P<.001), low back surgery (3.3 vs 4.8, P<.001), hospitalizations (9.3 vs 15.6, P<.001), and magnetic resonance imaging (43.2 vs 68.9, P<.001). Patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode-related costs ($289 vs $399, P<.001). Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care. Systematic access to managed chiropractic care not only may prove to be clinically beneficial but also may reduce overall health care costs.

  8. A blended design in acute care training: similar learning results, less training costs compared with a traditional format.

    Science.gov (United States)

    Dankbaar, Mary E W; Storm, Diana J; Teeuwen, Irene C; Schuit, Stephanie C E

    2014-09-01

    Introduction There is a demand for more attractive and efficient training programmes in postgraduate health care training. This retrospective study aims to show the effectiveness of a blended versus traditional face-to-face training design. For nurses in postgraduate Acute and Intensive Care training, the effectiveness of a blended course design was compared with a traditional design. Methods In a first pilot study 57 students took a traditional course (2-h lecture and 2-h workshop) and 46 students took a blended course (2-h lecture and 2-h online self-study material). Test results were compared for both groups. After positive results in the pilot study, the design was replicated for the complete programme in Acute and Intensive Care. Now 16 students followed the traditional programme (11 days face-to-face education) and 31 students did the blended programme (7 days face-to-face and 40 h online self-study). An evaluation was done after the pilot and course costs were calculated. Results Results show that the traditional and blended groups were similar regarding the main characteristics and did not differ in learning results for both the pilot and the complete programme. Student evaluations of both designs were positive; however, the blended group were more confident that they had achieved the learning objectives. Training costs were reduced substantially. Conclusion The blended training design offers an effective and attractive training solution, leading to a significant reduction in costs.

  9. The cost-utility of open prostatectomy compared with active surveillance in early localised prostate cancer

    Science.gov (United States)

    2014-01-01

    Background There is an on-going debate about whether to perform surgery on early stage localised prostate cancer and risk the common long term side effects such as urinary incontinence and erectile dysfunction. Alternatively these patients could be closely monitored and treated only in case of disease progression (active surveillance). The aim of this paper is to develop a decision-analytic model comparing the cost-utility of active surveillance (AS) and radical prostatectomy (PE) for a cohort of 65 year old men with newly diagnosed low risk prostate cancer. Methods A Markov model comparing PE and AS over a lifetime horizon was programmed in TreeAge from a German societal perspective. Comparative disease specific mortality was obtained from the Scandinavian Prostate Cancer Group trial. Direct costs were identified via national treatment guidelines and expert interviews covering in-patient, out-patient, medication, aids and remedies as well as out of pocket payments. Utility values were used as factor weights for age specific quality of life values of the German population. Uncertainty was assessed deterministically and probabilistically. Results With quality adjustment, AS was the dominant strategy compared with initial treatment. In the base case, it was associated with an additional 0.04 quality adjusted life years (7.60 QALYs vs. 7.56 QALYs) and a cost reduction of €6,883 per patient (2011 prices). Considering only life-years gained, PE was more effective with an incremental cost-effectiveness ratio of €96,420/life year gained. Sensitivity analysis showed that the probability of developing metastases under AS and utility weights under AS are a major sources of uncertainty. A Monte Carlo simulation revealed that AS was more likely to be cost-effective even under very high willingness to pay thresholds. Conclusion AS is likely to be a cost-saving treatment strategy for some patients with early stage localised prostate cancer. However, cost-effectiveness is

  10. Comparative evaluation of distributed-collector solar thermal electric power plants

    Science.gov (United States)

    Fujita, T.; El Gabalawi, N.; Herrera, G. G.; Caputo, R. S.

    1978-01-01

    Distributed-collector solar thermal-electric power plants are compared by projecting power plant economics of selected systems to the 1990-2000 timeframe. The approach taken is to evaluate the performance of the selected systems under the same weather conditions. Capital and operational costs are estimated for each system. Energy costs are calculated for different plant sizes based on the plant performance and the corresponding capital and maintenance costs. Optimum systems are then determined as the systems with the minimum energy costs for a given load factor. The optimum system is comprised of the best combination of subsystems which give the minimum energy cost for every plant size. Sensitivity analysis is done around the optimum point for various plant parameters.

  11. The cost-effectiveness of sestamibi scanning compared to bilateral neck exploration for the treatment of primary hyperparathyroidism.

    Science.gov (United States)

    Ruda, James; Stack, Brendan C; Hollenbeak, Christopher S

    2004-08-01

    This article presents a cost-effectiveness analysis to determine whether preoperative imaging with Tc99m-sestamibi for detection and treatment of solitary adenomas associated with primary hyperparathyroidism is cost-effective compared with routine bilateral neck exploration.

  12. An evaluation of the cost/benefits of concrete biodecontamination

    Energy Technology Data Exchange (ETDEWEB)

    Gorschboth, F.F.; Hamilton, M.A.

    1998-08-01

    Two candidate technologies for decontamination of extensive areas of radioactively contaminated concrete, a biological technology and electro-hydraulic scabbling, that had been rated as highly useful in an earlier study were assessed more precisely. These technologies were compared to a base technology, scarification. The evaluation method was an adaptation of the Multi-Attribute Utility Technique (MAUT), a formal quantitative approach for analyzing decisions with regard to multiple objectives. The advantages of the biodecontamination technology were confirmed by this more precise quantitative analysis.

  13. Evaluation of Low-Cost, Objective Instruments for Assessing Physical Activity in 10-11-Year-Old Children

    Science.gov (United States)

    Hart, Teresa L.; Brusseau, Timothy; Kulinna, Pamela Hodges; McClain, James J.; Tudor-Locke, Catrine

    2011-01-01

    This study compared step counts detected by four, low-cost, objective, physical-activity-assessment instruments and evaluated their ability to detect moderate-to-vigorous physical activity (MVPA) compared to the ActiGraph accelerometer (AG). Thirty-six 10-11-year-old children wore the NL-1000, Yamax Digiwalker SW 200, Omron HJ-151, and Walk4Life…

  14. Performance evaluation of hybrid VLC using device cost and power over data throughput criteria

    Science.gov (United States)

    Lee, C. C.; Tan, C. S.; Wong, H. Y.; Yahya, M. B.

    2013-09-01

    Visible light communication (VLC) technology has attained its attention in both academic and industry lately. It is determined by the development of light emitting diode (LED) technology for solid-state lighting (SSL).It has great potential to gradually replace radio frequency (RF) wireless technology because it offers unregulated and unlicensed bandwidth to withstand future demand of indoor wireless access to real-time bandwidth-demanding applications. However, it was found to provide intrusive uplink channel that give rise to unpleasant irradiance from the user device which could interfere with the downlink channel of VLC and hence limit mobility to users as a result of small coverage (field of view of VLC).To address this potential problem, a Hybrid VLC system which integrates VLC (for downlink) and RF (for uplink) technology is proposed. It offers a non-intrusive RF back channel that provides high throughput VLC and maintains durability with conventional RF devices. To deploy Hybrid VLC system in the market, it must be energy and cost saving to attain its equivalent economical advantage by comparing to existing architecture that employs fluorescent or LED lights with RF technology. In this paper, performance evaluation on the proposed hybrid system was carried out in terms of device cost and power consumption against data throughput. Based on our simulation, Hybrid VLC system was found to reduce device cost by 3% and power consumption by 68% when compares to fluorescent lights with RF technology. Nevertheless, when it is compared to LED lights with RF technology, our proposed hybrid system is found to achieve device cost saving as high as 47% and reduced power consumption by 49%. Such promising results have demonstrated that Hybrid VLC system is a feasible solution and has paved the way for greater cost saving and energy efficient compares with the current RF architecture even with the increasing requirement of indoor area coverage.

  15. A cost-effectiveness analysis to illustrate the impact of cost definitions on results, interpretations and comparability of pharmacoeconomic studies in the US.

    Science.gov (United States)

    Tunis, Sandra L

    2009-01-01

    There is a lack of a uniform proxy for defining direct medical costs in the US. This potentially important source of variation in modelling and other types of economic studies is often overlooked. The extent to which increased expenditures for an intervention can be offset by reductions in subsequent service costs can be directly related to the choice of cost definitions. To demonstrate how different cost definitions for direct medical costs can impact results and interpretations of a cost-effectiveness analysis. The IMS-CORE Diabetes Model was used to project the lifetime (35-year) cost effectiveness in the US of one pharmacological intervention 'medication A' compared with a second 'medication B' (both unspecified) for type 2 diabetes mellitus. The complications modelled included cardiovascular disease, renal disease, eye disease and neuropathy. The model had a Markov structure with Monte Carlo simulations. Utility values were derived from the published literature. Complication costs were obtained from a retrospective database study that extracted anonymous patient-level data from (primarily private payer) adjudicated medical and pharmaceutical claims. Costs for pharmacy services, outpatient services and inpatient hospitalizations were included. Cost definitions for complications included charged, allowed and paid amounts, and for medications included both wholesale acquisition cost (WAC) and average wholesale price (AWP). Costs were reported in year 2007 values. The cost-effectiveness results differed according to the particular combination of cost definitions employed. The use of charges greatly increased costs for complications. When the analysis incorporated WAC medication prices with charged amounts for complication costs, the incremental cost-effectiveness ratio (ICER) for medication A versus medication B was $US6337 per QALY. When AWP prices were used with charged amounts, medication A became a dominant treatment strategy, i.e. lower costs with greater

  16. Methodology for Evaluating Cost-effectiveness of Commercial Energy Code Changes

    Energy Technology Data Exchange (ETDEWEB)

    Hart, Philip R. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Liu, Bing [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2015-01-31

    This document lays out the U.S. Department of Energy’s (DOE’s) method for evaluating the cost-effectiveness of energy code proposals and editions. The evaluation is applied to provisions or editions of the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) Standard 90.1 and the International Energy Conservation Code (IECC). The method follows standard life-cycle cost (LCC) economic analysis procedures. Cost-effectiveness evaluation requires three steps: 1) evaluating the energy and energy cost savings of code changes, 2) evaluating the incremental and replacement costs related to the changes, and 3) determining the cost-effectiveness of energy code changes based on those costs and savings over time.

  17. Event rates, hospital utilization, and costs associated with major complications of diabetes: a multicountry comparative analysis.

    Directory of Open Access Journals (Sweden)

    Philip M Clarke

    2010-02-01

    Full Text Available Diabetes imposes a substantial burden globally in terms of premature mortality, morbidity, and health care costs. Estimates of economic outcomes associated with diabetes are essential inputs to policy analyses aimed at prevention and treatment of diabetes. Our objective was to estimate and compare event rates, hospital utilization, and costs associated with major diabetes-related complications in high-, middle-, and low-income countries.Incidence and history of diabetes-related complications, hospital admissions, and length of stay were recorded in 11,140 patients with type 2 diabetes participating in the Action in Diabetes and Vascular Disease (ADVANCE study (mean age at entry 66 y. The probability of hospital utilization and number of days in hospital for major events associated with coronary disease, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and nephropathy were estimated for three regions (Asia, Eastern Europe, and Established Market Economies using multiple regression analysis. The resulting estimates of days spent in hospital were multiplied by regional estimates of the costs per hospital bed-day from the World Health Organization to compute annual acute and long-term costs associated with the different types of complications. To assist, comparability, costs are reported in international dollars (Int$, which represent a hypothetical currency that allows for the same quantities of goods or services to be purchased regardless of country, standardized on purchasing power in the United States. A cost calculator accompanying this paper enables the estimation of costs for individual countries and translation of these costs into local currency units. The probability of attending a hospital following an event was highest for heart failure (93%-96% across regions and lowest for nephropathy (15%-26%. The average numbers of days in hospital given at least one admission were greatest for stroke (17-32 d across

  18. Resources and costs for microbial sequence analysis evaluated using virtual machines and cloud computing.

    Directory of Open Access Journals (Sweden)

    Samuel V Angiuoli

    Full Text Available BACKGROUND: The widespread popularity of genomic applications is threatened by the "bioinformatics bottleneck" resulting from uncertainty about the cost and infrastructure needed to meet increasing demands for next-generation sequence analysis. Cloud computing services have been discussed as potential new bioinformatics support systems but have not been evaluated thoroughly. RESULTS: We present benchmark costs and runtimes for common microbial genomics applications, including 16S rRNA analysis, microbial whole-genome shotgun (WGS sequence assembly and annotation, WGS metagenomics and large-scale BLAST. Sequence dataset types and sizes were selected to correspond to outputs typically generated by small- to midsize facilities equipped with 454 and Illumina platforms, except for WGS metagenomics where sampling of Illumina data was used. Automated analysis pipelines, as implemented in the CloVR virtual machine, were used in order to guarantee transparency, reproducibility and portability across different operating systems, including the commercial Amazon Elastic Compute Cloud (EC2, which was used to attach real dollar costs to each analysis type. We found considerable differences in computational requirements, runtimes and costs associated with different microbial genomics applications. While all 16S analyses completed on a single-CPU desktop in under three hours, microbial genome and metagenome analyses utilized multi-CPU support of up to 120 CPUs on Amazon EC2, where each analysis completed in under 24 hours for less than $60. Representative datasets were used to estimate maximum data throughput on different cluster sizes and to compare costs between EC2 and comparable local grid servers. CONCLUSIONS: Although bioinformatics requirements for microbial genomics depend on dataset characteristics and the analysis protocols applied, our results suggests that smaller sequencing facilities (up to three Roche/454 or one Illumina GAIIx sequencer invested

  19. Comparative treatment-related adverse event cost burden in immune thrombocytopenic purpura.

    Science.gov (United States)

    Donga, Prina Z; Bilir, Sara P; Little, Gregg; Babinchak, Tim; Munakata, Julie

    2017-09-08

    Real-world evidence on the safety profile and costs associated with immune thrombocytopenic purpura (ITP) treatment in adults is lacking. This study quantifies and compares adverse event (AE) crude rates and costs associated with ITP treatments as found in claims data. A retrospective claims-based analysis was conducted using IMS Pharmetrics Plus database. Included patients were ≥18 years old, with a diagnosis of ITP (2007-2012); an ITP-related claim for anti-D, intravenous immunoglobulin (IVIG), rituximab, romiplostim, or eltrombopag; and 1-year continuous enrollment (3-years for rituximab) during follow-up. AEs and event costs were identified during active treatment, defined from the first claim of each drug to a pre-defined treatment gap or end of study period. Descriptive statistics were reported with Wilcoxon rank-sum significance tests. A total of 2,518 patients were identified (mean age = 50.8 (±16.3 years); 55.8% male). Of all patients, 22.8% experienced any AE. Significantly fewer anti-D patients had any AE (13.8% vs IVIG: 21.1%, rituximab: 29.4%, romiplostim: 28.1%, eltrombopag: 22.4%). Nausea/vomiting and arthralgia/musculoskeletal pain were most common across treatments, and hemolytic events did not differ significantly across treatments. Most costly AEs were urinary tract infection, aseptic meningitis, and fever ($5000+/case); headache, nasal congestion, and hemolytic event were $4,000-5,000/case. Cost per AE did not differ by treatment. Although lower than trial-based AE rates, claims for ITP treatment-related AEs are common, with higher numbers for rituximab and lower numbers for anti-D. This disparity suggests a possible differential cost burden overall that future analysis should explore.

  20. DESIGN AND EVALUATION OF LOW COST DIRECTLY COMPRESSIBLE EXCIPIENTS - II

    Directory of Open Access Journals (Sweden)

    Swamy P. V.

    2010-12-01

    Full Text Available The aim of the present study was to develop dispersible / mouth dissolving tablets (orodispersible tablets using piroxicam as a model drug for improving patient compliance, employing low cost directly compressible co-processed granular excipients developed in our laboratory, based on various sugars/polyols such as mannitol, maltodextrin and dicalcium phosphate dihydrate along with a native food grade corn starch. The designed tablet formulations were evaluated for hardness, friability, weight variation, in vitro dispersion time, wetting time, water absorption ratio, drug content, in-vitro dissolution rate (in pH 6.8 phosphate buffer, short-term stability and drug-excipient interaction (IR spectroscopy. Among the designed piroxicam tablets, one formulation prepared with the granular excipient containing 25% w/w corn starch and 75% w/w dicalcium phosphate dihydrate using starch paste for granulation, without super disintegrant addition was found to be promising dispersible tablet formulation (in vitro dispersion time of 17.66 s and wetting time 8.4 s. Another tablet formulation prepared with the granular excipient containing mannitol and food grade corn starch (50:50 ratio and granulated with starch paste, along with 2% w/w crospovidone as superdisintegrant emerged as promising orodispersible tablet formulation (in vitro dispersion time 17.66 s and wetting time 14.3 s. Short-term stability studies of promising formulations (over a period of 3 months indicated that there are no significant changes in drug content and in vitro dispersion time (p<0.05. IR-spectroscopic studies indicated that there are no drug–excipient interactions.

  1. The cost-effectiveness analysis of video capsule endoscopy compared to other strategies to manage acute upper gastrointestinal hemorrhage in the ED.

    Science.gov (United States)

    Meltzer, Andrew C; Ward, Michael J; Gralnek, Ian M; Pines, Jesse M

    2014-08-01

    Acute upper gastrointestinal (GI) hemorrhage is a common presentation in hospital-based emergency departments (EDs). A novel diagnostic approach is to use video capsule endoscopy to directly visualize the upper GI tract and identify bleeding. Our objective was to evaluate and compare the relative costs and benefits of video capsule endoscopy compared to other strategies in low- to moderate-risk ED patients with acute upper GI hemorrhage. We constructed a model using standard decision analysis software to examine the cost-effectiveness of 4 available strategies for a base-case patient who presents to the ED with either mild- or moderate-risk scenarios (by Glasgow-Blatchford Score) for requiring invasive hemostatic intervention (ie, endoscopic, surgical, etc) The 4 available diagnostic strategies were (1) direct imaging with video capsule endoscopy performed in the ED; (2) risk stratification using the Glasgow-Blatchford score; (3) nasogastric tube placement; and, finally, (4) an admit-all strategy. In the low-risk scenario, video capsule endoscopy was the preferred strategy (cost $5691, 14.69 quality-adjusted life years [QALYs]) and was more cost-effective than the remaining strategies including nasogastric tube strategy (cost $8159, 14.69 QALYs), risk stratification strategy (cost $10,695, 14.69 QALYs), and admit-all strategy (cost $22,766, 14.68 QALYs). In the moderate-risk scenario, video capsule endoscopy continued to be the preferred strategy (cost $9190, 14.56 QALYs) compared to nasogastric tube (cost $9487, 14.58 QALYs, incremental cost-effectiveness ratio $15,891) and more cost effective than admit-all strategy (cost, $22,584, 14.54 QALYs.) Video capsule endoscopy may be cost-effective for low- and moderate-risk patients presenting to the ED with acute upper GI hemorrhage. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Integrating Evaluation into a Program for Increased Utility and Cost-Effectiveness.

    Science.gov (United States)

    Patton, Michael Quinn

    1988-01-01

    An approach toward integrating evaluation into a program at its inception is presented as a way to increase utility and cost-effectiveness. Examples illustrate that such integration, combining internal and external evaluation, is preferable to independent and separate evaluation in terms of the cost to stakeholders. (SLD)

  3. Municipal solid wastes management. cost evaluation of selective collecting; Gestion integral de residuos urbanos. Evaluacion de rendimientos y costes de la recogida selectiva (Parte I)

    Energy Technology Data Exchange (ETDEWEB)

    Baldasano, J. M.; Ginestar, X.; Perez, C.; Gasso, S.

    2002-07-01

    The Spanish Nuclear Plan for Municipal Solid Waste (PNRU 2000-2006) includes and integrated waste management model that arranges the management options of waste in order of priority: minimization, re-use, recycling (including composting and biomethanisation), energy recovery and final disposal. This paper makes an evaluation of the cost increase of the MSW separate collection for recycling compared to the traditional collection system. This first part includes a description of the different possibilities to carry out the separate collection in terms of materials (containers and collectors), human resources and performances, as well as a comparison between its unitary costs. (Author)

  4. Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost?

    Science.gov (United States)

    Shah, Nirali M; Wang, Wenjuan; Bishai, David M

    2011-07-01

    Policy makers in developing countries need to assess how public health programmes function across both public and private sectors. We propose an evaluation framework to assist in simultaneously tracking performance on efficiency, quality and access by the poor in family planning services. We apply this framework to field data from family planning programmes in Ethiopia and Pakistan, comparing (1) independent private sector providers; (2) social franchises of private providers; (3) non-government organization (NGO) providers; and (4) government providers on these three factors. Franchised private clinics have higher quality than non-franchised private clinics in both countries. In Pakistan, the costs per client and the proportion of poorest clients showed no differences between franchised and non-franchised private clinics, whereas in Ethiopia, franchised clinics had higher costs and fewer clients from the poorest quintile. Our results highlight that there are trade-offs between access, cost and quality of care that must be balanced as competing priorities. The relative programme performance of various service arrangements on each metric will be context specific.

  5. Evaluation of the causes and cost impact of returned intravenous ...

    African Journals Online (AJOL)

    intravenous medications at a tertiary care hospital in. Riyadh ... cost impact in an in-patient setting in a Saudi tertiary care hospital. ..... Lean Techniques to Reduce Intravenous Waste. Through Premixed Solutions and Increasing Production.

  6. CAIRSENSE-Atlanta Low Cost Sensor Evaluation Versus Reference Monitors

    Data.gov (United States)

    U.S. Environmental Protection Agency — Short time interval comparisons of low cost sensor response and corresponding Federal Reference or Federal Equivalent Monitors at an NCOR site located in proximity...

  7. Evaluation and Cost Analysis of National Health Policy of Thalassaemia Screening in West-Azerbaijan Province of Iran

    Science.gov (United States)

    Ahmadnezhad, Elham; Sepehrvand, Nariman; Jahani, Farshid Fayyaz; Hatami, Sanaz; Kargar, Catauon; Mirmohammadkhani, Majid; Bazargan-Hejazi, Shahrzad

    2012-01-01

    Background: Thalassaemia is one of the most common Mendelian disorders in Mediterranean area. Iran has about 26,000 Thalassaemic patients, so it is one of the most affected countries. The aim of this study was to evaluate the screening program and cost analysis of Thalassaemia prevention program in West-Azerbaijan province of Iran. Methods: This study evaluated the efficacy of Health system's Thalassaemia prevention program with a sensitivity analysis for its costs. The second five years of the program was evaluated. The economic burden of Thalassaemia is determined by the birth prevalence of the affected infants and the cost that is accrued to treat the infected individuals and was compared with the total cost of screening the couples for thalassemia trait. Results: The average incidence rate of major Thalassaemia was 19.8 per 100,000 live births and mean coverage rate of program was 74%. The rate of canceling the marriage among carrier couples was 53%. Cost analysis showed that the cost of screening and prenatal diagnosis program was much lower than the cost of treatment in potential thalassaemic patients. Conclusions: The prevention program of Thalassaemia including a premarital and pre-natal screening in west Azerbaijan province is demonstrated to be cost-effective. Taking some actions in order to increase the coverage of pre-marital screening, providing pre-natal diagnosis in private and public sector, complete insurance coverage for the high-risk couples to perform the investigations more easily, were recommended. PMID:23112894

  8. Evaluation and cost analysis of national health policy of thalassaemia screening in west-azerbaijan province of iran.

    Science.gov (United States)

    Ahmadnezhad, Elham; Sepehrvand, Nariman; Jahani, Farshid Fayyaz; Hatami, Sanaz; Kargar, Catauon; Mirmohammadkhani, Majid; Bazargan-Hejazi, Shahrzad

    2012-10-01

    Thalassaemia is one of the most common Mendelian disorders in Mediterranean area. Iran has about 26,000 Thalassaemic patients, so it is one of the most affected countries. The aim of this study was to evaluate the screening program and cost analysis of Thalassaemia prevention program in West-Azerbaijan province of Iran. This study evaluated the efficacy of Health system's Thalassaemia prevention program with a sensitivity analysis for its costs. The second five years of the program was evaluated. The economic burden of Thalassaemia is determined by the birth prevalence of the affected infants and the cost that is accrued to treat the infected individuals and was compared with the total cost of screening the couples for thalassemia trait. The average incidence rate of major Thalassaemia was 19.8 per 100,000 live births and mean coverage rate of program was 74%. The rate of canceling the marriage among carrier couples was 53%. Cost analysis showed that the cost of screening and prenatal diagnosis program was much lower than the cost of treatment in potential thalassaemic patients. The prevention program of Thalassaemia including a premarital and pre-natal screening in west Azerbaijan province is demonstrated to be cost-effective. Taking some actions in order to increase the coverage of pre-marital screening, providing pre-natal diagnosis in private and public sector, complete insurance coverage for the high-risk couples to perform the investigations more easily, were recommended.

  9. Cost-utility and cost-effectiveness analyses of a long-term, high-intensity exercise program compared with conventional physical therapy in patients with rheumatoid arthritis.

    NARCIS (Netherlands)

    Hout, W.B. van den; Jong, Z. de; Munneke, M.; Hazes, J.M.W.; Breedveld, F.C.; Vliet Vlieland, T.P.M.

    2005-01-01

    OBJECTIVE: To estimate the cost utility and cost effectiveness of long-term, high-intensity exercise classes compared with usual care in rheumatoid arthritis (RA) patients. METHODS: RA patients (n = 300) were randomly assigned to either exercise classes or UC; followup lasted for 2 years. Outcome me

  10. Cost-utility and cost-effectiveness analyses of a long-term, high-intensity exercise program compared with conventional physical therapy in patients with rheumatoid arthritis.

    NARCIS (Netherlands)

    Hout, W.B. van den; Jong, Z. de; Munneke, M.; Hazes, J.M.W.; Breedveld, F.C.; Vliet Vlieland, T.P.M.

    2005-01-01

    OBJECTIVE: To estimate the cost utility and cost effectiveness of long-term, high-intensity exercise classes compared with usual care in rheumatoid arthritis (RA) patients. METHODS: RA patients (n = 300) were randomly assigned to either exercise classes or UC; followup lasted for 2 years. Outcome me

  11. Cost-effectiveness of centralised and partly centralised care compared to usual care for patients with type 2 diabetes

    NARCIS (Netherlands)

    Van Der Heijden, A.A.W.; Feenstra, T.L.; De Bruijne, M.C.; Baan, C.A.; Donker, G.A.; Dekker, J.M.; Nijpels, G.

    Background and aims: Due to an ever increasing number of type 2 diabetes patients, innovations to control the increasing health care use and costs are needed. Results of diabetes care programs on the costs or (cost-) effectiveness are heterogeneous. The aim of this study is to compare the

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

    Directory of Open Access Journals (Sweden)

    Colin Green

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

  13. Comparing the cost of spinal MR with conventional myelography and radiculography.

    Science.gov (United States)

    du Boulay, G H; Hawkes, S; Lee, C C; Teather, B A; Teather, D

    1990-01-01

    All spinal magnetic resonance imaging examinations carried out during a three month period were analysed retrospectively in order to determine the clinical reasons for the scan requests. Technical details of the examinations they received and the clinical profiles formed a data set which revealed 10 separate "Clinical groups" for management purposes. Hardware, salary and expendables were costed as though the imaging unit had been sited within a National Health Service radiology department. A spread sheet was designed capable of calculating costs per patient for a variety of types of working week and of different staffing structures, sensitive to the mixture of clinical groups referred for examination. The spreadsheet also accomodated straight line depreciation for hardware value and interest rates for borrowed capital. A second, prospectively observed, sample of spinal MR examinations was used to improve the accuracy of the timing of the length of patient examinations. Costs were compared with those for patients submitted for myelography and radiculography at the adjacent hospital during the same period. The comparison indicated that spinal MR was less costly than myelography and radiculography. The most important element of the extra cost of myelography related to the need to admit patients to hospital for at least one night for this examination because of the likelihood of headache and other common (though usually minor) complications following lumbar puncture and/or the injection of contrast medium. From the limited information that it was possible to obtain in the period of follow up, it appeared that MR had either been superior or equivalent to myelography or radiculography in all the clinical groups of patients where both could be tested. There were a number of groups in which no myelograms had been requested, presumably because clinical suspicions had pointed toward conditions like tumours, developmental abnormalities and demyelinating diseases in which

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

    NARCIS (Netherlands)

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

    2015-01-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  17. Costing the lifecycle of networked learning: documenting the costs from conception to evaluation

    Directory of Open Access Journals (Sweden)

    Paul Bacsich

    2000-12-01

    Full Text Available Analysing the costs of new learning technologies within the educational sector is currently a neglected area, yet the issue of how to spend money effectively in this context is a question that must be answered. This question is made especially pertinent with the current expansion of information technology into higher and further education. To know the costeffectiveness of these initiatives, it is first necessary to gain some comprehension of the costs involved. This must be done in a way that is comprehensible to everyone in academia. A recently completed research study undertaken by the authors addressed these problems.

  18. The Cost-Effectiveness Analysis of Video Capsule Endoscopy Compared to Other Strategies to Manage Acute Upper Gastrointestinal Hemorrhage in the Emergency Department

    Science.gov (United States)

    Meltzer, Andrew C.; Ward, Michael J.; Gralnek, Ian M.; Pines, Jesse M.

    2014-01-01

    Study objective Acute upper gastrointestinal (GI) hemorrhage is a common presentation in hospital-based emergency departments (EDs). A novel diagnostic approach is to use video capsule endoscopy to directly visualize the upper GI tract and identify bleeding. Our objective was to evaluate and compare the relative costs and benefits of video capsule endoscopy compared to other strategies in low to moderate risk ED patients with acute upper GI hemorrhage. Methods We constructed a model using standard decision analysis software to examine the cost-effectiveness of four available strategies for a base-case patient who presents to the ED with either mild or moderate risk scenarios (by Glasgow-Blatchford Score) for requiring invasive hemostatic intervention (i.e., endoscopic, surgical, etc.) The four available diagnostic strategies were (1) direct imaging with video capsule endoscopy performed in the ED, (2) risk stratification using the Glasgow-Blatchford score, (3) nasogastric tube placement and, finally, (4) an admit-all strategy. Results In the low-risk scenario, video capsule endoscopy was preferred strategy (cost $5,691, 14.69 QALYs) and more cost effective than the remaining strategies including nasogastric tube strategy (cost $8,159, 14.69 QALYs), risk stratification strategy (cost $10,695, 14.69 QALYs) and admit-all strategy (cost $22,766, 14.68 QALYs). In the moderate risk scenario, video capsule endoscopy continued to be preferred strategy (cost $9,190, 14.56 QALYs) compared to nasogastric tube (cost $9,487, 14.58 QALYs, ICER $15,891) and more cost effective than admit-all strategy (cost, $22,584, 14.54 QALYs.) Conclusion Video capsule endoscopy may be cost-effective for low and moderate risk patients presenting to the ED with acute upper GI hemorrhage. PMID:24961149

  19. Absence of appropriate hospitalization cost control for patients with medical insurance: a comparative analysis study.

    Science.gov (United States)

    Pan, Xilong; Dib, Hassan H; Zhu, Minmin; Zhang, Ying; Fan, Yang

    2009-10-01

    Expose the weak loops in the Chinese medical insurance coverage and uncover hospitals' role of over-pricing hospitalized insured patients compared with those non-insured. A multi-linear regression method was used to analyze hospitalization expense for insured and uninsured patients with uncomplicated acute appendicitis, cholecystitis, benign uterine tumors, and normal delivery. Hospitalization cost is higher among insured than uninsured patients due to longer hospitalization lengths of stay, type of disease (highest among cholecystitis patients), type of gender - females, old-aged people, and type of marital status - singles, as well as drugs expenses, surgical expenses, and other medical acts. Require a better government's supervision system over medical insurance expenses such as reforming methods of payments, building up new cost compensation mechanism, and unifying and stabilizing prices for each category of medicines.

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

    Directory of Open Access Journals (Sweden)

    von Voß, Hubertus

    2003-12-01

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

  1. Multiple imputation strategies for zero-inflated cost data in economic evaluations : which method works best?

    NARCIS (Netherlands)

    MacNeil Vroomen, Janet; Eekhout, Iris; Dijkgraaf, Marcel G; van Hout, Hein; de Rooij, Sophia E; Heymans, Martijn W; Bosmans, Judith E

    2015-01-01

    Cost and effect data often have missing data because economic evaluations are frequently added onto clinical studies where cost data are rarely the primary outcome. The objective of this article was to investigate which multiple imputation strategy is most appropriate to use for missing cost-effecti

  2. Multiple imputation strategies for zero-inflated cost data in economic evaluations : which method works best?

    NARCIS (Netherlands)

    Vroomen, Janet MacNeil; Eekhout, Iris; Dijkgraaf, Marcel G.; van Hout, Hein; de Rooij, Sophia E.; Heymans, Martijn W.; Bosmans, Judith E.

    2016-01-01

    Cost and effect data often have missing data because economic evaluations are frequently added onto clinical studies where cost data are rarely the primary outcome. The objective of this article was to investigate which multiple imputation strategy is most appropriate to use for missing cost-effecti

  3. Cost-utility analysis comparing laparoscopic vs open aortobifemoral bypass surgery

    Directory of Open Access Journals (Sweden)

    Krog AH

    2017-06-01

    .001 in favor of laparoscopic aortobifemoral bypass. The total cost of surgery, equipment and hospital stay after laparoscopic surgery (9,953 € was less than open surgery (17,260 €, (p=0.001. Conclusion: Laparoscopic aortobifemoral bypass seems to be cost-effective compared with open surgery, due to an increase in QALYs and lower procedure-related costs. Keywords: laparoscopy, aortobifemoral bypass, cost-utility, quality-adjusted life years, QALYs, EQ-5D, health-related quality of life, HRQoL, cost-effectiveness

  4. Computerized telephone nurse triage. An evaluation of service quality and cost.

    Science.gov (United States)

    Cariello, Francesca P

    2003-01-01

    The current reimbursement structure of health care in the United States motivates the providers of health care services to deliver these services with a cost-conscious mentality without compromising quality. This has led to the development of alternative methods of delivering health care services, one of which is computerized telephone nurse triage. This study investigates service quality from the perception of callers who used this system on behalf of a pediatric client. Cost was evaluated by comparing what the caller would have done if they did not speak with nurse triage with what they actually did after their interaction. A modified version of the SERVQUAL tool was administered via telephone survey to members of a managed health care plan who recently used nurse triage services for a pediatric patient. Findings were that the majority of callers--employed female parents--rated the level of service quality very highly. Education, employment status, age of the caller, child gender, birth order among siblings, and age of child did not affect the rating of service quality. Relationship to the child had an effect on the rating of service quality as men/fathers rated the level of service quality slightly lower than their female/mother counterparts. The evaluation of cost revealed that the action taken by the caller after they spoke with the nurse resulted in significant cost savings. Computerized telephone nurse triage is a well-accepted cost-saving alternative method of health care delivery that can effectively serve a variety of callers and pediatric patients.

  5. Parametric Portfolio Selection: Evaluating and Comparing to Markowitz Portfolios

    Directory of Open Access Journals (Sweden)

    Marcelo C. Medeiros

    2014-10-01

    Full Text Available In this paper we exploit the parametric portfolio optimization in the Brazilian market. Our data consists of monthly returns of 306 Brazilian stocks in the period between 2001 and 2013. We tested the model both in and out of sample and compared the results with the value and equal weighted portfolios and with a Markowitz based portfolio. We performed statistical inference in the parametric optimization using bootstrap techniques in order to build the parameters empirical distributions. Our results showed that the parametric optimization is a very efficient technique out of sample. It consistently showed superior results when compared with the VW, EW and Markowitz portfolios even when transaction costs were included. Finally, we consider the parametric approach to be very flexible to the inclusion of constraints in weights, transaction costs and listing and delisting of stocks.

  6. The Estimation and Inclusion of Presenteeism Costs in Applied Economic Evaluation: A Systematic Review.

    Science.gov (United States)

    Kigozi, Jesse; Jowett, Sue; Lewis, Martyn; Barton, Pelham; Coast, Joanna

    2017-03-01

    Given the significant costs of reduced productivity (presenteeism) in comparison to absenteeism, and overall societal costs, presenteeism has a potentially important role to play in economic evaluations. However, these costs are often excluded. The objective of this study is to review applied cost of illness studies and economic evaluations to identify valuation methods used for, and impact of including presenteeism costs in practice. A structured systematic review was carried out to explore (i) the extent to which presenteeism has been applied in cost of illness studies and economic evaluations and (ii) the overall impact of including presenteeism on overall costs and outcomes. Potential articles were identified by searching Medline, PsycINFO and NHS EED databases. A standard template was developed and used to extract information from economic evaluations and cost of illness studies incorporating presenteeism costs. A total of 28 studies were included in the systematic review which also demonstrated that presenteeism costs are rarely included in full economic evaluations. Estimation and monetisation methods differed between the instruments. The impact of disease on presenteeism whilst in paid work is high. The potential impact of presenteeism costs needs to be highlighted and greater consideration should be given to including these in economic evaluations and cost of illness studies. The importance of including presenteeism costs when conducting economic evaluation from a societal perspective should be emphasised in national economic guidelines and more methodological work is required to improve the practical application of presenteeism instruments to generate productivity cost estimates. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  7. Evaluation and Optimization of an Innovative Low-Cost Photovoltaic Solar Concentrator

    Directory of Open Access Journals (Sweden)

    Franco Cotana

    2011-01-01

    Full Text Available Many researches showed that the cost of the energy produced by photovoltaic (PV concentrators is strongly reduced with respect to flat panels, especially in those countries that have a high solar irradiation. The cost drop comes from the reduction of the expensive high-efficiency photovoltaic surface through the use of optical concentrators of the solar radiation. In this paper, an experimental innovative PV low-concentration system is analysed. Numerical simulations were performed to determine the possible reasons of energy losses in the prototype, primarily due to geometrical factors. In particular, the effect of the shadows produced from the mirrors on the prototype performances was analysed: shadows are often neglected in the design phase of such systems. The study demonstrates that shadows may affect the performances of a hypothetical optimized PV low-concentration system up to 15%. Finally, an economical evaluation was carried out comparing the proposed optimized system to a traditional flat PV panel.

  8. An evaluation of Comparative Genome Sequencing (CGS by comparing two previously-sequenced bacterial genomes

    Directory of Open Access Journals (Sweden)

    Herring Christopher D

    2007-08-01

    Full Text Available Abstract Background With the development of new technology, it has recently become practical to resequence the genome of a bacterium after experimental manipulation. It is critical though to know the accuracy of the technique used, and to establish confidence that all of the mutations were detected. Results In order to evaluate the accuracy of genome resequencing using the microarray-based Comparative Genome Sequencing service provided by Nimblegen Systems Inc., we resequenced the E. coli strain W3110 Kohara using MG1655 as a reference, both of which have been completely sequenced using traditional sequencing methods. CGS detected 7 of 8 small sequence differences, one large deletion, and 9 of 12 IS element insertions present in W3110, but did not detect a large chromosomal inversion. In addition, we confirmed that CGS also detected 2 SNPs, one deletion and 7 IS element insertions that are not present in the genome sequence, which we attribute to changes that occurred after the creation of the W3110 lambda clone library. The false positive rate for SNPs was one per 244 Kb of genome sequence. Conclusion CGS is an effective way to detect multiple mutations present in one bacterium relative to another, and while highly cost-effective, is prone to certain errors. Mutations occurring in repeated sequences or in sequences with a high degree of secondary structure may go undetected. It is also critical to follow up on regions of interest in which SNPs were not called because they often indicate deletions or IS element insertions.

  9. An evaluation of advantages and cost measurement methodology for leasing in the health care industry.

    Science.gov (United States)

    Henry, J B; Roenfeldt, R L

    1977-01-01

    Lease financing in hospitals is growing rapidly. Many articles published on the topic of lease financing point only to the benefits that may be derived. Very few articles actually analyze the pros and cons of leasing from a financial cost measurement point of view, which includes real world parameters. This article critically evaluates two articles published in this issue which lead the reader to believe leasing for the most part is a bargain when compared to debt financing. The authors discuss some misconceptions in these articles and point out some facts viewed from a financial analyst's position.

  10. At what price? A cost-effectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean delivery.

    Directory of Open Access Journals (Sweden)

    Christopher G Fawsitt

    Full Text Available BACKGROUND: Elective repeat caesarean delivery (ERCD rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland. METHODS: Using a decision analytic model, a cost-effectiveness analysis (CEA was performed where the measure of health gain was quality-adjusted life years (QALYs over a six-week time horizon. A review of international literature was conducted to derive representative estimates of adverse maternal health outcomes following a trial of labour after caesarean (TOLAC and ERCD. Delivery/procedure costs derived from primary data collection and combined both "bottom-up" and "top-down" costing estimations. RESULTS: Maternal morbidities emerged in twice as many cases in the TOLAC group than the ERCD group. However, a TOLAC was found to be the most-effective method of delivery because it was substantially less expensive than ERCD (€ 1,835.06 versus € 4,039.87 per women, respectively, and QALYs were modestly higher (0.84 versus 0.70. Our findings were supported by probabilistic sensitivity analysis. CONCLUSIONS: Clinicians need to be well informed of the benefits and risks of TOLAC among low risk women. Ideally, clinician-patient discourse would address differences in length of hospital stay and postpartum recovery time. While it is premature advocate a policy of TOLAC across maternity units, the results of the study prompt further analysis and repeat iterations, encouraging future studies to synthesis previous research and new and relevant evidence under a single

  11. Cost and effectiveness evaluation of prophylactic HPV vaccine in developing countries.

    Science.gov (United States)

    Termrungruanglert, Wichai; Havanond, Piyalamporn; Khemapech, Nipon; Lertmaharit, Somrat; Pongpanich, Sathirakorn; Khorprasert, Chonlakiet; Taneepanichskul, Surasak

    2012-01-01

    Approximately 80% of cervical cancer cases occur in developing countries. In Thailand, cervical cancer has been the leading cancer in females, with an incidence of 24.7 cases per 100,000 individuals per year. We constructed a decision model to simulate the lifetime economic impact for women in the context of human papillomavirus (HPV) infection prevention. HPV-related diseases were of interest: cervical cancer, cervical intraepithelial neoplasia, and genital warts. The two strategies used were 1) current practice and 2) prophylactic quadrivalent vaccine against HPV types 6, 11, 16, and 18. We developed a Markov simulation model to evaluate the incremental cost-effectiveness ratio of prophylactic HPV vaccine. Women transition through a model either healthy or developing HPV or its related diseases, or die from cervical cancer or from other causes according to transitional probabilities under the Thai health-care context. Costs from a provider perspective were obtained from King Chulalongkorn Memorial Hospital. Costs and benefits were discounted at 3% annually. Compared with no prophylactic HPV vaccine, the incremental cost-effectiveness ratio was 160,649.50 baht per quality-adjusted life-year. The mortality rate was reduced by 54.8%. The incidence of cervical cancer, cervical intraepithelial neoplasia grade 1, cervical intraepithelial neoplasia grade 2/3, and genital warts was reduced by up to 55.1%. Compared with commonly accepted standard thresholds recommended by the World Health Organization Commission on Macroeconomics and Health, the nationwide coverage of HPV vaccination in girls is likely to be cost-effective in Thailand. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Johannesson, M

    1994-01-01

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

  13. The evaluation of Spanish environmental impact. Costs and limitations; La evaluacion de impacto ambiental en Espana. Coste y limitaciones

    Energy Technology Data Exchange (ETDEWEB)

    Canto, S.; Riera, P.; Borrego, A.

    2009-07-01

    The environmental impact assessment applies to new investments in public infrastructure and in industrial activities. The latter accounts for most of the environmental impact studies undertaken in Spain. This evaluation tool has a number of limitations and weaknesses, both in the analysis and its implementation. This article discusses some of these limitations, including the private cost of the process. (Author) 14 refs.

  14. The cost effectiveness of an early transition from hospital to nursing home for stroke patients: design of a comparative study

    Directory of Open Access Journals (Sweden)

    Limburg Martien

    2010-05-01

    Full Text Available Abstract Background As the incidence of stroke has increased, its impact on society has increased accordingly, while it continues to have a major impact on the individual. New strategies to further improve the quality, efficiency and logistics of stroke services are necessary. Early discharge from hospital to a nursing home with an adequate rehabilitation programme could help to optimise integrated care for stroke patients. The objective is to describe the design of a non-randomised comparative study evaluating early admission to a nursing home, with multidisciplinary assessment, for stroke patients. The study is comprised of an effect evaluation, an economic evaluation and a process evaluation. Methods/design The design involves a non-randomised comparative trial for two groups. Participants are followed for 6 months from the time of stroke. The intervention consists of a redesigned care pathway for stroke patients. In this care pathway, patients are discharged from hospital to a nursing home within 5 days, in comparison with 12 days in the usual situation. In the nursing home a structured assessment takes place, aimed at planning adequate rehabilitation. People in the control group receive the usual care. The main outcome measures of the effect evaluation are quality of life and daily functioning. In addition, an economic evaluation will be performed from a societal perspective. A process evaluation will be carried out to evaluate the feasibility of the intervention as well as the experiences and opinions of patients and professionals. Discussion The results of this study will provide information about the cost effectiveness of the intervention and its effects on clinical outcomes and quality of life. Relevant strengths and weaknesses of the study are addressed in this article. Trial registration Current Controlled Trails ISRCTN58135104

  15. Comparing climate and cost impacts of reference levels for reducing emissions from deforestation

    Energy Technology Data Exchange (ETDEWEB)

    Busch, Jonah [Center for Applied Biodiversity Science, Conservation International, 2011 Crystal Drive, Suite 500, Arlington, VA (United States); Strassburg, Bernardo [Center for Social and Economic Research on the Global Environment, University of East Anglia, Norwich NR4 7TJ (United Kingdom); Cattaneo, Andrea [Woods Hole Research Center, 149 Woods Hole Road, Falmouth, MA 02540-1644 (United States); Lubowski, Ruben [Environmental Defense Fund, 1875 Connecticut Avenue NW, Washington, DC (United States); Bruner, Aaron; Rice, Richard; Boltz, Frederick [Conservation International, 2011 Crystal Drive, Suite 500, Arlington, VA (United States); Creed, Anna; Ashton, Ralph, E-mail: jbusch@conservation.or [Terrestrial Carbon Group, 900 17th Street NW, Suite 700, Washington, DC (United States)

    2009-10-15

    The climate benefit and economic cost of an international mechanism for reducing emissions from deforestation and degradation (REDD) will depend on the design of reference levels for crediting emission reductions. We compare the impacts of six proposed reference level designs on emission reduction levels and on cost per emission reduction using a stylized partial equilibrium model (the open source impacts of REDD incentives spreadsheet; OSIRIS). The model explicitly incorporates national incentives to participate in an international REDD mechanism as well as international leakage of deforestation emissions. Our results show that a REDD mechanism can provide cost-efficient climate change mitigation benefits under a broad range of reference level designs. We find that the most effective reference level designs balance incentives to reduce historically high deforestation emissions with incentives to maintain historically low deforestation emissions. Estimates of emission reductions under REDD depend critically on the degree to which demand for tropical frontier agriculture generates leakage. This underscores the potential importance to REDD of complementary strategies to supply agricultural needs outside of the forest frontier.

  16. Evaluating the cost effectiveness of national program for control of blindness in Jorhat district, India

    Science.gov (United States)

    Laskar, Nasrin B.

    2015-01-01

    Background: We evaluated the cost of different components of the national program for control of blindness (NPCB) and assess the cost effectiveness of this program. Materials and Methods: An observational study was conducted in Jorhat District of Assam, India from July 2009 to June 2010 for assessing the cost effectiveness of the NPCB. Four broad categories of cost inputs, that is, capital costs, recurrent costs, prime/variable costs, and fixed costs were considered. The cost incurred by the provider was taken as the actual cost of delivery of different component of services to the patients, which was calculated from the costs of labor, material, and capital costs using the time utilization pattern recommended by WHO. Result: The District Blindness Control Society, Jorhat had spent 58.93% of total expense on fixed heads of which 65.86% had been spent for cataract surgery. The medical care cost was found to be Indian rupee (INR) 425 for intracapsular cataract extraction (ICCE), INR 675 for extracapsular cataract extraction + intraocular lens (ECCE + IOL) and INR 225 for refractive error correction. The patient-wise provider cost was estimated to be INR 519 for ICCE, INR 769 for ECCE + IOL implantation and INR 319 for spectacle correction of refractive error. Conclusion: National program for control of blindness is a cost effective means of controlling and treating blindness. PMID:26283841

  17. Cost of equity on the Polish and global coal market - comparative analysis

    Directory of Open Access Journals (Sweden)

    Aneta Michalak

    2014-04-01

    Full Text Available The mining industry in Poland as well as in the world is considered to be a strategic industry, of special significance for the economy. At the same time it is an industry requiring high capital outlays. Equity plays an important role in financing of the mining enterprises. The objective of the article is to compare the cost of equity on the Polish and global coal market. The object of the research are the Polish and foreign mining enterprises listed on the stock markets. The basic research method is CAPM.

  18. Comparative Analysis of Selected Factors Affecting Heating Costs of Schools in Selected Balkan Countries

    Directory of Open Access Journals (Sweden)

    Koppitz David

    2015-06-01

    Full Text Available The paper aims to carry out a comparative analysis of heating of school facilities under the administration of municipalities in Macedonia, Moldova and Kosovo and to test the factors that affect the heating costs of school facilities. For a definition of the theoretical fundament parts of the theory of fiscal federalism are used. Subsequently five hypotheses are put forward that are verified using the method of benchmarking. The theoretical conclusions and recommendations may be used for a more effective implementation of public policies within the surveyed countries.

  19. Why and how to monitor the cost and evaluate the cost-effectiveness of HIV services in countries.

    Science.gov (United States)

    Beck, Eduard J; Santas, Xenophon M; Delay, Paul R

    2008-07-01

    The number of people in the world living with HIV is increasing as HIV-related mortality has declined but the annual number of people newly infected with HIV has not. The international response to contain the HIV pandemic, meanwhile, has grown. Since 2006, an international commitment to scale up prevention, treatment, care and support services in middle and lower-income countries by 2010 has been part of the Universal Access programme, which itself plays an important part in achieving the Millennium Development Goals by 2015. Apart from providing technical support, donor countries and agencies have substantially increased their funding to enable countries to scale up HIV services. Many countries have been developing their HIV monitoring and evaluation systems to generate the strategic information required to track their response and ensure the best use of the new funds. Financial information is an important aspect of the strategic information required for scaling up existing services as well as assessing the effect of new ones. It involves two components: tracking the money available and spent on HIV at all levels, through budget tracking, national health accounts and national AIDS spending assessments, and estimating the cost and efficiency of HIV services. The cost of service provision should be monitored over time, whereas evaluations of the cost-effectiveness of services are required periodically; both should be part of any country's HIV monitoring and evaluation system. This paper provides country examples of the complementary relationship between monitoring the cost of HIV services and evaluating their cost-effectiveness. It also summarizes global initiatives that enable countries to develop their own HIV monitoring and evaluation systems and to generate relevant, robust and up-to-date strategic information.

  20. 10 CFR 436.42 - Evaluation of Life-Cycle Cost Effectiveness.

    Science.gov (United States)

    2010-01-01

    ...) ENERGY STAR qualified and FEMP designated products may be assumed to be life-cycle cost-effective. (b) In... 10 Energy 3 2010-01-01 2010-01-01 false Evaluation of Life-Cycle Cost Effectiveness. 436.42... PROGRAMS Agency Procurement of Energy Efficient Products § 436.42 Evaluation of Life-Cycle...

  1. Study of the comparative costs of five wet/dry cooling tower concepts

    Energy Technology Data Exchange (ETDEWEB)

    Zaloudek, F.R.; Allemann, R.T.; Faletti, D.W.; Johnson, B.M.; Parry, H.L.; Smith, G.C.; Tokarz, R.D.; Walter, R.A.

    1976-09-01

    The projected cost of five alternative dry/wet power plant heat rejection concepts was studied under conditions imposed by hypothetical use in association with the San Juan Plant Unit 3, a 550-MWe facility currently under construction near the ''Four Corners'' area of New Mexico. The five alternative concepts were: integrated dry/wet tower; separate dry and wet towers; metal fin-tube induced draft tower with deluge water augmentation; plastic heat exchanger tower with deluge water augmentation, and metal fin-tube/deluge augmentation tower with an intermediate ammonia evaporation-condensation condenser and the cooling tower. The integrated dry/wet tower concept, already chosen for service at San Juan Unit 3, was included for reference purposes. All concepts were conceptually designed and estimated using the same bases and employing uniform practices. Each concept was assumed to use all water allocated for consumptive use in Unit 3. The cost estimates obtained showed the following descending order of ''comparable capital cost'': separate dry/wet; metal fin-tube/deluge; integrated dry/wet; plastic tube/deluge; and metal fin-tube/deluge/ammonia. The results indicate that two of the advanced concepts considered, i.e., the plastic tube/deluge concept and the metal fin tube/deluge/ammonia concept, can possibly reduce the overall costs of dry/wet cooling under conditions imposed by the site considered. It was recommended that these two concepts receive additional attention by the ERDA Dry Cooling Tower Program and industry to further quantify their potential benefits and demonstrate their performance and reliability.

  2. Cost-Effectiveness of 30- Compared to 20-Milliliter Blood Cultures: a Retrospective Study.

    Science.gov (United States)

    Cheruvanky, Anita; Kirn, Thomas J; Weinstein, Melvin P

    2016-01-01

    The importance of blood culture (BC) volume for detection of bloodstream infections (BSIs) is documented. Recently, improved diagnostic sensitivity was demonstrated for 30- versus 20-ml BCs in adults (Cockerill FR, Wilson JW, Vetter EA, Goodman KM, Torgerson CA, Harmsen WS, Schleck CD, IIstrup DM, Washington JA, Wilson WR. Clin Infect Dis 38:1724-1730, 2004, http://dx.doi.org/10.1128/JCM.01314-11). Hospitals receive higher reimbursement for patients with documented septicemia. We determined the cost-effectiveness of 30-ml versus 20-ml BCs using results from our institution and previously published data. Positive BC results from 292 bacteremic episodes were reviewed. The costs of the reagents, equipment, phlebotomist, and technologist time were determined. The medical records department provided Medicare reimbursement (MR) data for patients with selected ICD-9 codes. These data provided an estimate of the annualized increase in MR versus costs associated with conversion to 30-ml BCs. MR for 464 annual primary BSIs was $24,808/episode. An expected 7.2% increase in BSIs detected using 30-ml BCs would add 34 additional cases annually and increase MR by $843,472. Comparative MR data for cases where septicemia complicated another diagnosis were available for 4 International Classification of Diseases, Ninth Revision (ICD-9) codes: laparoscopic cholecystectomy, biliary tract disorders, pneumonia, and cellulitis. The mean incremental MR was $9,667 per episode, which projected to a $483,350 revenue increase annually. The annual cost associated with conversion to 30-ml BCs was estimated to be $157,798. Thus, the potential net increase in hospital revenue would be $1,169,031 for 30-ml versus 20-ml BCs. Our results suggest that conversion to 30-ml BCs may not only improve patient care by detecting more BSIs but also increase hospital revenue substantially.

  3. Exploring the relationship between costs and quality. Does the joint evaluation of costs and quality alter the rankings of Danish hospital departments?

    DEFF Research Database (Denmark)

    Hvenegaard, Anne; Nielsen Arendt, Jacob; Street, Andrew

    2011-01-01

    vascular departments, we estimate fixed effect models for costs (linear) and quality (logistic). We consider two quality measures; mortality and wound complications. To assess whether the joint evaluation of costs and quality affects the ranking of departments, we construct joint confidence regions......OBJECTIVE: The purpose is to evaluate the relationship between costs and quality and to assess whether the joint evaluation of costs and quality affects the ranking of hospital departments relative to comparison based on costs alone. METHODS: Using patient level data for 3,754 patients in six...... for each pair of departmental effects for costs and quality using a bootstrap method and rank departments according to their cost-effectiveness ratio. The findings are used to evaluate a theory of a U-shaped cost/quality relationship. RESULTS: The association between cost and quality differs depending...

  4. The Cost-Effectiveness of Two Forms of Case Management Compared to a Control Group for Persons with Dementia and Their Informal Caregivers from a Societal Perspective

    Science.gov (United States)

    Eekhout, Iris; Joling, Karlijn J.; van Mierlo, Lisa D.; Meiland, Franka J. M.; van Hout, Hein P. J.; de Rooij, Sophia E.

    2016-01-01

    Objectives The objective of this article was to compare the costs and cost-effectiveness of the two most prominent types of case management in the Netherlands (intensive case management and linkage models) against no access to case management (control group) for people with already diagnosed dementia and their informal caregivers. Methods The economic evaluation was conducted from a societal perspective embedded within a two year prospective, observational, controlled, cohort study with 521 informal caregivers and community-dwelling persons with dementia. Case management provided within one care organization (intensive case management model, ICMM), case management where care was provided by different care organizations within one region (Linkage model, LM), and a group with no access to case management (control) were compared. The economic evaluation related incremental costs to incremental effects regarding neuropsychiatric symptoms (NPI), psychological health of the informal caregiver (GHQ-12), and quality adjusted life years (QALY) of the person with dementia and informal caregiver. Results Inverse-propensity-score-weighted models showed no significant differences in clinical or total cost outcomes between the three groups. Informal care costs were significantly lower in the ICMM group compared to both other groups. Day center costs were significantly lower in the ICMM group compared to the control group. For all outcomes, the probability that the ICMM was cost-effective in comparison with LM and the control group was larger than 0.97 at a threshold ratio of 0 €/incremental unit of effect. Conclusion This study provides preliminary evidence that the ICMM is cost-effective compared to the control group and the LM. However, the findings should be interpreted with caution since this study was not a randomized controlled trial. PMID:27655234

  5. Report on Geothermal Power Plant Cost and Comparative Cost of Geothermal and Coal Fired Steam Power Plants

    Energy Technology Data Exchange (ETDEWEB)

    None

    1977-07-01

    This report is to be used by Utah Power and Light Company (UP and L) in making studies of geothermal power plants. The dollars per kilowatt comparison between a geothermal plant and a UP and L coal-fired plant is to be developed. Geothermal gathering system costs and return to owner are to be developed for information.

  6. Evaluating water quality investments using cost utility analysis.

    Science.gov (United States)

    Hajkowicz, Stefan; Spencer, Rachel; Higgins, Andrew; Marinoni, Oswald

    2008-09-01

    This study borrows concepts from healthcare economics and uses cost utility analysis (CUA) to select an optimum portfolio of water quality enhancement projects in Perth, Western Australia. In CUA, costs are handled via standard discounted cash flow analysis, but the benefits, being intangible, are measured with a utility score. Our novel methodology combines CUA with a binary combinatorial optimisation solver, known as a 'knapsack algorithm', to identify the optimum portfolio of projects. We show how water quality projects can be selected to maximise an aggregate utility score while not exceeding a budget constraint. Our CUA model applies compromise programming (CP) to measure utility over multiple attributes in different units. CUA is shown to provide a transparent and analytically robust method to maximise benefits from water quality remediation investments under a constrained budget.

  7. An evaluation of low-cost payload carrier

    Science.gov (United States)

    Yost, V. H.

    1980-01-01

    Payload carrier designed for space vehicles is essentially cargo carrier that supports, positions, and protects various equipment and materials used in conducting experiments in weightless space environment. Proposed carrier entitled Materials Experiment Assembly II (MEA-II) is considered superior to previously developed models in size, weight, and cost to user. Structure is lightweight with insulated exterior and can be custom sized to meet user needs.

  8. Cost Evaluation and Portfolio Management Optimization for Biopharmaceutical Product Development

    OpenAIRE

    Nie, W.

    2015-01-01

    The pharmaceutical industry is suffering from declining R&D productivity and yet biopharmaceutical firms have been attracting increasing venture capital investment. Effective R&D portfolio management can deliver above average returns under increasing costs of drug development and the high risk of clinical trial failure. This points to the need for advanced decisional tools that facilitate decision-making in R&D portfolio management by efficiently identifying optimal solutions while accounting...

  9. Evaluation of global onshore wind energy potential and generation costs.

    Science.gov (United States)

    Zhou, Yuyu; Luckow, Patrick; Smith, Steven J; Clarke, Leon

    2012-07-17

    In this study, we develop an updated global estimate of onshore wind energy potential using reanalysis wind speed data, along with updated wind turbine technology performance, land suitability factors, cost assumptions, and explicit consideration of transmission distance in the calculation of transmission costs. We find that wind has the potential to supply a significant portion of the world energy needs, although this potential varies substantially by region and with assumptions such as on what types of land can be used to site wind farms. Total global economic wind potential under central assumptions, that is, intermediate between optimistic and pessimistic, is estimated to be approximately 119.5 petawatt hours per year (13.6 TW) at less than 9 cents/kWh. A sensitivity analysis of eight key parameters is presented. Wind potential is sensitive to a number of input parameters, particularly wind speed (varying by -70% to +450% at less than 9 cents/kWh), land suitability (by -55% to +25%), turbine density (by -60% to +80%), and cost and financing options (by -20% to +200%), many of which have important policy implications. As a result of sensitivities studied here we suggest that further research intended to inform wind supply curve development focus not purely on physical science, such as better resolved wind maps, but also on these less well-defined factors, such as land-suitability, that will also have an impact on the long-term role of wind power.

  10. Comparative costs of flexible package cells and rigid cells for lithium-ionhybrid electric vehicle batteries.

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, P. A.; Jansen, A. N.

    2006-11-28

    We conducted a design study to compare the manufacturing costs at a level of 100,000 hybrid vehicle batteries per year for flexible package (Flex) cells and for rigid aluminum container (Rigid) cells. Initially, the Rigid cells were considered to have welded closures and to be deep-drawn containers of about the same shape as the Flex cells. As the study progressed, the method of fabricating and sealing the Rigid cells was expanded to include lower cost options including double seaming and other mechanically fastened closures with polymer sealants. Both types of batteries were designed with positive electrodes containing Li(Ni{sub 1/3}Co{sub 1/3}Mn{sub 1/3})O{sub 2} and graphite negative electrodes. The use of a different combination of lithium-ion electrodes would have little effect on the difference in costs for the two types of cells. We found that 20-Ah cells could be designed with excellent performance and heat rejection capabilities for either type of cell. Many parts in the design of the Flex cells are identical or nearly identical to those of the Rigid Cell, so for these features there would be no difference in the cost of manufacturing the two types of batteries. We judged the performance, size and weight of the batteries to be sufficiently similar that the batteries would have the same value for their application. Some of the design features of the Flex cells were markedly different than those of the deep-drawn and welded Rigid cells and would result in significant cost savings. Fabrication and processing steps for which the Flex cells appear to have a cost advantage over these Rigid cells are (1) container fabrication and sealing, (2) terminal fabrication and sealing, and (3) intercell connections. The costs of providing cooling channels adjacent to the cells and for module and battery hardware appear to favor Rigid cell batteries slightly. Overall, Flex cell batteries appear to have an advantage of about $1.20-$3.70 per cell for a 25-kW Battery of 20

  11. The costs of evaluating species densities and composition of snakes to assess development impacts in amazonia.

    Directory of Open Access Journals (Sweden)

    Rafael de Fraga

    Full Text Available Studies leading to decision-making for environmental licensing often fail to provide accurate estimates of diversity. Measures of snake diversity are regularly obtained to assess development impacts in the rainforests of the Amazon Basin, but this taxonomic group may be subject to poor detection probabilities. Recently, the Brazilian government tried to standardize sampling designs by the implementation of a system (RAPELD to quantify biological diversity using spatially-standardized sampling units. Consistency in sampling design allows the detection probabilities to be compared among taxa, and sampling effort and associated cost to be evaluated. The cost effectiveness of detecting snakes has received no attention in Amazonia. Here we tested the effects of reducing sampling effort on estimates of species densities and assemblage composition. We identified snakes in seven plot systems, each standardised with 14 plots. The 250 m long centre line of each plot followed an altitudinal contour. Surveys were repeated four times in each plot and detection probabilities were estimated for the 41 species encountered. Reducing the number of observations, or the size of the sampling modules, caused significant loss of information on species densities and local patterns of variation in assemblage composition. We estimated the cost to find a snake as $ 120 U.S., but general linear models indicated the possibility of identifying differences in assemblage composition for half the overall survey costs. Decisions to reduce sampling effort depend on the importance of lost information to target-issues, and may not be the preferred option if there is the potential for identifying individual snake species requiring specific conservation actions. However, in most studies of human disturbance on species assemblages, it is likely to be more cost-effective to focus on other groups of organisms with higher detection probabilities.

  12. The Costs of Evaluating Species Densities and Composition of Snakes to Assess Development Impacts in Amazonia

    Science.gov (United States)

    de Fraga, Rafael; Stow, Adam J.; Magnusson, William E.; Lima, Albertina P.

    2014-01-01

    Studies leading to decision-making for environmental licensing often fail to provide accurate estimates of diversity. Measures of snake diversity are regularly obtained to assess development impacts in the rainforests of the Amazon Basin, but this taxonomic group may be subject to poor detection probabilities. Recently, the Brazilian government tried to standardize sampling designs by the implementation of a system (RAPELD) to quantify biological diversity using spatially-standardized sampling units. Consistency in sampling design allows the detection probabilities to be compared among taxa, and sampling effort and associated cost to be evaluated. The cost effectiveness of detecting snakes has received no attention in Amazonia. Here we tested the effects of reducing sampling effort on estimates of species densities and assemblage composition. We identified snakes in seven plot systems, each standardised with 14 plots. The 250 m long centre line of each plot followed an altitudinal contour. Surveys were repeated four times in each plot and detection probabilities were estimated for the 41 species encountered. Reducing the number of observations, or the size of the sampling modules, caused significant loss of information on species densities and local patterns of variation in assemblage composition. We estimated the cost to find a snake as $ 120 U.S., but general linear models indicated the possibility of identifying differences in assemblage composition for half the overall survey costs. Decisions to reduce sampling effort depend on the importance of lost information to target-issues, and may not be the preferred option if there is the potential for identifying individual snake species requiring specific conservation actions. However, in most studies of human disturbance on species assemblages, it is likely to be more cost-effective to focus on other groups of organisms with higher detection probabilities. PMID:25147930

  13. The costs of evaluating species densities and composition of snakes to assess development impacts in amazonia.

    Science.gov (United States)

    Fraga, Rafael de; Stow, Adam J; Magnusson, William E; Lima, Albertina P

    2014-01-01

    Studies leading to decision-making for environmental licensing often fail to provide accurate estimates of diversity. Measures of snake diversity are regularly obtained to assess development impacts in the rainforests of the Amazon Basin, but this taxonomic group may be subject to poor detection probabilities. Recently, the Brazilian government tried to standardize sampling designs by the implementation of a system (RAPELD) to quantify biological diversity using spatially-standardized sampling units. Consistency in sampling design allows the detection probabilities to be compared among taxa, and sampling effort and associated cost to be evaluated. The cost effectiveness of detecting snakes has received no attention in Amazonia. Here we tested the effects of reducing sampling effort on estimates of species densities and assemblage composition. We identified snakes in seven plot systems, each standardised with 14 plots. The 250 m long centre line of each plot followed an altitudinal contour. Surveys were repeated four times in each plot and detection probabilities were estimated for the 41 species encountered. Reducing the number of observations, or the size of the sampling modules, caused significant loss of information on species densities and local patterns of variation in assemblage composition. We estimated the cost to find a snake as $ 120 U.S., but general linear models indicated the possibility of identifying differences in assemblage composition for half the overall survey costs. Decisions to reduce sampling effort depend on the importance of lost information to target-issues, and may not be the preferred option if there is the potential for identifying individual snake species requiring specific conservation actions. However, in most studies of human disturbance on species assemblages, it is likely to be more cost-effective to focus on other groups of organisms with higher detection probabilities.

  14. Metrics to Compare Aircraft Operating and Support Costs in the Department of Defense

    Science.gov (United States)

    2015-01-01

    search costs associated with the missing Malaysia Airlines Flight 370. World Maritime News (2014), for instance, quotes Pentagon spokesman Army Col...commercial airline industry uses the metric cost per available seat mile, i.e., the cost to fly one seat one mile. This is a simple cost metric that

  15. Comparing evaluation activities across multiple theories of practice.

    Science.gov (United States)

    Dillman, Lisa M

    2013-06-01

    This article compares and contrasts the evaluation activities described in Practical Participatory Evaluation (Cousins & Whitmore, 1998), Values-engaged Evaluation (Greene, 2005), and Emergent Realist Evaluation (Mark, Henry, & Julnes, 1998). Using the logic models developed to depict each of the three evaluation theories (Hansen, Alkin, & Wallace, 2013) as a starting point, both quantitative and qualitative analysis techniques are employed to discuss the similarities and differences across the practice prescriptions. The approaches are then described according to Miller's (2010) standards for empirical examinations of evaluation theory. Specifically, I offer speculation about their operational specificity and feasibility in practice. I argue that none of the models is completely specific, or wholly unique, and they all present challenges of adaptation into the field. However, the models each offer varying degrees of guidance and unique elements through their prescriptions.

  16. Cost-effectiveness model comparing olanzapine and other oral atypical antipsychotics in the treatment of schizophrenia in the United States

    Directory of Open Access Journals (Sweden)

    Smolen Lee J

    2009-04-01

    Full Text Available Abstract Background Schizophrenia is often a persistent and costly illness that requires continued treatment with antipsychotics. Differences among antipsychotics on efficacy, safety, tolerability, adherence, and cost have cost-effectiveness implications for treating schizophrenia. This study compares the cost-effectiveness of oral olanzapine, oral risperidone (at generic cost, primary comparator, quetiapine, ziprasidone, and aripiprazole in the treatment of patients with schizophrenia from the perspective of third-party payers in the U.S. health care system. Methods A 1-year microsimulation economic decision model, with quarterly cycles, was developed to simulate the dynamic nature of usual care of schizophrenia patients who switch, continue, discontinue, and restart their medications. The model captures clinical and cost parameters including adherence levels, relapse with and without hospitalization, quality-adjusted life years (QALYs, treatment discontinuation by reason, treatment-emergent adverse events, suicide, health care resource utilization, and direct medical care costs. Published medical literature and a clinical expert panel were used to develop baseline model assumptions. Key model outcomes included mean annual total direct cost per treatment, cost per stable patient, and incremental cost-effectiveness values per QALY gained. Results The results of the microsimulation model indicated that olanzapine had the lowest mean annual direct health care cost ($8,544 followed by generic risperidone ($9,080. In addition, olanzapine resulted in more QALYs than risperidone (0.733 vs. 0.719. The base case and multiple sensitivity analyses found olanzapine to be the dominant choice in terms of incremental cost-effectiveness per QALY gained. Conclusion The utilization of olanzapine is predicted in this model to result in better clinical outcomes and lower total direct health care costs compared to generic risperidone, quetiapine, ziprasidone, and

  17. Telerehabilitation after total knee replacement in Italy: cost-effectiveness and cost-utility analysis of a mixed telerehabilitation-standard rehabilitation programme compared with usual care

    Science.gov (United States)

    Fusco, Francesco; Turchetti, Giuseppe

    2016-01-01

    Objectives To assess cost-effectiveness and cost utility of telerehabilitation (TR) versus standard rehabilitation (SR) after total knee replacement (TKR). Design Markov decision modelling of cost-effectiveness and cost-utility analysis based on patient-level and secondary data sources employing Italian National Health Service (NHS; Ita-NHS) and Society perspectives. Setting Primary care units (PCUs) in Italy. Participants Patients discharged after TKR. Interventions Mixed SR-TR service (10 face-to-face sessions and 10 telesessions) versus SR (20 face-to-face sessions) Primary and secondary outcome measures The incremental cost per additional knee flexion range of motion (ROM) and per QALY gained by SR-TR compared with SR. Second, we considered the probability of being cost-effective and the probability of being more effective and less expensive. Results TR appears to be the cost-effective in the base case and in all of the considered scenarios, but is no longer more effective and less expensive if transportation costs are excluded. Comparing SR-TR with SR, the incremental cost-effectiveness ratio (ICER) adopting the Ita-NHS perspective for the base case was −€117/ROM gained. The cost-effectiveness probability for SR-TR was 0.98 (ceiling ratio: €50/ROM), while the joint probability of being more effective and less expensive was 0.87. Assuming that TR would increase health-related quality of life (HRQOL) utilities by 2.5%, the ICER adopting Ita-NHS perspective is −€960/QALY (cost-effectiveness probability: 1; ceiling ratio: €30 000/QALY). All the performed sensitivity analyses did not change the conclusions, but if transportation costs were excluded, the probability for SR-TR of being more clinically effective and less expensive reduced to 0.56. Conclusions The analysis suggested SR-TR to be cost-effective, even less expensive and more effective if the PCUs provide ambulance transportations. However, the uncertainty related to TR costs, HRQOL and long

  18. Comparative Evaluation of Financing Programs: Insights From California’s Experience

    Energy Technology Data Exchange (ETDEWEB)

    Deason, Jeff [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Electricity Markets and Policy Group

    2017-07-31

    Berkeley Lab examines criteria for a comparative assessment of multiple financing programs for energy efficiency, developed through a statewide public process in California. The state legislature directed the California Alternative Energy and Advanced Transportation Financing Authority (CAEATFA) to develop these criteria. CAEATFA's report to the legislature, an invaluable reference for other jurisdictions considering these topics, discusses the proposed criteria and the rationales behind them in detail. Berkeley Lab's brief focuses on several salient issues that emerged during the criteria development and discussion process. Many of these issues are likely to arise in other states that plan to evaluate the impacts of energy efficiency financing programs, whether for a single program or multiple programs. Issues discussed in the brief include: -The stakeholder process to develop the proposed assessment criteria -Attribution of outcomes - such as energy savings - to financing programs vs. other drivers -Choosing the outcome metric of primary interest: program take-up levels vs. savings -The use of net benefits vs. benefit-cost ratios for cost-effectiveness evaluation -Non-energy factors -Consumer protection factors -Market transformation impacts -Accommodating varying program goals in a multi-program evaluation -Accounting for costs and risks borne by various parties, including taxpayers and utility customers, in cost-effectiveness analysis -How to account for potential synergies among programs in a multi-program evaluation

  19. Evaluation of the Super ESPC Program: Level 2 -- Recalculated Cost Savings

    Energy Technology Data Exchange (ETDEWEB)

    Shonder, John A [ORNL; Hughes, Patrick [ORNL

    2009-04-01

    This report presents the results of Level 2 of a three-tiered evaluation of the U.S. Department of Energy Federal Energy Management Program's Super Energy Savings Performance Contract (Super ESPC) Program. Level 1 of the analysis studied all of the Super ESPC projects for which at least one Annual Measurement & Verification (M&V) Report had been produced by April 2006. For those 102 projects in aggregate, we found that the value of cost savings reported by the energy service company (ESCO) in the Annual M&V Reports was 108% of the cost savings guaranteed in the contracts. We also compared estimated energy savings (which are not guaranteed, but are the basis for the guaranteed cost savings) to the energy savings reported by the ESCO in the Annual M&V Report. In aggregate, reported energy savings were 99.8% of estimated energy savings on the basis of site energy, or 102% of estimated energy savings based on source energy. Level 2 focused on a random sample of 27 projects taken from the 102 Super ESPC projects studied in Level 1. The objectives were, for each project in the sample, to: repeat the calculations of the annual energy and cost savings in the most recent Annual M&V Report to validate the ESCO's results or correct any errors, and recalculate the value of the reported energy, water, and operations and maintenance (O&M) savings using actual utility prices paid at the project site instead of the 'contract' energy prices - the prices that are established in the project contract as those to be used by the ESCO to calculate the annual cost savings, which determine whether the guarantee has been met. Level 3 analysis will be conducted on three to five projects from the Level 2 sample that meet validity criteria for whole-building or whole-facility data analysis. This effort will verify energy and cost savings using statistical analysis of actual utility use, cost, and weather data. This approach, which can only be used for projects meeting

  20. Power plant asset market evaluations: Forecasting the costs of power production

    Energy Technology Data Exchange (ETDEWEB)

    Lefton, S.A.; Grunsrud, G.P. [Aptech Engineering Services, Inc., Sunnyvale, CA (United States)

    1998-12-31

    This presentation discusses the process of evaluating and valuing power plants for sale. It describes a method to forecast the future costs at a power plant using a portion of the past fixed costs, variable energy costs, and most importantly the variable cycling-related wear-and-tear costs. The presentation then discusses how to best determine market share, expected revenues, and then to forecast plant future costs based on future expected unit cycling operations. The presentation concludes with a section on recommendations to power plant buyers or sellers on how to manage the power plant asset and how to increase its market value. (orig.) 4 refs.

  1. Performance and cost evaluation of health information systems using micro-costing and discrete-event simulation.

    Science.gov (United States)

    Rejeb, Olfa; Pilet, Claire; Hamana, Sabri; Xie, Xiaolan; Durand, Thierry; Aloui, Saber; Doly, Anne; Biron, Pierre; Perrier, Lionel; Augusto, Vincent

    2017-05-17

    Innovation and health-care funding reforms have contributed to the deployment of Information and Communication Technology (ICT) to improve patient care. Many health-care organizations considered the application of ICT as a crucial key to enhance health-care management. The purpose of this paper is to provide a methodology to assess the organizational impact of high-level Health Information System (HIS) on patient pathway. We propose an integrated performance evaluation of HIS approach through the combination of formal modeling using the Architecture of Integrated Information Systems (ARIS) models, a micro-costing approach for cost evaluation, and a Discrete-Event Simulation (DES) approach. The methodology is applied to the consultation for cancer treatment process. Simulation scenarios are established to conclude about the impact of HIS on patient pathway. We demonstrated that although high level HIS lengthen the consultation, occupation rate of oncologists are lower and quality of service is higher (through the number of available information accessed during the consultation to formulate the diagnostic). The provided method allows also to determine the most cost-effective ICT elements to improve the care process quality while minimizing costs. The methodology is flexible enough to be applied to other health-care systems.

  2. French Modular Impoundment: Final Cost and Performance Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Drown, Peter [French Development Enterprises, LLC, North Billerica, MA (United States); French, Bill [French Development Enterprises, LLC, North Billerica, MA (United States)

    2017-05-17

    This report comprises the Final Cost and Performance Report for the Department of Energy Award # EE0007244, the French Modular Impoundment (aka the “French Dam”.) The French Dam is a system of applying precast modular construction to water control structures. The “French Dam” is a term used to cover the construction means/methods used to construct or rehabilitate dams, diversion structures, powerhouses, and other hydraulic structures which impound water and are covered under FDE’s existing IP (Patents # US8414223B2; US9103084B2.)

  3. Counting the costs: Comparing depot medroxyprogesterone acetate and norethisterone oenanthate utilisation patterns in South Africa

    Directory of Open Access Journals (Sweden)

    Gray Andrew

    2001-06-01

    Full Text Available Abstract Background In South Africa, where health care resources are limited, it is important to ensure that drugs provision and use is rational. The Essential Drug List includes depot medroxyprogesterone acetate (DMPA and norethisterone oenanthate (NET-EN as injectable progestagen-only contraceptives (IPCs, and both products are extensively used. Objectives and Methods Utilisation patterns of the injectable contraceptive products DMPA and NET-EN are compared in the context of current knowledge of the safety and efficacy of these agents. Utilisation patterns were analysed by means of a Pareto (ABC analysis of IPCs issued from 4 South African provincial pharmaceutical depots over 3 financial years. A case study from rural KwaZulu-Natal, South Africa, is used to examine utilisation patterns and self-reported side effects experienced by 187 women using IPCs. Results IPCs accounted for a substantial share of total state expenditure on drugs. While more DMPA than NET-EN was issued, NET-EN distribution from 2 depots increased over the 3-year period. Since DMPA was cheaper, if all NET-EN clients in the 1999/2000 financial year (annualised had used DMPA, the 4 depots could have saved 4.95 million South African Rands on product acquisition costs alone. The KZN case study showed slightly more NET-EN (54% than DMPA (46% use; no significant differences in self-reported side effects; and that younger women were more likely to use NET-EN than DMPA (p = 0.0001. Conclusions Providing IPCs on the basis of age is not appropriate or cost effective. Rational use of these products should include consideration of the cost of prescribing one over another.

  4. Safety, efficacy and costs associated with direct coronary stenting compared with stenting after predilatation

    Science.gov (United States)

    IJsselmuiden, A.; Serruys, P.W.; Tangelder, G.J.; Slagboom, T.; van der Wieken, R.; Kiemeneij, F.; Laarman, G.J.

    2004-01-01

    Objectives Comparison of the in-hospital success rates, procedural costs and short-term clinical outcomes of direct stenting versus stenting after balloon predilatation. Methods Altogether, 400 patients with angina pectoris and/or myocardial ischaemia due to coronary stenoses in a single native vessel were randomised to either direct stenting or stenting after predilatation. Baseline characteristics were evenly distributed between the two groups. Results Procedural success rates were similar (96.0% direct stenting group vs. 94.5% predilatation) as well as final successful stent implantation (98.3 vs. 97.8%), while the primary success rate of direct stenting alone was 88.3%, p=0.01. In multivariate analysis, angiographic lesion calcification was an independent predictor of unsuccessful direct stenting (odds ratio 7.1, 95% confidence interval 2.8-18.2, p0.15 μg/l, used as a measure of distal embolisation, were similar in both groups (17.8 vs. 17.1%). Rates of major adverse cardiac events at 30 days were 4.5% in the direct stenting group versus 5.5% in the predilated group (ns). Direct stenting was associated with savings in fluoroscopy time, and angiographic contrast agent use, and a reduction in utilisation of angioplasty balloons (0.4 vs. 1.17 balloons per patient, p<0.001). Mean per patient procedural costs associated with direct stenting versus predilatation were €2545±914 versus €2763±842 (p=0.01), despite the implantation of more stents in the directly stented group. Conclusion Compared with a strategy of stenting preceded by balloon predilatation, direct stenting was equally safe and effective, with similar in-hospital and 30-day clinical outcomes, and modest procedural cost-savings. A calcified lesion predicted unsuccessful direct stenting. PMID:25696356

  5. Characterization and comparative evaluation of novel planar electromagnetic sensors

    OpenAIRE

    Mukhopadhyay, S. C.; Gooneratne, C. P.; Sen, Gupta G.; Yamada, Sotoshi

    2005-01-01

    The characterization of three types of novel planar electromagnetic sensors: 1) meander; 2) mesh; and 3) interdigital configuration, has been studied and their comparative performance has been evaluated based on their areas of applications. All of them are suitable for inspection and evaluation of system properties without destroying them. The experiments on fabricated sensors have been conducted and the results are presented here. The target application is to use a mixture of different types...

  6. Sustaining and Improving Study Abroad Experiences Through Comparative Evaluation.

    Science.gov (United States)

    Johanson, Linda S

    Researchers have related participation in study abroad experiences to many positive outcomes for nursing students; however, educators are faced with the task of not only developing meaningful study abroad opportunities but sustaining and improving them as well. Educators can evaluate repeat study abroad programs by comparing experiences, looking for trends, and conjecturing rationales. To illustrate this process, an example of a study abroad opportunity that has been repeated over 11 years is presented. The first six years have been compared to the most recent five years, revealing three categories of change for evaluation and the resulting course improvements.

  7. Evaluating the Cost-effectiveness of Pharmaceuticals in Canada

    OpenAIRE

    Katherine Boothe

    2016-01-01

    Canada adopted guidelines for the economic evaluation of pharmaceuticals in 1994, and a central process for drug assessment in 2003. The context and the way the issue reached the agenda in the two time periods differed. The guidelines were adopted amidst growing academic interest in methods for economic evaluation of pharmaceuticals in Canada and internationally, and were first promoted by an entrepreneur from the pharmaceutical industry. The Common Drug Review (CDR) was adopted in a context ...

  8. Cost-utility of Intravenous Immunoglobulin (IVIG compared with corticosteroids for the treatment of Chronic Inflammatory Demyelinating Polyneuropathy (CIDP in Canada

    Directory of Open Access Journals (Sweden)

    Campbell Kaitryn

    2010-06-01

    Full Text Available Abstract Objectives Intravenous immunoglobulin (IVIG has demonstrated improvement in chronic inflammatory demyelinating polyneuropathy (CIDP patients in placebo controlled trials. However, IVIG is also much more expensive than alternative treatments such as corticosteroids. The objective of the paper is to evaluate, from a Canadian perspective, the cost-effectiveness of IVIG compared to corticosteroid treatment of CIDP. Methods A markov model was used to evaluate the costs and QALYs for IVIG and corticosteroids over 5 years of treatment for CIDP. Patients initially responding to IVIG could remain a responder or relapse every 12 week model cycle. Non-responding IVIG patients were assumed to be switched to corticosteroids. Patients on corticosteroids were at risk of a number of adverse events (fracture, diabetes, glaucoma, cataract, serious infection in each cycle. Results Over the 5 year time horizon, the model estimated the incremental costs and QALYs of IVIG treatment compared to corticosteroid treatment to be $124,065 and 0.177 respectively. The incremental cost per QALY gained of IVIG was estimated to be $687,287. The cost per QALY of IVIG was sensitive to the assumptions regarding frequency and dosing of maintenance IVIG. Conclusions Based on common willingness to pay thresholds, IVIG would not be perceived as a cost effective treatment for CIDP.

  9. Cost-effectiveness of biological therapy compared with methotrexate in the treatment for rheumatoid arthritis in Colombia.

    Science.gov (United States)

    Valle-Mercado, Carolina; Cubides, Maria-Fernanda; Parra-Torrado, Monica; Rosselli, Diego

    2013-12-01

    The objectives of the study are to develop a cost-effectiveness model comparing biological therapy (BT) with methotrexate (MTX) alone, in the treatment for rheumatoid arthritis (RA), combining clinical and quality-of-life data from international trials with local costs and local epidemiological data. We designed a six-month cycle Markov model with five functional states, based on Health Assessment Questionnaire, with patients initiating treatment in any of the predefined states, based on a sample of 150 local RA patients. Simulations ran for 10 and 20 years, and for the whole life span. Utilities, in quality-adjusted life years (QALY), were taken from international literature. Discount rate was 3 % for costs and utilities. We calculated direct and indirect costs using a combination of international and local data. Results are presented as incremental cost-effectiveness ratios (ICER). ICERs in euros per QALY were 143,072 for 10 years; 139,332 for 20 years; and 137,712 for the whole life span. Total costs with MTX were lower than with BT, despite higher out of pocket, productivity, and complication costs. Under conventional thresholds, and for the "average" RA patient, BT would not be cost-effective in Colombia. BT compared to MTX provides more QALYs, but at a high cost. When ICERs were estimated for Colombia, BT would not be cost-effective. We propose different thresholds for different conditions, perhaps prioritizing chronic diseases that lead to disability.

  10. Overview and comparative study of GPR international standards and guidelines - COST Action TU1208

    Science.gov (United States)

    Pajewski, Lara; Marciniak, Marian; Benedetto, Andrea; Tosti, Fabio

    2016-04-01

    Ground Penetrating Radar (GPR) can be effectively used for non-destructive testing of composite structures and diagnostics affecting the whole life-cycle of civil engineering works. Nevertheless, few recognised international standards exist in this field and inhomogeneous recommendations are present in different countries. Moreover, the levels of knowledge, awareness and experience regarding the use of GPR in civil engineering vary strongly across different European areas. The COST Action TU1208 is working hard on leveraging these differences, by sharing and disseminating knowledge and experience, as well as by developing guidelines and protocols for a safe and effective use of GPR in civil engineering. GPR users need to know which is the best way to conduct GPR measurements and what the quality level for the results should be. The TU1208 guidelines will ensure a higher efficiency and quality of GPR services and they will constitute a scientific basis for the introduction of European Standards on the application of GPR in civil engineering. The aim of this contribution is to present an in-depth overview and critical analysis of the existing GPR international and national standards and guidelines. The main documents considered in our work are listed and briefly described in the following. Three standards are provided by the American Society for Testing and Materials (ASTM), to guide the GPR use for subsurface investigation, evaluation of asphalt-covered concrete bridge decks, and determination of pavement-layer thickness: 1. ASTM D6432-11, Standard Guide for Using the Surface Ground Penetrating Radar Method for Subsurface Investigation, ASTM International, West Conshohocken, PA, 2011, www.astm.org, DOI: 10.1520/D6432-11. 2. ASTM D6087-08, Standard Test Method for Evaluating Asphalt-Covered Concrete Bridge Decks Using Ground Penetrating Radar, ASTM International, West Conshohocken, PA, 2008, www.astm.org, DOI: 10.1520/D6087-08. 3. ASTM D4748-10, Standard Test Method

  11. Coal gasification systems engineering and analysis. Appendix E: Cost estimation and economic evaluation methodology

    Science.gov (United States)

    1980-01-01

    The cost estimation and economic evaluation methodologies presented are consistent with industry practice for assessing capital investment requirements and operating costs of coal conversion systems. All values stated are based on January, 1980 dollars with appropriate recognition of the time value of money. Evaluation of project economic feasibility can be considered a two step process (subject to considerable refinement). First, the costs of the project must be quantified and second, the price at which the product can be manufacturd must be determined. These two major categories are discussed. The summary of methodology is divided into five parts: (1) systems costs, (2)instant plant costs, (3) annual operating costs, (4) escalation and discounting process, and (5) product pricing.

  12. An Evaluation of the Automated Cost Estimating Integrated Tools (ACEIT) System

    Science.gov (United States)

    1989-09-01

    C~4p DTIC S ELECTE fl JAN12 19 .1R ~OF S%. B -U AN EVALUATION OF THE AUTOMATED COST ESTIMATING INTEGRATED TOOLS ( ACEIT ) SYSTEM THESIS Caroline L...Ohio go 91 022 AFIT/GCA/LSQ/89S-5 AN EVALUATION OF THE AUTOMATED COST ESTIMATING INTEGRATED TOOLS ( ACEIT ) SYSTEM THESIS Caroline L. Hanson Major, USAF...Department of Defense. AFIT/GCA/LSQ/89S-5 AN EVALUATION OF THE AUTOMATED COST ESTIMATING INTEGRATED TOOLS ( ACEIT ) SYSTEM THESIS Presented to the

  13. Ambient and laboratory evaluation of a low-cost particulate matter sensor.

    Science.gov (United States)

    Kelly, K E; Whitaker, J; Petty, A; Widmer, C; Dybwad, A; Sleeth, D; Martin, R; Butterfield, A

    2017-02-01

    Low-cost, light-scattering-based particulate matter (PM) sensors are becoming more widely available and are being increasingly deployed in ambient and indoor environments because of their low cost and ability to provide high spatial and temporal resolution PM information. Researchers have begun to evaluate some of these sensors under laboratory and environmental conditions. In this study, a low-cost, particulate matter sensor (Plantower PMS 1003/3003) used by a community air-quality network is evaluated in a controlled wind-tunnel environment and in the ambient environment during several winter-time, cold-pool events that are associated with high ambient levels of PM. In the wind-tunnel, the PMS sensor performance is compared to two research-grade, light-scattering instruments, and in the ambient tests, the sensor performance is compared to two federal equivalent (one tapered element oscillating microbalance and one beta attenuation monitor) and gravimetric federal reference methods (FEMs/FRMs) as well as one research-grade instrument (GRIMM). The PMS sensor response correlates well with research-grade instruments in the wind-tunnel tests, and its response is linear over the concentration range tested (200-850 μg/m(3)). In the ambient tests, this PM sensor correlates better with gravimetric methods than previous studies with correlation coefficients of 0.88. However additional measurements under a variety of ambient conditions are needed. Although the PMS sensor correlated as well as the research-grade instrument to the FRM/FEMs in ambient conditions, its response varies with particle properties to a much greater degree than the research-grade instrument. In addition, the PMS sensors overestimate ambient PM concentrations and begin to exhibit a non-linear response when PM2.5 concentrations exceed 40 μg/m(3). These results have important implications for communicating results from low-cost sensor networks, and they highlight the importance of using an

  14. Cost-effectiveness analysis of arthroscopic surgery compared with non-operative management for osteoarthritis of the knee

    Science.gov (United States)

    Marsh, Jacquelyn D; Birmingham, Trevor B; Giffin, J Robert; Isaranuwatchai, Wanrudee; Hoch, Jeffrey S; Feagan, Brian G; Litchfield, Robert; Willits, Kevin; Fowler, Peter

    2016-01-01

    Objective To determine the cost-effectiveness of arthroscopic surgery in addition to non-operative treatments compared with non-operative treatments alone in patients with knee osteoarthritis (OA). Design, setting and participants We conducted an economic evaluation alongside a single-centre, randomised trial among patients with symptomatic, radiographic knee OA (KL grade ≥2). Interventions Patients received arthroscopic debridement and partial resection of degenerative knee tissues in addition to optimised non-operative therapy, or optimised non-operative therapy only. Main outcome measures Direct and indirect costs were collected prospectively over the 2-year study period. The effectiveness outcomes were the Western Ontario McMaster Osteoarthritis Index (WOMAC) and quality-adjusted life years (QALYs). Cost-effectiveness was estimated using the net benefit regression framework considering a range of willingness-to-pay values from the Canadian public payer and societal perspectives. We calculated incremental cost-effectiveness ratios and conducted sensitivity analyses using the extremes of the 95% CIs surrounding mean differences in effect between groups. Results 168 patients were included. Patients allocated to arthroscopy received partial resection and debridement of degenerative meniscal tears (81%) and/or articular cartilage (97%). There were no significant differences between groups in use of non-operative treatments. The incremental net benefit was negative for all willingness-to-pay values. Uncertainty estimates suggest that even if willing to pay $400 000 to achieve a clinically important improvement in WOMAC score, or ≥$50 000 for an additional QALY, there is therapies only. Our sensitivity analysis suggests that even when assuming the largest treatment effect, the addition of arthroscopic surgery is not economically attractive compared with non-operative treatments only. Conclusions Arthroscopic debridement of degenerative articular cartilage and

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

    Science.gov (United States)

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

    2015-01-01

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

  16. Cost-Effectiveness of a Biodegradable Compared to a Titanium Fixation System in Maxillofacial Surgery : A Multicenter Randomized Controlled Trial

    NARCIS (Netherlands)

    van Bakelen, N. B.; Vermeulen, K. M.; Buijs, G. J.; Jansma, J.; de Visscher, J. G. A. M.; Hoppenreijs, Th. J. M.; Bergsma, J. E.; Stegenga, B.; Bos, R. R. M.

    2015-01-01

    Background Biodegradable fixation systems could reduce/delete the problems associated with titanium plate removal. This means less surgical discomfort, and a reduction in costs. Aim The aim of the present study was to compare the cost-effectiveness between a biodegradable and a titanium system in

  17. A cost-utility analysis comparing second-line chemotherapy schemes in patients with metastatic breast cancer

    NARCIS (Netherlands)

    Li, N; van Agthoven, M; Willemse, PHB; Uyl-de Groot, CA

    2001-01-01

    A cost-utility analysis has been performed comparing taxanes, vinorelbine and standard therapy for metastatic breast cancer considering clinical efficacy, quality-adjusted-life-years (QALYs) and costs, A decision model has been built, Clinical efficacy data were collected by literature review. Utili

  18. Hospital costs during the first 5 years of life for multiples compared with singletons born after IVF or ICSI

    NARCIS (Netherlands)

    Heesch, M.M. van; Evers, J.L.; Hoeven, M.A. van der; Dumoulin, J.C.; Beijsterveldt, C.E. van; Bonsel, G.J.; Dykgraaf, R.H.; Goudoever, J.B. van; Koopman-Esseboom, C.; Nelen, W.L.D.M.; Steiner, K.; Tamminga, P.; Tonch, N.; Torrance, H.L.; Dirksen, C.D.

    2015-01-01

    STUDY QUESTION: Do in vitro fertilization (IVF) multiples generate higher hospital costs than IVF singletons, from birth up to age 5? SUMMARY ANSWER: Hospital costs from birth up to age 5 were significantly higher among IVF/ICSI multiple children compared with IVF/ICSI singletons; however, when

  19. Evaluation of corporate income tax compliance costs and compliance behaviour under the self-assessment system

    OpenAIRE

    Sapiei, Noor Sharoja

    2017-01-01

    Commitment to compliance may cause taxpayers to experience unnecessary compliance costs burden resulting in non-compliance behaviour. This study evaluates the tax compliance costs of corporate taxpayers and their compliance with the corporate income tax (CIT) reporting requirements under the Self-Assessment System (SAS) environment. Tax compliance costs, corporate characteristics, tax attitudinal aspects and the likely compliance behaviour of public listed companies (PLCs) are integrated into...

  20. Accounting for Heterogeneity in Hedging Behavior: Comparing & Evaluating Grouping Methods

    NARCIS (Netherlands)

    Pennings, J.M.E.; Garcia, P.; Irwin, S.H.

    2011-01-01

    Abstract Heterogeneity, i.e., the notion that individuals respond differently to economic stimuli, can have profound consequences for the interpretation of behavior and the formulation of agricultural policy. This paper compares and evaluates three grouping techniques that can be used to account for

  1. Comparative evaluation of root canal disinfection by conventional ...

    African Journals Online (AJOL)

    2013-03-25

    Mar 25, 2013 ... Objective: The aim of this study was to comparatively evaluate in vivo the disinfecting ... laser containing the gallium aluminum and arsenic, which emitted 980 nm wavelengths. .... canal with pulp necrosis mainly involving obligate anaerobes .... 99.98% of the bacteria injected in the root canal could be.

  2. COMPARATIVE EVALUATION OF FILTERS USED IN TRACKING AIR TARGETS

    Directory of Open Access Journals (Sweden)

    Y. I. Strekalovskaya

    2015-01-01

    Full Text Available Using an imitation model for a flow of heterogeneous air targets the comparative assessment of the αβ, αβγ and the Kalman filters efficiency is evaluated. In the case of slightly maneuvering target the difference in filters’ efficiency is statistically insignificant; in the case of sharp maneuvering the Kalman filter is significantly more precise.

  3. Comparative Evaluation of Handheld Robot-Aided Intraocular Laser Surgery

    Science.gov (United States)

    Yang, Sungwook; MacLachlan, Robert A.; Martel, Joseph N.; Lobes, Louis A.; Riviere, Cameron N.

    2015-01-01

    This paper presents robot-aided intraocular laser surgery using a handheld robot known as Micron. The micromanipulator incorporated in Micron enables visual servoing of a laser probe, while maintaining a constant distance of the tool tip from the retinal surface. The comparative study was conducted with various control methods for evaluation of robot-aided intraocular laser surgery. PMID:27019653

  4. Activity-based costing evaluation of [{sup 18}F]-fludeoxyglucose production

    Energy Technology Data Exchange (ETDEWEB)

    Krug, Bruno; Pirson, Anne-Sophie; Borght, Thierry vander [Mont-Godinne Medical Centre, Nuclear Medicine Division, Universite Catholique de Louvain, Yvoir (Belgium); Zanten, Annie van [University Medical Centre Groningen, Nuclear Medicine Division, Groningen (Netherlands); Crott, Ralph [Belgian Healthcare Knowledge Centre, Brussels (Belgium)

    2008-01-15

    As healthcare expenses are escalating in many countries, the sector faces a new challenge of becoming more cost efficient. There is an urgent need for more accurate data on the costs of healthcare procedures. The cost of Positron Emission Tomography (PET) with [{sup 18}F]-fludeoxyglucose ({sup 18}F-FDG) studies is mainly influenced by the price of the radiopharmaceutical, which may vary throughout Europe from 300 to 500 Euro per patient dose (370 MBq). The aim of the current study is to conduct an activity-based costing (ABC) estimation of {sup 18}F-FDG production in Europe to better identify the different cost components and to analyse their relative contribution to the total cost. Financial data were collected on capital expense and global operating costs through interviews with industry experts, PET centre managers, evaluation of prior studies, and review of expenses incurred at the University Medical Centre in Groningen (The Netherlands). After mapping the activities, we divided the cost in five categories: wage, equipment, consumables, overhead and space costs. A sensitivity analysis was performed for key cost components, including the compliance with regulatory requirements. The critical factor for profitability was throughput. Including the European regulation procedure, the cost for 370 MBq {sup 18}F-FDG patient dose, 3 h EOS without delivery cost, ranges between 155 and 177 Euro/dose for two production runs and between 210 and 237 Euro/dose for one production run. These costs are predominantly determined by personnel and equipment costs, although the cost for quality assurance increases steadily. The ABC analysis provides significant insight into the production cost components of {sup 18}F-FDG through different operating configurations. Reductions in equipment prices, increased availability of radiopharmaceuticals, growth in demand, and improvements in reimbursement will all contribute to the financial viability of this imaging technique. (orig.)

  5. Cost-Effectiveness of Autologous Stem Cell Treatment as Compared to Conventional Chemotherapy for Treatment of Multiple Myeloma in India.

    Science.gov (United States)

    Prinja, Shankar; Kaur, Gunjeet; Malhotra, Pankaj; Jyani, Gaurav; Ramachandran, Raja; Bahuguna, Pankaj; Varma, Subhash

    2017-03-01

    Recent innovations in treatment of multiple myeloma include autologous stem cell transplantation (ASCT) along with high dose chemotherapy (HDC). We undertook this study to estimate incremental cost per quality adjusted life year gained (QALY) with use of ASCT along with HDC as compared to conventional chemotherapy (CC) alone in treatment of multiple myeloma. A combination of decision tree and markov model was used to undertake the analysis. Incremental costs and effects of ASCT were compared against the baseline scenario of CC (based on Melphalan and Prednisolone regimen) in the patients of multiple myeloma. A lifetime study horizon was used and future costs and consequences were discounted at 5%. Consequences were valued in terms of QALYs. Incremental cost per QALY gained using ASCT as against CC for treatment of multiple myeloma was estimated using both a health system and societal perspective. The cost of providing ASCT (with HDC) for multiple myeloma patients was INR 500,631, while the cost of CC alone was INR 159,775. In the long run, cost per patient per year for ASCT and CC arms was estimated to be INR 119,740 and INR 111,565 respectively. The number of QALYs lived per patient in case of ASCT and HDC alone were found to be 4.1 and 3.5 years respectively. From a societal perspective, ASCT was found to incur an incremental cost of INR 334,433 per QALY gained. If the ASCT is initiated early to patients, the incremental cost for ASCT was found to be INR 180,434 per QALY gained. With current mix of patients, stem cell treatment for multiple myeloma is not cost effective at a threshold of GDP per capita. It becomes marginally cost-effective at 3-times the GDP per capita threshold. However, accounting for the model uncertainties, the probability of ASCT to be cost effective is 59%. Cost effectiveness of ASCT can be improved with early detection and initiation of treatment.

  6. Anticipated identification costs: Improving assortment evaluation by diagnostic attributes

    NARCIS (Netherlands)

    Herpen, van E.; Pieters, F.G.M.

    2007-01-01

    Abstract Consumers often make quick assessments of product assortments, to determine if these are worthwhile for further investigation. They anticipate how difficult it will be to distinguish the various options in the assortment, which will influence their assortment evaluations. We reason that the

  7. A risk-profiling approach for surveillance of inflammatory bowel disease-colorectal carcinoma is more cost-effective: a comparative cost-effectiveness analysis between international guidelines.

    Science.gov (United States)

    Lutgens, Maurice; van Oijen, Martijn; Mooiweer, Erik; van der Valk, Mirthe; Vleggaar, Frank; Siersema, Peter; Oldenburg, Bas

    2014-11-01

    Colonoscopic surveillance for neoplasia is recommended for patients with inflammatory bowel disease (IBD)-related colitis. However, data on cost-effectiveness predate current international guidelines. To compare cost-effectiveness based on contemporary data between the surveillance strategies of the American Gastroenterological Association (AGA) and British Society of Gastroenterology (BSG). We constructed a Markov decision model to simulate the clinical course of IBD patients. We compared the 2 surveillance strategies for a base case of a 40-year-old colitis patient who was followed for 40 years. AGA surveillance distinguishes 2 groups: a high-risk group with annual surveillance and an average-risk group with biannual surveillance. BSG surveillance distinguishes 3 risk groups with yearly, 3-year, or 5-year surveillance. Patients could move from a no-dysplasia state with colonoscopic surveillance to 1 of 3 states for which proctocolectomy was indicated: (1) dysplasia/local cancer, (2) regional/metastasized cancer, or (3) refractory disease. After proctocolectomy, a patient moved to a no-colon state without surveillance. Direct costs of medical care, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. BSG surveillance dominated AGA surveillance with $9846 per QALY. Both strategies were equally effective with 24.16 QALYs, but BSG surveillance was associated with lower costs because of fewer colonoscopies performed. Costs related to IBD, surgery, or cancer did not affect cost-effectiveness. The model depends on the accuracy of derived data, and the assumptions that were made to reflect real-life situations. Study conclusions may only apply to the U.S. health care system. The updated risk-profiling approach for surveillance of IBD colorectal carcinoma by the BSG guideline appears to be more cost-effective. Copyright © 2014. Published by Elsevier Inc.

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

    NARCIS (Netherlands)

    Schäfer, W.L.A.; Boerma, W.G.W.; Kringos, D.S.; Maeseneer, J. de; Gress, S.; Heinemann, S.; Rotar-Pavlic, D.; Seghieri, C.; Svab, I.; Berg, M.J. van den; Vainieri, M.; Westert, G.P.; Willems, S.; Groenewegen, P.P.

    2011-01-01

    Background: The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects primary c

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

    NARCIS (Netherlands)

    Schafer, W.L.; Boerma, W.G.; Kringos, D.S.; Maeseneer, J. De; Gress, S.; Heinemann, S.; Rotar-Pavlic, D.; Seghieri, C.; Svab, I.; Berg, M.J. van den; Vainieri, M.; Westert, G.P.; Willems, S.; Groenewegen, P.P.

    2011-01-01

    ABSTRACT: BACKGROUND: The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects

  10. Two Computer Programs for Equipment Cost Estimation and Economic Evaluation of Chemical Processes.

    Science.gov (United States)

    Kuri, Carlos J.; Corripio, Armando B.

    1984-01-01

    Describes two computer programs for use in process design courses: an easy-to-use equipment cost estimation program based on latest cost correlations available and an economic evaluation program which calculates two profitability indices. Comparisons between programed and hand-calculated results are included. (JM)

  11. Adapting and Evaluating a Rapid, Low-Cost Method to Enumerate Flies in the Household Setting

    Science.gov (United States)

    Wolfe, Marlene K.; Dentz, Holly N.; Achando, Beryl; Mureithi, MaryAnne; Wolfe, Tim; Null, Clair; Pickering, Amy J.

    2017-01-01

    Diarrhea is a leading cause of death among children under 5 years of age worldwide. Flies are important vectors of diarrheal pathogens in settings lacking networked sanitation services. There is no standardized method for measuring fly density in households; many methods are cumbersome and unvalidated. We adapted a rapid, low-cost fly enumeration technique previously developed for industrial settings, the Scudder fly grill, for field use in household settings. We evaluated its performance in comparison to a sticky tape fly trapping method at latrine and food preparation areas among households in rural Kenya. The grill method was more sensitive; it detected the presence of any flies at 80% (433/543) of sampling locations versus 64% (348/543) of locations by the sticky tape. We found poor concordance between the two methods, suggesting that standardizing protocols is important for comparison of fly densities between studies. Fly species identification was feasible with both methods; however, the sticky tape trap allowed for more nuanced identification. Both methods detected a greater presence of bottle flies near latrines compared with food preparation areas (P < 0.01). The grill method detected more flies at the food preparation area compared with near the latrine (P = 0.014) while the sticky tape method detected no difference. We recommend the Scudder grill as a sensitive fly enumeration tool that is rapid and low cost to implement. PMID:27956654

  12. Costs evaluation methodic of energy efficient computer network reengineering

    Directory of Open Access Journals (Sweden)

    S.A. Nesterenko

    2016-09-01

    Full Text Available A key direction of modern computer networks reengineering is their transfer to a new energy-saving technology IEEE 802.3az. To make a reasoned decision about the transition to the new technology is needed a technique that allows network engineers to answer the question about the economic feasibility of a network upgrade. Aim: The aim of this research is development of methodic for calculating the cost-effectiveness of energy-efficient computer network reengineering. Materials and Methods: The methodic uses analytical models for calculating power consumption of a computer network port operating in IEEE 802.3 standard and energy-efficient mode of IEEE 802.3az standard. For frame transmission time calculation in the communication channel used the queuing model. To determine the values of the network operation parameters proposed to use multiagent network monitoring method. Results: The methodic allows calculating the economic impact of a computer network transfer to energy-saving technology IEEE 802.3az. To determine the network performance parameters proposed to use network SNMP monitoring systems based on RMON MIB agents.

  13. Using counterfactuals to evaluate the cost-effectiveness of controlling biological invasions.

    Science.gov (United States)

    McConnachie, Matthew M; van Wilgen, Brian W; Ferraro, Paul J; Forsyth, Aurelia T; Richardson, David M; Gaertner, Mirijam; Cowling, Richard M

    2016-03-01

    Prioritizing limited conservation funds for controlling biological invasions requires accurate estimates of the effectiveness of interventions to remove invasive species and their cost-effectiveness (cost per unit area or individual). Despite billions of dollars spent controlling biological invasions worldwide, it is unclear whether those efforts are effective, and cost-effective. The paucity of evidence results from the difficulty in measuring the effect of invasive species removal: a researcher must estimate the difference in outcomes (e.g. invasive species cover) between where the removal program intervened and what might have been observed if the program had not intervened. In the program evaluation literature, this is called a counterfactual analysis, which formally compares what actually happened and what would have happened in the absence of an intervention. When program implementation is not randomized, estimating counterfactual outcomes is especially difficult. We show how a thorough understanding of program implementation, combined with a matching empirical design can improve the way counterfactual outcomes are estimated in nonexperimental contexts. As a practical demonstration, we estimated the cost-effectiveness of South Africa's Working for Water program, arguably the world's most ambitious invasive species control program, in removing invasive alien trees from different land use types, across a large area in the Cape Floristic Region. We estimated that the proportion of the treatment area covered by invasive trees would have been 49% higher (5.5% instead of 2.7% of the grid cells occupied) had the program not intervened. Our estimates of cost per hectare to remove invasive species, however, are three to five times higher than the predictions made when the program was initiated. Had there been no control (counter-factual), invasive trees would have spread on untransformed land, but not on land parcels containing plantations or land transformed by

  14. Total elbow arthroplasty in the United States: evaluation of cost, patient demographics, and complication rates

    Directory of Open Access Journals (Sweden)

    Hanbing Zhou

    2016-03-01

    Full Text Available Total elbow arthroplasty (TEA is utilized in the treatment of rheumatoid and post-traumatic elbow arthritis. TEA is a relatively low volume surgery in comparison to other types of arthroplasty and therefore little is known about current surgical utilization, patient demographics and complication rates in the United States. The purpose of our study is to evaluate the current practice trends and associated inpatient complications of TEA at academic centers in the United States. We queried the University Health Systems Consortium administrative database from 2007 to 2011 for patients who underwent an elective TEA. A descriptive analysis of demographics was performed which included patient age, sex, race, and insurance status. We also evaluated the following patient clinical benchmarks: hospital length of stay (LOS, hospital direct cost, inhospital mortality, complications, and 30-day readmission rates. Our cohort consisted of 3146 adult patients (36.5% male and 63.5% female with an average age of 58 years who underwent a total elbow arthroplasty (159 academic medical centers in the United States. The racial demographics included 2334 (74% Caucasian, 285 (9% black, 236 (7.5% Hispanic, 16 (0.5% Asian, and 283 (9% other patients. The mean LOS was 4.2±5 days and the mean total direct cost for the hospital was 16,300±4000 US Dollars per case. The overall inpatient complication rate was 3.1% and included mortality <1%, DVT (0.8%, re-operation (0.5%, and infection (0.4%. The 30-day readmission rate was 4.4%. TEA is a relatively uncommon surgery in comparison to other forms of arthroplasty but is associated with low in-patient and 30-day perioperative complication rate. Additionally, the 30-day readmission rate and overall hospital costs are comparable to the traditional total hip and knee arthroplasty surgeries.

  15. Comparative Analysis Of Conventional Method With Activity Based Costing In PT Mulia Sejati Gallery

    Directory of Open Access Journals (Sweden)

    Irma Nadia Erena

    2016-09-01

    Full Text Available The goal of this research was to provide readers the information about the calculation methods, both traditional and activity-based costing in the application of the cost of production. The method used in this research was the qualitative method. The analysis was done by calculating the amount of the production cost using the traditional system and the magnitude of the production cost when using the activity-based costing system. The amount of each acquisition was then performed into data analysis. The results achieved are massive distortion between the calculations using traditional systems and activity based costing system. The conclusions of the whole thesis are activity-based costing system is considered more relevant than traditional systems that are currently used by the company.

  16. Comparative Studies on the Composition and Purchase Costs of some Edible Land Snails in Nigeria

    Directory of Open Access Journals (Sweden)

    Omo Erigbe, P.

    2009-01-01

    Full Text Available Four species of edible land snails of the moist forest belt of Nigeria, Archachatina marginata (Swainson, Archachatina papyracae (Pfeiffer, Limicolaria flammea (Muller and Limicolaria aurora (Jay were used in the study of their body composition and purchase cost analysis. Data on Limicolaria flammea and Limicolaria aurora were pooled together to simulate their occurrence in nature and presentation in the markets. They were designated as Limicolaria flammea / aurora throughout this study. The results showed that there was no significant (P> 0.05 difference between the dressing out percentages of the three study group of snails. However, all body component parts studied were significantly (P< 0.01 greater for A. marginata than for A. papyracae or L. flammea/aurora. When the mean weights of shell, visceral mass, edible flesh and the sum of the mean weights of drainable fluid, mucus and other wettings were in each case expressed as percentages of the liveweight, the results were consistently similar (P> 0.05, indicating some regular pattern of weight distribution for these mollusk species studied. When the cost implications were carefully analyzed, the results showed possible savings of $ 1.95 and $ 2.06 US dollars in favour of consumption of fresh edible snail meat from one kilogram liveweight each of A. papyracae and L. flammea/aurora respectively, as compared to the consumption of fresh edible snail meat from one kilogram liveweight of A. marginata. On dried snail meat basis, A. papyracae was cheapest ($ 0.28 US dollars / 100 g, followed closely by L. flammea/aurora ($0.40 US dollars / 100 g, while A. marginata was the costliest ($ 2.30 US dollars / 100 g.

  17. Circumferential fusion is dominant over posterolateral fusion in a long-term perspective: cost-utility evaluation of a randomized controlled trial in severe, chronic low back pain

    DEFF Research Database (Denmark)

    Soegaard, Rikke; Bünger, Cody E; Christiansen, Terkel

    2007-01-01

    STUDY DESIGN: Cost-utility evaluation of a randomized, controlled trial with a 4- to 8-year follow-up. OBJECTIVE: To investigate the incremental cost per quality-adjusted-life-year (QALY) when comparing circumferential fusion to posterolateral fusion in a long-term, societal perspective. SUMMARY ...

  18. Comparative evaluation of ultrasound scanner accuracy in distance measurement

    Science.gov (United States)

    Branca, F. P.; Sciuto, S. A.; Scorza, A.

    2012-10-01

    The aim of the present study is to develop and compare two different automatic methods for accuracy evaluation in ultrasound phantom measurements on B-mode images: both of them give as a result the relative error e between measured distances, performed by 14 brand new ultrasound medical scanners, and nominal distances, among nylon wires embedded in a reference test object. The first method is based on a least squares estimation, while the second one applies the mean value of the same distance evaluated at different locations in ultrasound image (same distance method). Results for both of them are proposed and explained.

  19. Systematic comparative evaluation of methods for investigating the TCRβ repertoire

    DEFF Research Database (Denmark)

    Liu, Xiao; Zhang, Wei; Zeng, Xiaojing

    2016-01-01

    advantages and disadvantages; however, a systematic evaluation and direct comparison of them would benefit researchers in the selection of the most suitable method. In this study, we used both pooled control plasmids and spiked-in cells to benchmark the MPCR bias. RNA from three healthy donors...... was subsequently processed with the two methods to perform a comparative evaluation of the TCR β chain sequences. Both approaches demonstrated high reproducibility (R2 = 0.9958 and 0.9878, respectively). No differences in gene usage were identified for most V/J genes (>60%), and an average of 52.03% of the CDR3...

  20. System Evaluations and Life-Cycle Cost Analyses for High-Temperature Electrolysis Hydrogen Production Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Edwin A. Harvego; James E. O' Brien; Michael G. McKellar

    2012-05-01

    This report presents results of system evaluations and lifecycle cost analyses performed for several different commercial-scale high-temperature electrolysis (HTE) hydrogen production concepts. The concepts presented in this report rely on grid electricity and non-nuclear high-temperature process heat sources for the required energy inputs. The HYSYS process analysis software was used to evaluate both central plant designs for large-scale hydrogen production (50,000 kg/day or larger) and forecourt plant designs for distributed production and delivery at about 1,500 kg/day. The HYSYS software inherently ensures mass and energy balances across all components and it includes thermodynamic data for all chemical species. The optimized designs described in this report are based on analyses of process flow diagrams that included realistic representations of fluid conditions and component efficiencies and operating parameters for each of the HTE hydrogen production configurations analyzed. As with previous HTE system analyses performed at the INL, a custom electrolyzer model was incorporated into the overall process flow sheet. This electrolyzer model allows for the determination of the average Nernst potential, cell operating voltage, gas outlet temperatures, and electrolyzer efficiency for any specified inlet steam, hydrogen, and sweep-gas flow rates, current density, cell active area, and external heat loss or gain. The lifecycle cost analyses were performed using the H2A analysis methodology developed by the Department of Energy (DOE) Hydrogen Program. This methodology utilizes spreadsheet analysis tools that require detailed plant performance information (obtained from HYSYS), along with financial and cost information to calculate lifecycle costs. There are standard default sets of assumptions that the methodology uses to ensure consistency when comparing the cost of different production or plant design options. However, these assumptions may also be varied within the

  1. The decision model of the intuitionistic fuzzy group bid evaluation for urban infrastructure projects considering social costs

    National Research Council Canada - National Science Library

    Liu, Bingsheng; Huo, Tengfei; Wang, Xueqing; Shen, Qiping; Chen, Yuan

    2013-01-01

    ... loss, thus social costs are formed. The current bid evaluation mechanism has not yet taken social costs into account, while the present bid evaluation model for construction projects has ignored experts' group character and fuzziness...

  2. Comparative cost-effectiveness of focal and total salvage 125I brachytherapy for recurrent prostate cancer after primary radiotherapy

    Science.gov (United States)

    Piena, Marjanne A.; Steuten, Lotte M.G.; van der Voort van Zyp, Jochem R.N.; Moerland, Marinus A.; van Vulpen, Marco

    2016-01-01

    Purpose Focal salvage (FS) iodine 125 (125I) brachytherapy could be an effective treatment for locally radiorecurrent prostate cancer (PCa). Toxicity is often reduced compared to total salvage (TS) while cancer control can be maintained, which could increase cost-effectiveness. The current study estimates the incremental cost per quality-adjusted life year (QALY) of FS compared to TS. Material and methods A decision analytic Markov model was developed, which compares costs and QALYs associated with FS and TS. A 3-year time horizon was adopted with six month cycles, with a hospital perspective on costs. Probabilities for genitourinary (GU) and gastrointestinal (GI) toxicity and their impact on health-related quality of life (SF-36) were derived from clinical studies in the University Medical Center Utrecht (UMCU). Probabilistic sensitivity analysis, using 10,000 Monte Carlo simulations, was performed to quantify the joint decision uncertainty up to the recommended maximum willingness-to-pay threshold of €80,000/QALY. Results Focal salvage dominates TS as it results in less severe toxicity and lower treatment costs. Decision uncertainty is small, with a 97-100% probability for FS to be cost-effective compared to TS (€0-€80,000/QALY). Half of the difference in costs between FS and TS was explained by higher treatment costs of TS, the other half by higher incidence of severe toxicity. One-way sensitivity analyses show that model outcomes are most sensitive to utilities and probabilities for severe toxicity. Conclusions Focal salvage 125I brachytherapy dominates TS, as it has lower treatment costs and leads to less toxicity in our center. Larger comparative studies with longer follow-up are necessary to assess the exact influence on (biochemical disease free) survival and toxicity. PMID:28115953

  3. Recommendations From the International Colorectal Cancer Screening Network on the Evaluation of the Cost of Screening Programs.

    Science.gov (United States)

    Subramanian, Sujha; Tangka, Florence K L; Hoover, Sonja; Nadel, Marion; Smith, Robert; Atkin, Wendy; Patnick, Julietta

    2016-01-01

    Worldwide, colorectal cancer is the fourth leading cause of death from cancer and the incidence is projected to increase. Many countries are exploring the introduction of organized screening programs, but there is limited information on the resources required and guidance for cost-effective implementation. To facilitate the generating of the economics evidence base for program implementation, we collected and analyzed detailed program cost data from 5 European members of the International Colorectal Cancer Screening Network. The cost per person screened estimates, often used to compare across programs as an overall measure, varied significantly across the programs. In addition, there were substantial differences in the programmatic and clinical cost incurred, even when the same type of screening test was used. Based on these findings, several recommendations are provided to enhance the underlying methodology and validity of the comparative economic assessments. The recommendations include the need for detailed activity-based cost information, the use of a comprehensive set of effectiveness measures to adequately capture differences between programs, and the incorporation of data from multiple programs in cost-effectiveness models to increase generalizability. Economic evaluation of real-world colorectal cancer-screening programs is essential to derive valuable insights to improve program operations and ensure optimal use of available resources.

  4. Robotic upper limb rehabilitation after acute stroke by NeReBot: evaluation of treatment costs.

    Science.gov (United States)

    Stefano, Masiero; Patrizia, Poli; Mario, Armani; Ferlini, Gregorio; Rizzello, Roberto; Rosati, Giulio

    2014-01-01

    Stroke is the first cause of disability. Several robotic devices have been developed for stroke rehabilitation. Robot therapy by NeReBot is demonstrated to be an effective tool for the treatment of poststroke paretic upper limbs, able to improve the activities of daily living of stroke survivors when used both as additional treatment and in partial substitution of conventional rehabilitation therapy in the acute and subacute phases poststroke. This study presents the evaluation of the costs related to delivering such therapy, in comparison with conventional rehabilitation treatment. By comparing several NeReBot treatment protocols, made of different combinations of robotic and nonrobotic exercises, we show that robotic technology can be a valuable and economically sustainable aid in the management of poststroke patient rehabilitation.

  5. Pharmacoeconomic evaluation of the costs incurred by the ASP Messina for home therapy with liquid oxygen

    Directory of Open Access Journals (Sweden)

    Salvatore Coppolino

    2010-03-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is a very frequent disease in all industrialized countries. The cost for the community includes cost for hospitalisations, doctor visits, home care, rehabilitation, loss of working days, etc. From a therapeutical point of view, an effective progression of therapy and patients survival can be obtained only by stopping smoking and by following a long term oxygen therapy. The aim of this retrospective study is to evaluate costs of liquid oxygen therapy performed at home. Obtained results are very encouraging because a part from being cheap they also provide a better evaluation of the prescribed therapy which can also be extended to gaseous oxygen.

  6. Systematic comparative evaluation of methods for investigating the TCRβ repertoire

    DEFF Research Database (Denmark)

    Liu, Xiao; Zhang, Wei; Zeng, Xiaojing;

    2016-01-01

    advantages and disadvantages; however, a systematic evaluation and direct comparison of them would benefit researchers in the selection of the most suitable method. In this study, we used both pooled control plasmids and spiked-in cells to benchmark the MPCR bias. RNA from three healthy donors...... was subsequently processed with the two methods to perform a comparative evaluation of the TCR β chain sequences. Both approaches demonstrated high reproducibility (R2 = 0.9958 and 0.9878, respectively). No differences in gene usage were identified for most V/J genes (>60%), and an average of 52.03% of the CDR3...... variability was smaller compared with the biological variability. Through direct comparison, these findings provide novel insights into the two experimental methods, which will prove to be valuable in immune repertoire research and its interpretation....

  7. COMPARING AND CONTRASTING THE ALTERNATIVE METHODOLOGIES AVAILABLE FOR EVALUATING THE IMPACT OF TOURISM

    Directory of Open Access Journals (Sweden)

    Silvana DJURASEVIC

    2007-06-01

    Full Text Available Tourism has impacts upon a destination country. The aim of this work is to compare and contrast the alternative methodologies available for evaluating the impact of tourism. Tourism can be one of alternatives for development of a destination and sometimes the only possibility. For that reason it is very important to compare benefit and cost that tourism brings with corresponding valyes of alternative investment. Obtained results represent a very important input for planning and also for decision making policy. Different methodologies bring different results, different techniques have their own strenghts and weaknesses. For that reason, depending on the need, it is important to combine the methodologies in order to achieve the maximal benefit and minimal costs, from economical aspect, socio-cultural and environmental development.

  8. Comparative Cost-Benefit Analysis of Renewable Energy Resource Trade Offs for Military Installations

    Science.gov (United States)

    2012-12-01

    Palms Fully Operational Energy Products Minus Outlier ........81  Figure 18.  MCAS Beaufort Fully Operational Energy Projects...vast forests , agricultural waste in the large agricultural areas, and manure and other animal by-products. According to the Energy Information...total costs for wind turbines captured in an NREL report (NREL/TP- 500-40566) minus the utilities and insurance costs, which are assumed costs for our

  9. Analysis and evaluation in the production process and equipment area of the low-cost solar array project

    Science.gov (United States)

    Wolf, M.

    1981-01-01

    The effect of solar cell metallization pattern design on solar cell performance and the costs and performance effects of different metallization processes are discussed. Definitive design rules for the front metallization pattern for large area solar cells are presented. Chemical and physical deposition processes for metallization are described and compared. An economic evaluation of the 6 principal metallization options is presented. Instructions for preparing Format A cost data for solar cell manufacturing processes from UPPC forms for input into the SAMIC computer program are presented.

  10. Carboplatin plus pemetrexed offers superior cost-effectiveness compared to pemetrexed in patients with advanced non-small cell lung cancer and performance status 2.

    Science.gov (United States)

    Schluckebier, Luciene; Garay, Osvaldo U; Zukin, Mauro; Ferreira, Carlos G

    2015-09-01

    Pemetrexed plus carboplatin offers survival advantage in first line treatment of advanced lung cancer patients with performance status of 2. We estimated the cost-effectiveness of this combined regimen compared to pemetrexed alone in a Brazilian population. A cost-effectiveness analysis was conducted based on a randomized phase III trial in patients with advanced non-small cell lung cancer (NSCLC) and ECOG performance status of 2 (PS2), comparing doublet regimen pemetrexed plus carboplatin with pemetrexed alone. The perspective adopted was the public health care sector over a three-year period. Direct medical costs and survival time were calculated from patient-level data and utility values were extracted from the literature. Sensitivity analyses were performed to evaluate uncertainties in the results. The combined regimen pemetrexed plus carboplatin yielded a gain of 0.16 life year (LY) and 0.12 quality-adjusted life year (QALY) compared to pemetrexed alone. The total cost was 17,674.31 USD for the combined regimen and 15,722.39 USD for pemetrexed alone. The incremental cost-effectiveness ratio (ICER) was $12,016.09 per LY gained and $15,732.05 per QALY gained. The factors with the greatest impact on the ICER are pemetrexed price and the time to progression utility value. The cost-effectiveness acceptability curve showed an upper 90% probability of pemetrexed plus carboplatin being cost-effective with a threshold between two and three GDP per capita. Our study suggests superiority of the combined pemetrexed plus carboplatin regimen in terms of efficacy as well as cost-effectiveness in advanced NSCLC patients with a poor performance status of 2. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Which screening strategy should be offered to women with BRCA1 or BRCA2 mutations? A simulation of comparative cost-effectiveness.

    Science.gov (United States)

    de Bock, G H; Vermeulen, K M; Jansen, L; Oosterwijk, J C; Siesling, S; Dorrius, M D; Feenstra, T; Houssami, N; Greuter, M J W

    2013-04-30

    There is no consensus on the most effective strategy (mammography or magnetic resonance imaging (MRI)) for screening women with BRCA1 or BRCA2 mutations. The effectiveness and cost-effectiveness of the Dutch, UK and US screening strategies, which involve mammography and MRI at different ages and intervals were evaluated in high-risk women with BRCA1 or BRCA2 mutations. Into a validated simulation screening model, outcomes and cost parameters were integrated from published and cancer registry data. Main outcomes were life-years gained and incremental cost-effectiveness ratios. The simulation was situated in the Netherlands as well as in the United Kingdom, comparing the Dutch, UK and US strategies with the population screening as a reference. A discount rate of 3% was applied to both costs and health benefits. In terms of life-years gained, the strategies from least to most cost-effective were the UK, Dutch and US screening strategy, respectively. However, the differences were small. Applying the US strategy in the Netherlands, the costs were €43 800 and 68 800 for an additional life-year gained for BRCA1 and BRCA2, respectively. At a threshold of €20 000 per life-year gained, implementing the US strategy in the Netherlands has a very low probability of being cost-effective. Stepping back to the less-effective UK strategy would save relatively little in costs and results in life-years lost. When implementing the screening strategies in the United Kingdom, the Dutch, as well as the US screening strategy have a high probability of being cost-effective. From a cost-effectiveness perspective, the Dutch screening strategy is preferred for screening high-risk women in the Netherlands as well as in the United Kingdom.

  12. Nurse Family Partnership: Comparing Costs per Family in Randomized Trials Versus Scale-Up.

    Science.gov (United States)

    Miller, Ted R; Hendrie, Delia

    2015-12-01

    The literature that addresses cost differences between randomized trials and full-scale replications is quite sparse. This paper examines how costs differed among three randomized trials and six statewide scale-ups of nurse family partnership (NFP) intensive home visitation to low income first-time mothers. A literature review provided data on pertinent trials. At our request, six well-established programs reported their total expenditures. We adjusted the costs to national prices based on mean hourly wages for registered nurses and then inflated them to 2010 dollars. A centralized data system provided utilization. Replications had fewer home visits per family than trials (25 vs. 31, p = .05), lower costs per client ($8860 vs. $12,398, p = .01), and lower costs per visit ($354 vs. $400, p = .30). Sample size limited the significance of these differences. In this type of labor intensive program, costs probably were lower in scale-up than in randomized trials. Key cost drivers were attrition and the stable caseload size possible in an ongoing program. Our estimates reveal a wide variation in cost per visit across six state programs, which suggests that those planning replications should not expect a simple rule to guide cost estimations for scale-ups. Nevertheless, NFP replications probably achieved some economies of scale.

  13. DEVELOPMENT OF A METHODOLOGY FOR EVALUATING QUALITY COST IN A SEMIMECANIZED LOGGING OPERATION

    Directory of Open Access Journals (Sweden)

    Laércio Antônio Gonçalves Jacovine

    2009-09-01

    Full Text Available The etudy made a description and use of a methodology for evaluating quality cost in a semimechanized    logging   operation   was   developed. For  description  this  goal the logging sub-operations were detailed. The effects of the non conformity of one sub-operation on the succeeding ones were listed and analysed. Those consequences on which a money value could be atributed were specified. The methodology was applied to a case study. Quality cost were divided in three categories: evaluation cost, prevention cost, and faillure cost. It was concluded that the firm is not investing enough in evaluation and prevention causing a faillure cost of R$1.541,11/ha, which is considered too high. The percent composition of this cost was: log spliting 40,96%; error in wood volume determination in the stocking yeard 37,12%; wood waste in the stand 9,52%; non separation of thin logs 8,46%; logs left in the fire control line 1,49%; miscalculation of splited wood volume 1,53%; wood volume remaining in the coppices 0,51%; presence of branches in the fire control line 0,41%. The logs spliting operation must be worked out in order to diminish its cost. Firm profit may be increased throught investiment and research in reducing evaluation and prevention costs. Every waste cost must be avoided because is not only the firm itself, but the whole society who ends up paying the bill.

  14. Self-Evaluation Accuracy and Satisfaction with Performance: Are there Affective Costs or Benefits of Positive Self-Evaluation Bias?

    Science.gov (United States)

    Narciss, Susanne; Koerndle, Hermann; Dresel, Markus

    2011-01-01

    This paper examines how self-evaluation biases may influence satisfaction with performance. A review of theoretical positions suggests there are two views, both of which are supported by studies involving laboratory tasks. The first view predicts affective costs, and the second affective benefits of positive self-evaluation bias. We test the…

  15. What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation

    OpenAIRE

    2016-01-01

    Objective This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. Design Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. Setting Champlain health region in Eastern Ontario, Canada. Population Primary care providers and specialists registered to use the eConsult service. Main outcome measures Costs include...

  16. Cost Comparative Study On Steel Frame Folded Plate Roofing System Vs Conventional Truss Roofing System

    Directory of Open Access Journals (Sweden)

    T. Subramani

    2014-12-01

    Full Text Available Due to ever-increasing of construction materials, it becomes the foremost duty of a civil engineer to design economical and durable structures. In this project an attempt has been made to compare the cost of two types of roofing systems viz. conventional truss roofing system and steel frame folded plate roofing system. The steel frame folded plate roofing system, though found to be economical, is not widely practiced in India due to lack of knowledge regarding its analysis and design. On contrary to it, the conventional truss roofing system still remains as the widely adopted method of roofing for different types of buildings due to the available literature on its analysis, design and construction. The analysis and design of conventional truss roofing system and folded plate roofing system have been carried out for various spans. The analysis is carried out in STAAD.Pro 2004, which is based on stiffness method. Load calculations and design done manually, based on IS:875-1987, IS:800- 1984 & SP:38(1987

  17. [A comparative analysis of effectiveness, tolerance and cost of second generation antidepressants in France].

    Science.gov (United States)

    Fond, Guillaume

    2015-03-01

    While French authorities point to the need for rational prescribing, especially concerning psychotropic drugs, few data on the prescription of second-generation antidepressants (SGA) are synthesized for clinicians' use. Our objective is to carry out a comparative analysis of effectiveness and tolerability / acceptability of SGA. Considering the benefit/risk ratio and the cost (generic), the first-line treatment for a major depressive episode may be currently sertraline (50 mg / d). It may however have more digestive side effects than other SSRIs (due to the serotonin action), which calls for caution while increasing doses. Fluoxetine seems relevant in treatment of negative symptoms of schizophrenia (20mg / d) and in bulimia (60mg / d). Fluvoxamine seems relevant in the case of sexual side effects with a previous SSRI, in treatment of anxiety disorders (it's affinity for sigma receptors may confer a specific action) and in psychotic depression. Mirtazapine may be a treatment of interest when a fast remission of depressive symptoms (especially insomnia) is warranted but its tolerance profile makes it difficult to use.

  18. Cost-effectiveness of azacitidine compared with low-doses of chemotherapy (LDC in myelodysplastic syndrome (MDS

    Directory of Open Access Journals (Sweden)

    Myrna Candelaria-Hernández

    2017-05-01

    Full Text Available Introduction: Myelodysplastic syndrome (MDS comprises a group of clonal hematological disorders, characterized by ineffective hematopoiesis and progressive bone marrow failure. It increases the risk of transformation to acute myeloid leukemia (AML. Therapeutic benefit should include overall survival increase (OS, hematological improvement, transfusion dependence and time to progression to AML decrease. Objective: Assess, from a Mexican health-care perspective, the cost-effectiveness of azacitidine compared with low-doses of chemotherapy (LDC plus best supportive care (BSC for the treatment of adult patients with intermediate- 2 and high-risk MDS, who are not eligible for hematopoietic stem-cell transplantation. We developed a cost-effectiveness survival analysis model of three stages: MDS, AML, and death. OS and costs are extrapolated beyond three-year time horizon. Discount rate of 5% was applied. To estimate the model cycle probability transition to mortality state, survival curves were constructed for each treatment arm using individual patient-level data from Study AZA-001. Unitary costs are from public price list, and profiles for the management of MDS and AML were collected separately using a structured questionnaire. Probabilistic sensitivity analyses (PSA were conducted by simultaneously sampling from estimated probability distributions of model parameters. Results: Overall survival was projected to increase by 72.26 weeks with azacitidine. Incremental expected total costs for azacitidine compared to LDC was MXN$68,045. However, the cost of the drug therapy was lower with azacitidine. The incremental cost-effectiveness ratio (ICER for azacitidine compared to LDC was MXN$48,932 per life-year gained (LYG. PSA showed that azacitidine was a highly cost-effective option in 96.49% of the simulated cases in MXN$180,000/LYG willingness-to-pay. Conclusions: Compared with LDC, azacitidine represents a cost-effective treatment alternative in

  19. Product Costing in FMT: Comparing Deterministic and Stochastic Models Using Computer-Based Simulation for an Actual Case Study

    DEFF Research Database (Denmark)

    Nielsen, Steen

    2000-01-01

    This paper expands the traditional product costing technique be including a stochastic form in a complex production process for product costing. The stochastic phenomenon in flesbile manufacturing technologies is seen as an important phenomenon that companies try to decreas og eliminate. DFM has...... been used for evaluating the appropriateness of the firm's production capability. In this paper a simulation model is developed to analyze the relevant cost behaviour with respect to DFM and to develop a more streamlined process in the layout of the manufacturing process....

  20. 45 CFR 2522.540 - Do the costs of performance measurement or evaluation count towards the statutory cap on...

    Science.gov (United States)

    2010-10-01

    ... evaluation count towards the statutory cap on administrative costs? 2522.540 Section 2522.540 Public Welfare... measurement or evaluation count towards the statutory cap on administrative costs? No, the costs of performance measurement and evaluation do not count towards the statutory five percent cap on administrative...

  1. Who needs labs and who needs statins? Comparative and cost effectiveness analyses of non-laboratory-based, laboratory-based, and staged primary cardiovascular disease screening guidelines

    Science.gov (United States)

    Pandya, Ankur; Weinstein, Milton C.; Salomon, Joshua A.; Cutler, David; Gaziano, Thomas A.

    2014-01-01

    Background Early detection and treatment of cardiovascular disease (CVD) risk factors produces significant clinical benefits, but no consensus exists on optimal screening algorithms. This study aimed to evaluate the comparative and cost effectiveness of staged laboratory-based and non-laboratory-based total cardiovascular disease risk assessment. Methods and Results We used receiver operating characteristic (ROC) curve and cost-effectiveness modeling methods to compare strategies with and without laboratory components, and using single-stage and multistage algorithms, including approaches based on Framingham risk scores (laboratory-based assessments for all individuals). Analyses were conducted using data from 5,998 adults in the Third National Health and Nutrition Examination Survey without history of CVD, using 10-year CVD death as the main outcome. A micro-simulation model projected lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) for 60 Framingham-based, non-laboratory-based, and staged screening approaches. Across strategies the area under the ROC curve (AUC) was 0.774–0.780 in men and 0.812–0.834 in women. There were no statistically significant differences in AUC between multistage and Framingham-based approaches. In cost-effectiveness analyses, multistage strategies had ICERs of $52,000/QALY and $83,000/QALY for men and women, respectively. Single-stage/Framingham-based strategies were dominated (higher cost and lower QALYs) or had unattractive ICERs (>$300,000/QALY) compared to single-stage/non-laboratory-based and multistage approaches. Conclusions Non-laboratory-based CVD risk assessment can be useful in primary CVD prevention, as a substitute for laboratory-based assessments or as the initial component of a multistage approach. Cost-effective multistage screening strategies could avoid 25–75% of laboratory testing used in CVD risk screening with predictive power comparable to Framingham risks

  2. Costs and financial benefits of video communication compared to usual care at home: a systematic review.

    NARCIS (Netherlands)

    Peeters, J.M.; Mistiaen, P.; Francke, A.L.

    2011-01-01

    We conducted a systematic review of video communication in home care to provide insight into the ratio between the costs and financial benefits (i.e. cost savings). Four databases (PUBMED, EMBASE, COCHRANE LIBRARY, CINAHL) were searched for studies on video communication for patients living at home

  3. Comparative analysis for various redox flow batteries chemistries using a cost performance model

    Science.gov (United States)

    Crawford, Alasdair; Viswanathan, Vilayanur; Stephenson, David; Wang, Wei; Thomsen, Edwin; Reed, David; Li, Bin; Balducci, Patrick; Kintner-Meyer, Michael; Sprenkle, Vincent

    2015-10-01

    The total energy storage system cost is determined by means of a robust performance-based cost model for multiple flow battery chemistries. Systems aspects such as shunt current losses, pumping losses and various flow patterns through electrodes are accounted for. The system cost minimizing objective function determines stack design by optimizing the state of charge operating range, along with current density and current-normalized flow. The model cost estimates are validated using 2-kW stack performance data for the same size electrodes and operating conditions. Using our validated tool, it has been demonstrated that an optimized all-vanadium system has an estimated system cost of costs facilitated by economies of scale from larger production volumes, coupled with performance improvements enabled by technology development, the system cost is expected to decrease to 160 kWh-1 for a 4-h application, and to 100 kWh-1 for a 10-h application. This tool has been shared with the redox flow battery community to enable cost estimation using their stack data and guide future direction.

  4. Cost-effectiveness evaluations of spinal neuromodulation with ziconotide continuous infusion in cancer pain in a real clinical practice

    Directory of Open Access Journals (Sweden)

    Orietta Zaniolo

    2011-06-01

    Full Text Available Introduction and objective: ziconotide is the first-in-class drug of selective N-type voltage-sensitive calcium-channel blockers used to control severe chronic pain. The present study is developed in order to analyze clinical and economical outcomes of spinal neuromodulation with ziconotide continuous infusion in cancer pain in a real clinical practice.Methods: costs and effects of ziconotide are compared with those of traditional neuromodulation with morphine and adjuvant drugs, administered by intrathecal infusion.Effectiveness and resources consumption data were retrospectively collected in 22 patients with severe complex cancer pain followed by one Italian centre from the day of port implantation to drop-out , due to death or consent withdrawal. 11 patients received morphine regimens and the other 11 were treated with ziconotide. The evaluation of the number of days with controlled pain (i.e., with an at least 30% reduction on the Numeric Rating Scale-Pain Intensity, NRSPI is the primary outcome of the analysis. The evaluated consumed health resources include drugs, visits, port maintenance, and pump recharge and amortization. Current Italian prices, real practice acquisition and remuneration costs borne by the third payer are applied.Results: patients receiving ziconotide lived significantly more days with controlled pain (78% vs 40%; p < 0.05. Average weekly cost is about 232 € for ziconotide and 120 € for morphine; the main driver being the pharmaceutical cost (respectively 81% and 65% of the total. Higher ziconotide acquisition costs are partially offset by minor expenses for adjuvant therapies, as ziconotide-treated patients on average receive a lower number of drugs than those receiving a traditional regimen. The incremental cost for one further day with controlled pain resulted of 42,30 €.Conclusions: ziconotide permits effective treatment of extremely difficult-to-manage pain, with a mild increment of cost, as compared to

  5. Activity-based costing evaluation of a [(18)F]-fludeoxyglucose positron emission tomography study.

    Science.gov (United States)

    Krug, Bruno; Van Zanten, Annie; Pirson, Anne-Sophie; Crott, Ralph; Borght, Thierry Vander

    2009-10-01

    The aim of the study is to use the activity-based costing approach to give a better insight in the actual cost structure of a positron emission tomography procedure (FDG-PET) by defining the constituting components and by simulating the impact of possible resource or practice changes. The cost data were obtained from the hospital administration, personnel and vendor interviews as well as from structured questionnaires. A process map separates the process in 16 patient- and non-patient-related activities, to which the detailed cost data are related. One-way sensitivity analyses shows to which degree of uncertainty the different parameters affect the individual cost and evaluate the impact of possible resource or practice changes like the acquisition of a hybrid PET/CT device, the patient throughput or the sales price of a 370MBq (18)F-FDG patient dose. The PET centre spends 73% of time in clinical activities and the resting time after injection of the tracer (42%) is the single largest departmental cost element. The tracer cost and the operational time have the most influence on cost per procedure. The analysis shows a total cost per FDG-PET ranging from 859 Euro for a BGO PET camera to 1142 Euro for a 16 slices PET-CT system, with a distribution of the resource costs in decreasing order: materials (44%), equipment (24%), wage (16%), space (6%) and hospital overhead (10%). The cost of FDG-PET is mainly influenced by the cost of the radiopharmaceutical. Therefore, the latter rather than the operational time should be reduced in order to improve its cost-effectiveness.

  6. Comparative evaluation of patellar height methods in the Brazilian population☆

    Science.gov (United States)

    Behrendt, Christian; Zaluski, Alexandre; e Albuquerque, Rodrigo Pires; de Sousa, Eduardo Branco; Cavanellas, Naasson

    2015-01-01

    Objective The methods most used for patellar height measurement were compared with the plateau–patella angle method. Methods A cross-sectional study was conducted, in which lateral-view radiographs of the knee were evaluated using the three methods already established in the literature: Insall–Salvati (IS), Blackburne–Peel (BP) and Caton–Deschamps (CD). These were compared with the plateau–patella angle method. One hundred and ninety-six randomly selected patients were included in the sample. Results The data were initially evaluated using the chi-square test. This analysis was deemed to be positive with p < 0.0001. We compared the traditional methods with the plateau–patella angle measurement, using Fisher's exact test. In comparing the IS index with the plateau–patella angle, we did not find any statistically significant differences in relation to the proportion of altered cases between the two groups. The traditional methods were compared with the plateau–patella angle with regard to the proportions of cases of high and low patella, by means of Fisher's exact test. This analysis showed that the plateau–patella angle identified fewer cases of high patella than did the IS, BP and CD methods, but more cases of low patella. In comparing pairs, we found that the IS and CD indices were capable of identifying more cases of high patella than was the plateau–patella angle. In relation to the cases of low patella, the plateau–patella angle was capable of identifying more cases than were the other three methods. Conclusions The plateau–patella angle found more patients with low patella than did the classical methods and showed results that diverged from those of the other indices studied. PMID:26962492

  7. Comparative evaluation of patellar height methods in the Brazilian population

    Directory of Open Access Journals (Sweden)

    Christian Behrendt

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: The methods most used for patellar height measurement were compared with the plateau-patella angle method. METHODS: A cross-sectional study was conducted, in which lateral-view radiographs of the knee were evaluated using the three methods already established in the literature: Insall-Salvati (IS, Blackburne-Peel (BP and Caton-Deschamps (CD. These were compared with the plateau-patella angle method. One hundred and ninety-six randomly selected patients were included in the sample. RESULTS: The data were initially evaluated using the chi-square test. This analysis was deemed to be positive with p < 0.0001. We compared the traditional methods with the plateau-patella angle measurement, using Fisher's exact test. In comparing the IS index with the plateau-patella angle, we did not find any statistically significant differences in relation to the proportion of altered cases between the two groups. The traditional methods were compared with the plateau-patella angle with regard to the proportions of cases of high and low patella, by means of Fisher's exact test. This analysis showed that the plateau-patella angle identified fewer cases of high patella than did the IS, BP and CD methods, but more cases of low patella. In comparing pairs, we found that the IS and CD indices were capable of identifying more cases of high patella than was the plateau-patella angle. In relation to the cases of low patella, the plateau-patella angle was capable of identifying more cases than were the other three methods. CONCLUSIONS: The plateau-patella angle found more patients with low patella than did the classical methods and showed results that diverged from those of the other indices studied.

  8. Evaluation of Cost-Effectiveness Criteria in Supply Chain Management: Case Study

    Directory of Open Access Journals (Sweden)

    Reza Rostamzadeh

    2013-01-01

    Full Text Available The aim of this paper is to evaluate and prioritize the proposed cost-effectiveness criteria in supply chain management using fuzzy multiple attribute decision-making (MADM approach. Over the past few years, the determination of suitable cost-effectiveness criteria in the supply chain has become a key strategic issue. However, the nature of these kinds of decisions is usually complex and unstructured. Many quantitative and qualitative factors must be considered to determine the suitable criteria. As the human decision-making process usually contains fuzziness and vagueness, a hierarchy of MADM model based on fuzzy-sets theory is used in this research. Using a fuzzy analytic hierarchy process (FAHP, the weights of criteria and subcriteria are determined and then the final ranking is determined by technique for order preference by similarity to ideal solution (TOPSIS. Finally, fuzzy TOPSIS (FTOPSIS is employed to compare the results with classic TOPSIS. This paper concludes that the subcriteria in all the items are in the same rank.

  9. Cost-effectiveness of intensive multifactorial treatment compared with routine care for individuals with screen-detected Type 2 diabetes

    DEFF Research Database (Denmark)

    Tao, L; Wilson, E C F; Wareham, N J

    2015-01-01

    Aims To examine the short- and long-term cost-effectiveness of intensive multifactorial treatment compared with routine care among people with screen-detected Type 2 diabetes. Methods Cost–utility analysis in ADDITION-UK, a cluster-randomized controlled trial of early intensive treatment in people...... with screen-detected diabetes in 69 UK general practices. Unit treatment costs and utility decrement data were taken from published literature. Accumulated costs and quality-adjusted life years (QALYs) were calculated using ADDITION-UK data from 1 to 5 years (short-term analysis, n = 1024); trial data were...... extrapolated to 30 years using the UKPDS outcomes model (version 1.3) (long-term analysis; n = 999). All costs were transformed to the UK 2009/10 price level. Results Adjusted incremental costs to the NHS were £285, £935, £1190 and £1745 over a 1-, 5-, 10- and 30-year time horizon, respectively (discounted...

  10. A social cost-benefit criterion for evaluating Voluntary Counseling and Testing with an application to Tanzania.

    Science.gov (United States)

    Brent, Robert J

    2010-02-01

    There are many interventions for HIV/AIDS that require that people know their status and hence require a HIV test. Testing that is driven by a desire to prevent the spread of the disease often has an indirect effect on others. These external effects need to be identified, quantified and included as part of the benefits and costs of testing. Pioneering analyses of HIV testing by Philipson and Posner have introduced the economic calculus of individual expected benefits and costs of activities into an understanding of the HIV epidemic. What is required for social evaluations is an extension of the analysis to ensure that external effects are included. The objective of this paper is two-fold. First we seek to formulate cost-benefit criteria that incorporate fully the external effects in the evaluation of Voluntary Counseling and Testing (VCT). We achieve this by recasting the individual calculus of benefits and costs to a couple setting. We can then compare an individual's cost-benefit analysis of being tested with social criteria that look at outcomes from a couple's perspective for both separate and dual/joint testing. Second we aim to apply our social criteria to VCT programs as they currently operate in Tanzania and how these programs might operate in the future when they are scaled up to relate to the general population. We develop social criteria for evaluating separate and dual VCT using a couple's perspective with and without altruism. Therefore, the welfare function is based on two individual expected utility functions viewed as a couple, either married or regular partners. The benefits are the averted lives lost whenever discordant couples are revealed. The costs of VCT are the benefits of unprotected sex that the couple foregoes and the costs of the testing and counseling. The cost-benefit criteria are applied to VCT programs in Tanzania. The four main ingredients estimated are: the foregone benefit of unprotected sex (measured by the compensated wage

  11. Evaluation of the Super ESPC Program: Level 2 -- Recalculated Cost Savings

    Energy Technology Data Exchange (ETDEWEB)

    Shonder, John A [ORNL; Hughes, Patrick [ORNL

    2009-04-01

    This report presents the results of Level 2 of a three-tiered evaluation of the U.S. Department of Energy Federal Energy Management Program's Super Energy Savings Performance Contract (Super ESPC) Program. Level 1 of the analysis studied all of the Super ESPC projects for which at least one Annual Measurement & Verification (M&V) Report had been produced by April 2006. For those 102 projects in aggregate, we found that the value of cost savings reported by the energy service company (ESCO) in the Annual M&V Reports was 108% of the cost savings guaranteed in the contracts. We also compared estimated energy savings (which are not guaranteed, but are the basis for the guaranteed cost savings) to the energy savings reported by the ESCO in the Annual M&V Report. In aggregate, reported energy savings were 99.8% of estimated energy savings on the basis of site energy, or 102% of estimated energy savings based on source energy. Level 2 focused on a random sample of 27 projects taken from the 102 Super ESPC projects studied in Level 1. The objectives were, for each project in the sample, to: repeat the calculations of the annual energy and cost savings in the most recent Annual M&V Report to validate the ESCO's results or correct any errors, and recalculate the value of the reported energy, water, and operations and maintenance (O&M) savings using actual utility prices paid at the project site instead of the 'contract' energy prices - the prices that are established in the project contract as those to be used by the ESCO to calculate the annual cost savings, which determine whether the guarantee has been met. Level 3 analysis will be conducted on three to five projects from the Level 2 sample that meet validity criteria for whole-building or whole-facility data analysis. This effort will verify energy and cost savings using statistical analysis of actual utility use, cost, and weather data. This approach, which can only be used for projects meeting

  12. Cost-effectiveness of energy efficiency programmes. Evaluating the impacts of a regional programme in France

    Energy Technology Data Exchange (ETDEWEB)

    Suerkemper, F.; Thomas, S. [Wuppertal Institute for Climate, Environment and Energy, Doeppersberg 19, 42103 Wuppertal (Germany); Osso, D. [EDF-R and D, Site des Renardieres-Avenue des Renardieres, Ecuelles, 77818 Moret-sur-Loing cedex (France); Baudry, P. [EDF-R and D, 1, Avenue du General de Gaulle, 92141 Clamart Cedex (France)

    2012-01-15

    This paper presents the evaluation of a regional energy efficiency programme implemented in two 'departements' of France. Electricite de France (EDF), a French energy company, provides refurbishment advice and financial incentives to end-users in the residential sector as well as specific training courses and certification to local installation contractors and building firms. Refurbishment measures analysed in this paper are efficient space heating equipment (condensing boilers, heat pumps and wood stoves or boilers), solar water heating systems and the installation of double-glazed windows. A billing analysis based on a survey of programme participants' energy consumption is used to calculate the energy savings attributed to the programme. In order to receive an economic feedback of this demonstration programme, the evaluation of both saved energy and programme costs is of importance. Detailed knowledge of the programme's cost-effectiveness is essential for EDF to achieve the saving obligations imposed by the French White Certificate scheme at the lowest cost. Results of this evaluation can support the development and implementation of further energy efficiency programmes with similar characteristics in other regions of France. The cost-effectiveness is determined from the perspective of the programme participant and the society as well as the energy company in charge of the programme. All cost and benefit components are calculated in Euro per kilowatt-hour, which allows a direct comparison of levelized costs of conserved energy with the avoidable costs of the energy supply system.

  13. Cost-effectiveness analysis of ticagrelor compared to clopidogrel for the treatment of patients with acute coronary syndrome in Colombia.

    Science.gov (United States)

    Mejía, Aurelio; Senior, Juan Manuel; Ceballos, Mateo; Atehortúa, Sara; Toro, Juan Manuel; Saldarriaga, Clara; Mejía, María Elena; Ramírez, Carolina

    2015-01-01

    Acute coronary syndrome is one of the most frequent medical emergencies in developing countries. To determine, from the perspective of the Colombian health system, the cost-effectiveness of ticagrelor compared to clopidogrel for the treatment of patients with acute coronary syndrome. We conducted a cost-effectiveness analysis from the perspective of the Colombian health system comparing ticagrelor and clopidogrel for the treatment of patients with acute coronary syndrome. To estimate the expected costs and outcomes, a Markov model was constructed in which patients could remain stable without experiencing new cardiovascular events, suffer from a new event, or die. For the baseline case, a 10-year time horizon and a discount ratio of 3% for costs and benefits were adopted. The transition probabilities were extracted from the PLATO (Platelet Inhibition and Patient Outcomes) clinical trial. Vital statistics were drawn from the Departmento Administrativo Nacional de Estadística (DANE) and additional information from Colombian patients included in the Access registry. To identify and measure resource use, a standard case was built by consulting guidelines and protocols. Unit costs were obtained from Colombian rate lists. A probabilistic sensitivity analysis was conducted in which costs were represented by a triangular distribution, and the effectiveness through a beta distribution. In the base case, the additional cost per quality-adjusted life-year gained with ticagrelor was COP$ 28,411,503. The results were sensitive to changes in the time horizon and the unit cost of clopidogrel. For a willingness-to-pay equivalent to three times the Colombian per capita gross domestic product, the probability of ticagrelor being cost-effective was 75%. Ticagrelor is a cost-effective strategy for the treatment of patients with acute coronary syndrome in Colombia.

  14. Comparative assessment of nanomaterial definitions and safety evaluation considerations.

    Science.gov (United States)

    Boverhof, Darrell R; Bramante, Christina M; Butala, John H; Clancy, Shaun F; Lafranconi, Mark; West, Jay; Gordon, Steve C

    2015-10-01

    Nanomaterials continue to bring promising advances to science and technology. In concert have come calls for increased regulatory oversight to ensure their appropriate identification and evaluation, which has led to extensive discussions about nanomaterial definitions. Numerous nanomaterial definitions have been proposed by government, industry, and standards organizations. We conducted a comprehensive comparative assessment of existing nanomaterial definitions put forward by governments to highlight their similarities and differences. We found that the size limits used in different definitions were inconsistent, as were considerations of other elements, including agglomerates and aggregates, distributional thresholds, novel properties, and solubility. Other important differences included consideration of number size distributions versus weight distributions and natural versus intentionally-manufactured materials. Overall, the definitions we compared were not in alignment, which may lead to inconsistent identification and evaluation of nanomaterials and could have adverse impacts on commerce and public perceptions of nanotechnology. We recommend a set of considerations that future discussions of nanomaterial definitions should consider for describing materials and assessing their potential for health and environmental impacts using risk-based approaches within existing assessment frameworks. Our intent is to initiate a dialogue aimed at achieving greater clarity in identifying those nanomaterials that may require additional evaluation, not to propose a formal definition. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  15. 48 CFR 247.372 - DD Form 1654, Evaluation of Transportation Cost Factors.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false DD Form 1654, Evaluation... Transportation in Supply Contracts 247.372 DD Form 1654, Evaluation of Transportation Cost Factors. Contracting personnel may use the DD Form 1654 to furnish information to the transportation office for development...

  16. The value of psychological treatment for borderline personality disorder: Systematic review and cost offset analysis of economic evaluations

    Science.gov (United States)

    Meuldijk, Denise; McCarthy, Alexandra; Bourke, Marianne E.; Grenyer, Brin F. S.

    2017-01-01

    Aim Borderline Personality Disorder (BPD) is a common mental health condition with high patterns of service utilisation of inpatient and community treatment. Over the past five years there has been significant growth in research with economic data, making this systematic review a timely update. Methods Empirical studies written in English or German, published up to December 2015, and cited in major electronic databases were examined using the PRISMA systematic review method. Papers were included that had one of the following: data related to cost of BPD to society, the individual, the carer or families; cost benefits of interventions. Reported cost data were inflated to the year 2015 and converted into US- dollars (USD $) using purchasing power parities. Results We identified 30 economic evaluations providing cost data related to interventions for BPD across 134,136 patients. The methodological quality was good, almost all studies fulfilled ≥ 50% of the quality criteria. The mean cost saving for treating BPD with evidence-based psychotherapy across studies was USD $2,987.82 per patient per year. A further mean weighted reduction of USD $1,551 per patient per year (range $83 - $29,392) was found compared to treatment as usual. Evidence-based psychological treatment was both less expensive as well as more effective, despite considerable differences in health cost arrangements between individual studies and countries. Where it was able to be calculated, a significant difference in cost-savings between different types of evidence-based psychotherapies was found. Discussion Individuals with BPD consistently demonstrate high patterns of service utilization and therefore high costs. The findings of this review present a strong argument in favour of prioritizing BPD treatments in reimbursement decisions, both for the affected individual and the family. The provision of evidence based treatment, irrespective of the type of psychological treatment, may lead to widespread

  17. ISOS: A job evaluation system to implement comparable worth

    Directory of Open Access Journals (Sweden)

    Albert Corominas

    2008-01-01

    Full Text Available A fair pay structure is an essential element of the personnel policy of a firm. If the pay structure is perceived as arbitrary by the members of the staff, it becomes a cause of disturbance of the labor relations. Particularly, a pay structure is unfair if it discriminates against women. Job evaluation is a traditional tool used by companies to assist in the process of determining pay structures that can be also useful to detect and combat wage discrimination, since allow determining whether two jobs are of comparable worth or not. Although there are many kinds of systems, authors agree when defining point factor methods as the most appropriate and fair job evaluation systems. However, even being well defined from a technical point of view, most existing systems give discriminatory results regarding to gender. ISOS, a new job evaluation system which is described in this paper, has been designed, with the aim to define a neutral system with regard to gender, based on present jobs characteristics, existing job evaluation systems and job description questionnaires, international experts’ knowledge and a wide body of literature on gender discrimination and its relation with job evaluation. Using ISOS can contribute to detect, combat and eliminate part of the existing wage discrimination in general and, in particular, against women. ISOS includes all aspects of the work so no characteristics are omitted. The system can be applied in any company and to evaluate any job, and offers flexibility to be adapted to the specific characteristics of an organization. ISOS can also be used to detect and combat wage discrimination. Furthermore, characteristics of present jobs, such as cross-training or flexible working time, are also included so the system can be considered innovative in a very traditional field of industrial engineering.

  18. Systematic Comparative Evaluation of Methods for Investigating the TCRβ Repertoire.

    Science.gov (United States)

    Liu, Xiao; Zhang, Wei; Zeng, Xiaojing; Zhang, Ruifang; Du, Yuanping; Hong, Xueyu; Cao, Hongzhi; Su, Zheng; Wang, Changxi; Wu, Jinghua; Nie, Chao; Xu, Xun; Kristiansen, Karsten

    2016-01-01

    High-throughput sequencing has recently been applied to profile the high diversity of antibodyome/B cell receptors (BCRs) and T cell receptors (TCRs) among immune cells. To date, Multiplex PCR (MPCR) and 5'RACE are predominately used to enrich rearranged BCRs and TCRs. Both approaches have advantages and disadvantages; however, a systematic evaluation and direct comparison of them would benefit researchers in the selection of the most suitable method. In this study, we used both pooled control plasmids and spiked-in cells to benchmark the MPCR bias. RNA from three healthy donors was subsequently processed with the two methods to perform a comparative evaluation of the TCR β chain sequences. Both approaches demonstrated high reproducibility (R2 = 0.9958 and 0.9878, respectively). No differences in gene usage were identified for most V/J genes (>60%), and an average of 52.03% of the CDR3 amino acid sequences overlapped. MPCR exhibited a certain degree of bias, in which the usage of several genes deviated from 5'RACE, and some V-J pairings were lost. In contrast, there was a smaller rate of effective data from 5'RACE (11.25% less compared with MPCR). Nevertheless, the methodological variability was smaller compared with the biological variability. Through direct comparison, these findings provide novel insights into the two experimental methods, which will prove to be valuable in immune repertoire research and its interpretation.

  19. Systematic Comparative Evaluation of Methods for Investigating the TCRβ Repertoire.

    Directory of Open Access Journals (Sweden)

    Xiao Liu

    Full Text Available High-throughput sequencing has recently been applied to profile the high diversity of antibodyome/B cell receptors (BCRs and T cell receptors (TCRs among immune cells. To date, Multiplex PCR (MPCR and 5'RACE are predominately used to enrich rearranged BCRs and TCRs. Both approaches have advantages and disadvantages; however, a systematic evaluation and direct comparison of them would benefit researchers in the selection of the most suitable method. In this study, we used both pooled control plasmids and spiked-in cells to benchmark the MPCR bias. RNA from three healthy donors was subsequently processed with the two methods to perform a comparative evaluation of the TCR β chain sequences. Both approaches demonstrated high reproducibility (R2 = 0.9958 and 0.9878, respectively. No differences in gene usage were identified for most V/J genes (>60%, and an average of 52.03% of the CDR3 amino acid sequences overlapped. MPCR exhibited a certain degree of bias, in which the usage of several genes deviated from 5'RACE, and some V-J pairings were lost. In contrast, there was a smaller rate of effective data from 5'RACE (11.25% less compared with MPCR. Nevertheless, the methodological variability was smaller compared with the biological variability. Through direct comparison, these findings provide novel insights into the two experimental methods, which will prove to be valuable in immune repertoire research and its interpretation.

  20. Evaluation of an educational intervention using the enhanced food safety cost-of-illness model.

    Science.gov (United States)

    Scharff, Robert L; McDowell, Joyce; Medeiros, Lydia

    2009-01-01

    In recent years, a number of federally sponsored state-based food safety education programs have conducted economic evaluations aimed at demonstrating the efficacy of their approaches. These evaluations have typically been based on the "Virginia method," a comprehensive, but overly simplistic means of estimating benefit-cost ratios for food safety and nutrition education programs. In this article, we use the enhanced food safety cost-of-illness model, coupled with a more complete food safety education intervention model to evaluate the efficacy of the Ohio Family Nutrition Program. We find that, under most reasonable assumptions, the derived benefit-cost ratios imply that this program is socially beneficial. The model presented here is of particular use because it can be replicated to evaluate other broad-based food safety programs.

  1. Droplet Nucleation: Physically-Based Parameterizations and Comparative Evaluation

    Directory of Open Access Journals (Sweden)

    Steve Ghan

    2011-10-01

    Full Text Available One of the greatest sources of uncertainty in simulations of climate and climate change is the influence of aerosols on the optical properties of clouds. The root of this influence is the droplet nucleation process, which involves the spontaneous growth of aerosol into cloud droplets at cloud edges, during the early stages of cloud formation, and in some cases within the interior of mature clouds. Numerical models of droplet nucleation represent much of the complexity of the process, but at a computational cost that limits their application to simulations of hours or days. Physically-based parameterizations of droplet nucleation are designed to quickly estimate the number nucleated as a function of the primary controlling parameters: the aerosol number size distribution, hygroscopicity and cooling rate. Here we compare and contrast the key assumptions used in developing each of the most popular parameterizations and compare their performances under a variety of conditions. We find that the more complex parameterizations perform well under a wider variety of nucleation conditions, but all parameterizations perform well under the most common conditions. We then discuss the various applications of the parameterizations to cloud-resolving, regional and global models to study aerosol effects on clouds at a wide range of spatial and temporal scales. We compare estimates of anthropogenic aerosol indirect effects using two different parameterizations applied to the same global climate model, and find that the estimates of indirect effects differ by only 10%. We conclude with a summary of the outstanding challenges remaining for further development and application.

  2. Development and evaluation of low cost honey heating-cum-filtration system.

    Science.gov (United States)

    Alam, Md Shafiq; Sharma, D K; Sehgal, V K; Arora, M; Bhatia, S

    2014-11-01

    A fully mechanized honey heating-cum-filtration system was designed, developed, fabricated and evaluated for its performance. The system comprised of two sections; the top heating section and the lower filtering section. The developed system was evaluated for its performance at different process conditions (25 kg and 50 kg capacity using processing condition: 50 °C heating temperature and 60 °C heating temperature with 20 and 40 min holding time, respectively) and it was found that the total time required for heating, holding and filtration of honey was 108 and 142 min for 25 kg and 50 kg capacity of machine, respectively, irrespective of the processing conditions. The optimum capacity of the system was found to be 50 kg and it involved an investment of Rs 40,000 for its fabrication. The honey filtered through the developed filtration system was compared with the honey filtered in a high cost honey processing plant and raw honey for its microbial and biochemical (reducing sugars (%), moisture, acidity and pH) quality attributes. It was observed that the process of filtering through the developed unit resulted in reduction of microbes. The microbiological quality of honey filtered through the developed filtration system was better than that of raw honey and commercially processed honey. The treatment conditions found best in context of microbiological counts were 60 °C temperature for 20 min. There was 1.97 fold reductions in the plate count and 2.14 reductions in the fungal count of honey processed through the developed filtration system as compared to the raw honey. No coliforms were found in the processed honey. Honey processed through developed unit witnessed less moisture content, acidity and more reducing sugars as compared to raw honey, whereas its quality was comparable to the commercially processed honey.

  3. Comparing three methods for evaluating impact wrench vibration emissions.

    Science.gov (United States)

    McDowell, Thomas W; Marcotte, Pierre; Warren, Cristopher; Welcome, Daniel E; Dong, Ren G

    2009-08-01

    To provide a means for comparing impact wrenches and similar tools, the international standard ISO 8662-7 prescribes a method for measuring the vibrations at the handles of tools during their operations against a cotton-phenolic braking device. To improve the standard, alternative loading mechanisms have been proposed; one device comprises aluminum blocks with friction brake linings, while another features plate-mounted bolts to provide the tool load. The objective of this study was to evaluate these three loading methods so that tool evaluators can select appropriate loading devices in order to obtain results that can be applied to their specific workplace operations. Six experienced tool operators used five tool models to evaluate the loading mechanisms. The results of this study indicate that different loads can yield different tool comparison results. However, any of the three devices appears to be adequate for initial tool screenings. On the other hand, vibration emissions measured in the laboratory are unlikely to be fully representative of those in the workplace. Therefore, for final tool selections and for reliably assessing workplace vibration exposures, vibration measurements should be collected under actual working conditions. Evaluators need to use appropriate numbers of tools and tool operators in their assessments; recommendations are provided.

  4. A Trial-Based Economic Evaluation Comparing Spinal Cord Stimulation With Best Medical Treatment in Painful Diabetic Peripheral Neuropathy.

    Science.gov (United States)

    Slangen, Rachel; Faber, Catharina G; Schaper, Nicolaas C; Joosten, Elbert A; van Dongen, Robert T; Kessels, Alfons G; van Kleef, Maarten; Dirksen, Carmen D

    2017-04-01

    The objective was to perform an economic evaluation comparing spinal cord stimulation (SCS) in combination with best medical treatment (BMT) with BMT in painful diabetic peripheral neuropathy patients. Alongside a prospective 2-center randomized controlled trial, involving 36 painful diabetic peripheral neuropathy patients with severe lower limb pain not responding to conventional therapy, an economic evaluation was performed. Incremental cost-effectiveness ratios were based on: 1) societal costs and quality-adjusted life years (QALYs), and 2) direct health care costs and the number of successfully treated patients, respectively, both with a time horizon of 12 months. Bootstrap and secondary analyses were performed to address uncertainty. Total societal cost amounted to €26,539.18 versus €5,313.45 per patient in the SCS and BMT group, respectively. QALYs were .58 versus .36 and the number of successfully treated patients was 55% versus 7% for the SCS and BMT group, respectively. This resulted in incremental cost-effectiveness ratios of €94,159.56 per QALY and €34,518.85 per successfully treated patient, respectively. Bootstrap analyses showed that the probability of SCS being cost-effective ranges from 0 to 46% with willingness to pay threshold values ranging between €20,000 and €80,000 for a QALY. Secondary analyses showed that cost-effectiveness of SCS became more favorable after correcting for baseline cost imbalance between the 2 groups, extending the depreciation period of SCS material to 4 years, and extrapolation of the data up to 4 years. Although SCS was considerably more effective compared with BMT, the substantial initial investment that is required resulted in SCS not being cost-effective in the short term. Cost-effectiveness results were sensitive to baseline cost imbalances between the groups and the depreciation period of the SCS material.

  5. Comparative locomotor costs of domestic dogs reveal energetic economy of wolf-like breeds.

    Science.gov (United States)

    Bryce, Caleb M; Williams, Terrie M

    2017-01-15

    The broad diversity in morphology and geographic distribution of the 35 free-ranging members of the family Canidae is only rivaled by that of the domesticated dog, Canis lupus familiaris. Considered to be among nature's most elite endurance athletes, both domestic and wild canids provide a unique opportunity to examine the variability in mammalian aerobic exercise performance and energy expenditure. To determine the potential effects of domestication and selective breeding on locomotor gait and economy in canids, we measured the kinematics and mass-specific metabolism of three large (>20 kg) dog breed groups (northern breeds, retrievers and hounds) of varying morphological and genomic relatedness to their shared progenitor, the gray wolf. By measuring all individuals moving in preferred steady-state gaits along a level transect and on a treadmill, we found distinct biomechanical, kinematic and energetic patterns for each breed group. While all groups exhibited reduced total cost of transport (COT) at faster speeds, the total COT and net COT during trotting and galloping were significantly lower for northern breed dogs (3.0 and 2.1 J kg(-1) m(-1), respectively) relative to hound (4.2 and 3.4 J kg(-1) m(-1), respectively) and retriever dogs (3.8 and 3.0 J kg(-1) m(-1), respectively) of comparable mass. Similarly, northern breeds expended less energy per stride (3.5 J kg(-1) stride(-1)) than hounds or retrievers (5.0 and 4.0 J kg(-1) stride(-1), respectively). These results suggest that, in addition to their close genetic and morphological ties to gray wolves, northern breed dogs have retained highly cursorial kinematic and physiological traits that promote economical movement across the landscape.

  6. Road crash costs.

    OpenAIRE

    2010-01-01

    Road crashes result in all kinds of social costs, such as medical costs, production loss, human losses, property damage, settlement costs and costs due to congestion. Studies into road crash costs and their trends are carried out quite regularly. In 2009, the costs amounted to € 12.5 billion, or 2.2% of the Gross Domestic Product (GDP). Insight into these costs is used for policy preparation and evaluation, and makes it possible to compare them with costs in other areas. Another important app...

  7. GMOs in animal agriculture: time to consider both costs and benefits in regulatory evaluations

    Science.gov (United States)

    2013-01-01

    In 2012, genetically engineered (GE) crops were grown by 17.3 million farmers on over 170 million hectares. Over 70% of harvested GE biomass is fed to food producing animals, making them the major consumers of GE crops for the past 15 plus years. Prior to commercialization, GE crops go through an extensive regulatory evaluation. Over one hundred regulatory submissions have shown compositional equivalence, and comparable levels of safety, between GE crops and their conventional counterparts. One component of regulatory compliance is whole GE food/feed animal feeding studies. Both regulatory studies and independent peer-reviewed studies have shown that GE crops can be safely used in animal feed, and rDNA fragments have never been detected in products (e.g. milk, meat, eggs) derived from animals that consumed GE feed. Despite the fact that the scientific weight of evidence from these hundreds of studies have not revealed unique risks associated with GE feed, some groups are calling for more animal feeding studies, including long-term rodent studies and studies in target livestock species for the approval of GE crops. It is an opportune time to review the results of such studies as have been done to date to evaluate the value of the additional information obtained. Requiring long-term and target animal feeding studies would sharply increase regulatory compliance costs and prolong the regulatory process associated with the commercialization of GE crops. Such costs may impede the development of feed crops with enhanced nutritional characteristics and durability, particularly in the local varieties in small and poor developing countries. More generally it is time for regulatory evaluations to more explicitly consider both the reasonable and unique risks and benefits associated with the use of both GE plants and animals in agricultural systems, and weigh them against those associated with existing systems, and those of regulatory inaction. This would represent a shift away

  8. GMOs in animal agriculture: time to consider both costs and benefits in regulatory evaluations.

    Science.gov (United States)

    Van Eenennaam, Alison L

    2013-09-25

    In 2012, genetically engineered (GE) crops were grown by 17.3 million farmers on over 170 million hectares. Over 70% of harvested GE biomass is fed to food producing animals, making them the major consumers of GE crops for the past 15 plus years. Prior to commercialization, GE crops go through an extensive regulatory evaluation. Over one hundred regulatory submissions have shown compositional equivalence, and comparable levels of safety, between GE crops and their conventional counterparts. One component of regulatory compliance is whole GE food/feed animal feeding studies. Both regulatory studies and independent peer-reviewed studies have shown that GE crops can be safely used in animal feed, and rDNA fragments have never been detected in products (e.g. milk, meat, eggs) derived from animals that consumed GE feed. Despite the fact that the scientific weight of evidence from these hundreds of studies have not revealed unique risks associated with GE feed, some groups are calling for more animal feeding studies, including long-term rodent studies and studies in target livestock species for the approval of GE crops. It is an opportune time to review the results of such studies as have been done to date to evaluate the value of the additional information obtained. Requiring long-term and target animal feeding studies would sharply increase regulatory compliance costs and prolong the regulatory process associated with the commercialization of GE crops. Such costs may impede the development of feed crops with enhanced nutritional characteristics and durability, particularly in the local varieties in small and poor developing countries. More generally it is time for regulatory evaluations to more explicitly consider both the reasonable and unique risks and benefits associated with the use of both GE plants and animals in agricultural systems, and weigh them against those associated with existing systems, and those of regulatory inaction. This would represent a shift away

  9. Comparative costs of mobile and fixed-clinic primary health care ...

    African Journals Online (AJOL)

    maintenance of buildings and furniture, telephones and sundries were ... Table I. Analysis of costs of services provided by mobile and fixed clinics, 1992/93. Service. Total .... per minute consultation have better indicated the routes individual ...

  10. A cost-effectiveness analysis of pioglitazone plus metformin compared with rosiglitazone plus metformin from a third-party payer perspective in the US.

    Science.gov (United States)

    St Charles, Meaghan; Minshall, Michael E; Pandya, Bhavik J; Baran, Robert W; Tunis, Sandra L

    2009-06-01

    The long-term cost-effectiveness of using pioglitazone plus metformin (Actoplusmet dagger) compared with rosiglitazone plus metformin (Avandamet double dagger) in treating type 2 diabetes (T2DM) was assessed from a US third-party payer perspective. Clinical efficacy (change in HbA(1c) and lipids) and baseline cohort parameters were extracted from a 12-month, randomized clinical trial (Derosa et al., 2006) evaluating the efficacy and tolerability of pioglitazone versus rosiglitazone, both in addition to metformin, in adult T2DM patients with insufficient glucose control (n = 96). A Markov-based model was used to project clinical and economic outcomes over 35 years, discounted at 3% per annum. Costs for complications were taken from published sources. Base-case assumptions were assessed through several sensitivity analyses. Outcomes included incremental life-years, quality-adjusted life-years (QALYs), total direct medical costs, cumulative incidence of complications and associated costs, and incremental cost-effectiveness ratios (ICERs). Compared to rosiglitazone plus metformin, pioglitazone plus metformin was projected to result in a modest improvement in 0.187 quality-adjusted life-years. Over patients' lifetimes, total direct medical costs were projected to be marginally lower with pioglitazone plus metformin (difference -$526.), largely due to reduced CVD complication costs. While costs were higher among renal, ulcer/amputation/neuropathy, and eye complications in the pioglitazone plus metformin group, the cost savings for CVD complications outweighed their economic impact. Pioglitazone plus metformin was found to be a dominant long-term treatment strategy in the US compared to rosiglitazone plus metformin. Sensitivity analyses showed findings to be robust under almost all scenarios, including short-term time horizons, 6% discounting, removal of individual lipid parameters, and modifications of patient cohort to more closely represent a US T2DM population

  11. The application of NEPIS in evaluation of nuclear power generation cost

    Energy Technology Data Exchange (ETDEWEB)

    Do, J. W.; Kim, J. H.; Kim, Y. H. [Korea Hydro and Nuclear Power Company, Pusan (Korea, Republic of)

    2002-10-01

    IAEA(International Atomic Energy Agency) tried to evaluate generation cost by means of NEPIS (Nuclear Economic Performance International System) based on the ABC(Activity-Based Costing) method which has been developed since 1997 in order to cope with competition improvement of world nuclear power and operation environment. From that, the '98 O and M cost of Southern California Edison Co., and Vermont Yankee Nuclear Power Co., of U.S.A. was estimated to be 1.45 Cent/kWh and 2.3 Cent/kWh, respectively and that of Pacific Gas and Electric Co, of Hungary was 3.5 Cent/kWh. average '98 O and M Domestic nuclear power plant an was found to be 2.78 Cent/kWh. The standard O and M DB based on ABC might be required to evaluate domestic nuclear power plant O and M cost from NEPIS.

  12. Comparative and Cumulative Energetic Costs of Odontocete Responses to Anthropogenic Disturbance

    Science.gov (United States)

    2014-09-30

    predictive bioenergetic model of the metabolic costs of sound production across several cetacean species from the determination of the mass of sound...click sound production and the cost of sound production bioenergetic model will be completed, the estimates of cumulative impacts will be initiated...Consulting, Inc., and Maureen (Moe) Flannery at the California Academy of Sciences. These data will then be incorporated into a bioenergetic model

  13. Costs and financial benefits of video communication compared to usual care at home: a systematic review.

    Science.gov (United States)

    Peeters, José M; Mistiaen, Patriek; Francke, Anneke L

    2011-01-01

    We conducted a systematic review of video communication in home care to provide insight into the ratio between the costs and financial benefits (i.e. cost savings). Four databases (PUBMED, EMBASE, COCHRANE LIBRARY, CINAHL) were searched for studies on video communication for patients living at home (up to December 2009). Studies were only included when data about the costs of video communication as well as the financial benefits were presented. The methodological quality of the included studies was assessed. Nine studies, mainly conducted in the US, met the inclusion criteria. The methodological quality was poor, except for one study. Most studies (8 of the 9) did not demonstrate that the financial benefits were significantly greater than the costs of video communication. One study - the only one with a high methodological quality - found that costs for patients who received video communication were higher than for patients who received traditional care. The review found no evidence that the cost of implementing video communication in home care was lower than the resulting financial benefits. More methodologically well conducted research is needed.

  14. Comparative cost analyses: total flow vs other power conversion systems for the Salton Sea Geothermal Resource

    Energy Technology Data Exchange (ETDEWEB)

    Wright, G.W.

    1978-09-18

    Cost studies were done for Total Flow, double flash, and multistage flash binary systems for electric Energy production from the Salton Sea Geothermal Resource. The purpose was to provide the Department of energy's Division of Geothermal Energy with information by which to judge whether to continue development of the Total Flow system. Results indicate that the Total Flow and double flash systems have capital costs of $1,135 and $1,026 /kW with energy costs of 40.9 and 39.7 mills/kW h respectively. The Total Flow and double flash systems are not distinguishable on a cost basis alone; the multistage flash binary system, with capital cost of $1,343 /kW and energy cost of 46.9 mills/kW h, is significantly more expensive. If oil savings are considered in the total analysis, the Total Flow system could save 30% more oil than the double flash system, $3.5 billion at 1978 oil prices.

  15. Economic analysis including long-term risks and costs of alternative diagnostic strategies to evaluate patients with chest pain

    Science.gov (United States)

    Bedetti, Gigliola; Pasanisi, Emilio Maria; Pizzi, Carmine; Turchetti, Giuseppe; Loré, Cosimo

    2008-01-01

    Background Diagnosis costs for cardiovascular disease waste a large amount of healthcare resources. The aim of the study is to evaluate the clinical and economic outcomes of alternative diagnostic strategies in low risk chest pain patients. Methods We evaluated direct and indirect downstream costs of 6 strategies: coronary angiography (CA) after positive troponin I or T (cTn-I or cTnT) (strategy 1); after positive exercise electrocardiography (ex-ECG) (strategy 2); after positive exercise echocardiography (ex-Echo) (strategy 3); after positive pharmacologic stress echocardiography (PhSE) (strategy 4); after positive myocardial exercise stress single-photon emission computed tomography with technetium Tc 99m sestamibi (ex-SPECT-Tc) (strategy 5) and direct CA (strategy 6). Results The predictive accuracy in correctly identifying the patients was 83,1% for cTn-I, 87% for cTn-T, 85,1% for ex-ECG, 93,4% for ex-Echo, 98,5% for PhSE, 89,4% for ex-SPECT-Tc and 18,7% for CA. The cost per patient correctly identified results $2.051 for cTn-I, $2.086 for cTn-T, $1.890 for ex-ECG, $803 for ex-Echo, $533 for PhSE, $1.521 for ex-SPECT-Tc ($1.634 including cost of extra risk of cancer) and $29.673 for CA ($29.999 including cost of extra risk of cancer). The average relative cost-effectiveness of cardiac imaging compared with the PhSE equal to 1 (as a cost comparator), the relative cost of ex-Echo is 1.5×, of a ex-SPECT-Tc is 3.1×, of a ex-ECG is 3.5×, of cTnI is ×3.8, of cTnT is ×3.9 and of a CA is 56.3×. Conclusion Stress echocardiography based strategies are cost-effective versus alternative imaging strategies and the risk and cost of radiation exposure is void. PMID:18510723

  16. Economic analysis including long-term risks and costs of alternative diagnostic strategies to evaluate patients with chest pain

    Directory of Open Access Journals (Sweden)

    Pizzi Carmine

    2008-05-01

    Full Text Available Abstract Background Diagnosis costs for cardiovascular disease waste a large amount of healthcare resources. The aim of the study is to evaluate the clinical and economic outcomes of alternative diagnostic strategies in low risk chest pain patients. Methods We evaluated direct and indirect downstream costs of 6 strategies: coronary angiography (CA after positive troponin I or T (cTn-I or cTnT (strategy 1; after positive exercise electrocardiography (ex-ECG (strategy 2; after positive exercise echocardiography (ex-Echo (strategy 3; after positive pharmacologic stress echocardiography (PhSE (strategy 4; after positive myocardial exercise stress single-photon emission computed tomography with technetium Tc 99m sestamibi (ex-SPECT-Tc (strategy 5 and direct CA (strategy 6. Results The predictive accuracy in correctly identifying the patients was 83,1% for cTn-I, 87% for cTn-T, 85,1% for ex-ECG, 93,4% for ex-Echo, 98,5% for PhSE, 89,4% for ex-SPECT-Tc and 18,7% for CA. The cost per patient correctly identified results $2.051 for cTn-I, $2.086 for cTn-T, $1.890 for ex-ECG, $803 for ex-Echo, $533 for PhSE, $1.521 for ex-SPECT-Tc ($1.634 including cost of extra risk of cancer and $29.673 for CA ($29.999 including cost of extra risk of cancer. The average relative cost-effectiveness of cardiac imaging compared with the PhSE equal to 1 (as a cost comparator, the relative cost of ex-Echo is 1.5×, of a ex-SPECT-Tc is 3.1×, of a ex-ECG is 3.5×, of cTnI is ×3.8, of cTnT is ×3.9 and of a CA is 56.3×. Conclusion Stress echocardiography based strategies are cost-effective versus alternative imaging strategies and the risk and cost of radiation exposure is void.

  17. Comparative Evaluation of Remineralizing Potential of Three Pediatric Dentifrices

    Science.gov (United States)

    Kapoor, Ashna; Indushekar, KR; Saraf, Bhavna G; Sheoran, Neha

    2016-01-01

    Introduction Dentifrices are available in different formulations and more commonly a single dentifrice is used by whole family; be it an adult or child. However, concerns over high fluoride in pediatric formulations coupled with inability of the children to spit have led to recommendations to minimize fluoride ingestion during toothbrushing by using a small amount of toothpaste by children and incorporating minimal quantity of fluoride in the toothpastes. Literature is scarce on the remineralization potential of popularly known Indian pediatric dentifrices; hence, pediatric dentifrices containing lesser concentration of fluoride have been marketed relatively recently for the benefit of children without posing a threat of chronic fluoride toxicity at the same time. Aim and objectives The present study was undertaken to evaluate and compare the remineralization potential of three commercially available Indian pediatric dentifrices with different compositions on artificially induced carious lesions in vitro through scanning electron microscopy (SEM). Materials and methods The present in vitro study was conducted on 45 sound extracted primary molar surfaces divided into three groups (15 each). Artificial demineralization was carried out, followed by remineralization using dentifrice slurry as per the group allocation. All the samples were studied for remineralization using SEM and the results statistically compared. Results All three dentifrices tested showed remineralization; although insignificantly different from each other but significantly higher compared to the demineralizing surface. Conclusion One can use pediatric dentifrices for preventing dental caries and decelerating lesion progression with an added advantage of lower fluoride toxicity risk. How to cite this article Kapoor A, Indushekar KR, Saraf BG, Sheoran N, Sardana D. Comparative Evaluation of Remineralizing Potential of Three Pediatric Dentifrices. Int J Clin Pediatr Dent 2016;9(3):186-191. PMID

  18. Review of Australian health economic evaluation – 245 interventions: what can we say about cost effectiveness?

    Directory of Open Access Journals (Sweden)

    Mortimer Duncan

    2008-05-01

    Full Text Available Abstract Background There is an increasing body of published cost-utility analyses of health interventions which we sought to draw together to inform research and policy. Methods To achieve consistency in costing base and policy context, study scope was limited to Australian-based cost-effectiveness analyses. Through a comprehensive literature review we identified 245 health care interventions that met our study criteria. Results The median cost-effectiveness ratio was A$18,100 (~US$13,000 per QALY/DALY/LY (quality adjusted life year gained or, disability adjusted life year averted or life year gained. Some modalities tended to perform worse, such as vaccinations and diagnostics (median cost/QALY $58,000 and $68,000 respectively, than others such as allied health, lifestyle, in-patient interventions (median cost/QALY/DALY/LY all at ~A$9,000~US$6,500. Interventions addressing some diseases such as diabetes and impaired glucose tolerance or alcohol and drug dependence tended to perform well (median cost/QALY/DALY/LY 25 years (median cost/QALY/DALY/LY Conclusion For any given condition, modality or setting there are likely to be examples of interventions that are cost effective and cost ineffective. It will be important for decision makers to make decisions based on the individual merits of an intervention rather than rely on broad generalisations. Further evaluation is warranted to address gaps in the literature and to ensure that evaluations are performed in areas with greatest potential benefit.

  19. Caries and costs: an evaluation of a school-based fluoride varnish programme for adolescents in a Swedish region.

    Science.gov (United States)

    Bergström, E K; Lingström, P; Hakeberg, M; Gahnberg, L; Sköld, U M

    2016-06-01

    In 2003, 19 public dental clinics in Västra Götaland Region implemented a population-based programme with fluoride varnish applications at school every six months, for all 12 to 15 year olds. In 2008, the programme was extended to include all 112 clinics in the region. To evaluate caries increment and to perform a cost analysis of the programme. A retrospective design with caries data for two birth cohorts extracted from dental records. Three groups of adolescents were compared. For Group 1 (n = 3,132), born in 1993, the fluoride varnish programme started in 2003 and Group 2 (n = 13,490), also born in 1993, had no fluoride varnish programme at school. These groups were compared with Group 3 (n = 11,321), born in 1998, when the programme was implemented for all individuals. The total cost of the four-year programme was estimated at 400SEK (≈ 44€) per adolescent. Caries prevalence and caries increment in 15 year olds were significantly lower after the implementation of the programme. Group 2, without a programme, had the highest caries increment. The cost analysis showed that it was a break-even between costs and gains due to prevented fillings at the age of 15. This school-based fluoride varnish programme, implemented on a broad scale for all 12 to 15 year olds, contributed to a low caries increment at a low cost for the adolescents in the Västra Götaland Region in Sweden.

  20. You never compare alone: How social consensus and comparative context affect self-evaluation

    Directory of Open Access Journals (Sweden)

    Grabowski Adam

    2014-06-01

    Full Text Available Three studies address the role of social consensus on evaluative standards in different comparative contexts. Previous research has documented that self-categorisation at the individual or group level changes social comparison effects in terms of assimilation and contrast. With regard to self-ratings of physical attractiveness, the present studies show that people who focus on group membership can benefit from including outstanding others in their reference group, whereas people who focus on their individual attributes run the risk of self-devaluation. It is argued that high consensus strengthens the association between evaluative standards and group membership and renders the inclusion of outstanding others more likely. Study 3 shows that the need to protect self-esteem moderates the influence of perceived consensus. Stressing the individual self led participants who received negative feedback to exclude outstanding others when consensus was low. Stressing the social self, however, led participants to include outstanding others when consensus was high.

  1. Usability evaluation of low-cost virtual reality hand and arm rehabilitation games

    OpenAIRE

    Na Jin Seo, PhD; Jayashree Arun Kumar, MS; Pilwon Hur, PhD; Vincent Crocher, PhD; Binal Motawar, PT, MS; Kishor Lakshminarayanan, MS

    2016-01-01

    The emergence of lower-cost motion tracking devices enables home-based virtual reality rehabilitation activities and increased accessibility to patients. Currently, little documentation on patients' expectations for virtual reality rehabilitation is available. This study surveyed 10 people with stroke for their expectations of virtual reality rehabilitation games. This study also evaluated the usability of three lower-cost virtual reality rehabilitation games using a survey and House of Quali...

  2. Evaluation of Cost-Effectiveness Criteria in Supply Chain Management: Case Study

    OpenAIRE

    Reza Rostamzadeh; Mahdi Sabaghi; Ahmad Esmaili

    2013-01-01

    The aim of this paper is to evaluate and prioritize the proposed cost-effectiveness criteria in supply chain management using fuzzy multiple attribute decision-making (MADM) approach. Over the past few years, the determination of suitable cost-effectiveness criteria in the supply chain has become a key strategic issue. However, the nature of these kinds of decisions is usually complex and unstructured. Many quantitative and qualitative factors must be considered to determine the suitable crit...

  3. The Boundary and Object for Evaluation on Environmental Cost for Commercial Plantation

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    The improper cultivation of commercial plantation, which is a management activity with the properties of economy, will lead to environment losses such as land degradation, soil erosion, pests and diseases. Environmental cost is easily neglected by executives, however, it exists actually. The variety, intersecting and overlapping of environment losses decide the boundary of evaluation and the necessity of indices on environmental cost. The research analyzes the characteristics and disciplinarians of envi...

  4. Multi-dimensional project evaluation: Combining cost-benefit analysis and multi-criteria analysis with the COSIMA software system

    DEFF Research Database (Denmark)

    down a problem into its constituent parts in order to better understand the problem and consequently arrive at a decision. However, while MCA opens up for the possibility to include non-market impacts, it does not provide the decision makers with guidance combining the CBA with MCA. In the paper...... in a valuating all the criteria in monetary terms. Thus CBA does not meet the need for a comprehensive evaluation, for which reason MCA is introduced to overcome this problem. Not only does MCA provides an opportunity to include non-market impacts in the analysis, but MCA also provides a framework for breaking......, citizens in Nuuk and other citizens in Greenland) are examined and compared. The cost-benefit analysis of the three airport alternatives includes impacts like travel time (for business and local travellers), waiting time, drawback of shifts, regularity, out of pocket costs, operating costs...

  5. The cost of crime to society: new crime-specific estimates for policy and program evaluation.

    Science.gov (United States)

    McCollister, Kathryn E; French, Michael T; Fang, Hai

    2010-04-01

    Estimating the cost to society of individual crimes is essential to the economic evaluation of many social programs, such as substance abuse treatment and community policing. A review of the crime-costing literature reveals multiple sources, including published articles and government reports, which collectively represent the alternative approaches for estimating the economic losses associated with criminal activity. Many of these sources are based upon data that are more than 10 years old, indicating a need for updated figures. This study presents a comprehensive methodology for calculating the cost to society of various criminal acts. Tangible and intangible losses are estimated using the most current data available. The selected approach, which incorporates both the cost-of-illness and the jury compensation methods, yields cost estimates for more than a dozen major crime categories, including several categories not found in previous studies. Updated crime cost estimates can help government agencies and other organizations execute more prudent policy evaluations, particularly benefit-cost analyses of substance abuse treatment or other interventions that reduce crime.

  6. CHARACTERIZATION AND EVALUATION OF TIME-DRIVEN ACTIVITY BASED COSTING BASED ON ABC’S DEVELOPMENT

    DEFF Research Database (Denmark)

    Israelsen, Poul; Kristensen, Thomas Borup

    2014-01-01

    The paper provides a description of the development of Activity Based Costing (ABC) in four variants. This is used to characterize and evaluated the changes made in Time-Driven ABC (TDABC). It is found that TDABC in some cases reaches back to cost calculations prior to ABC (e.g. homogenous...... departments instead of activities), in other features to the early development of ABC (transaction driver versus more sophisticated drivers), and in yet other areas to methods outside regular ABC techniques, i.e. standard variable costing. All in all TDABC is argued to be an improvement vis-à-vis ABC...

  7. Paying for convenience: comparing the cost of takeaway meals with their healthier home-cooked counterparts in New Zealand.

    Science.gov (United States)

    Mackay, Sally; Vandevijvere, Stefanie; Xie, Pei; Lee, Amanda; Swinburn, Boyd

    2017-09-01

    Convenience and cost impact on people's meal decisions. Takeaway and pre-prepared foods save preparation time but may contribute to poorer-quality diets. Analysing the impact of time on relative cost differences between meals of varying convenience contributes to understanding the barrier of time to selecting healthy meals. Six popular New Zealand takeaway meals were identified from two large national surveys and compared with similar, but healthier, home-made and home-assembled meals that met nutrition targets consistent with New Zealand Eating and Activity Guidelines. The cost of each complete meal, cost per kilogram, and confidence intervals of the cost of each meal type were calculated. The time-inclusive cost was calculated by adding waiting or preparation time cost at the minimum wage. A large urban area in New Zealand. For five of six popular meals, the mean cost of the home-made and home-assembled meals was cheaper than the takeaway meals. When the cost of time was added, all home-assembled meal options were the cheapest and half of the home-made meals were at least as expensive as the takeaway meals. The home-prepared meals were designed to provide less saturated fat and Na and more vegetables than their takeaway counterparts; however, the home-assembled meals provided more Na than the home-made meals. Healthier home-made and home-assembled meals were, except one, cheaper options than takeaways. When the cost of time was added, either the home-made or the takeaway meal was the most expensive. This research questions whether takeaways are better value than home-prepared meals.

  8. Resource utilization and costs associated with the diagnostic evaluation of nonrefluxing primary hydronephrosis in infants.

    Science.gov (United States)

    Akhavan, Ardavan; Shnorhavorian, Margarett; Garrison, Louis P; Merguerian, Paul A

    2014-09-01

    Long-term evaluation of postnatal nonrefluxing primary hydronephrosis presents a dilemma for urologists since most cases resolve without surgery. We report longitudinal resource utilization and costs associated with diagnostic evaluation of infants with isolated primary nonrefluxing hydronephrosis to determine the costs associated with diagnosing a surgical case, and we assess the implications using a cost-consequences analysis. A retrospective chart review was used to capture resource utilization for all patients younger than 6 months with hydronephrosis evaluated at our institution during a 5-year period. Infants with confounding urological diagnoses were excluded. Payer and societal perspectives were used. Costs were estimated from resource utilization, including radiographic imaging and clinical encounter types. Data were collected from first clinic visit until surgery or resolution or 3 years, whichever was shortest. Of 165 included patients surgical rates for hydronephrosis were 0% for grade I, 5% for grade II, 21% for grade III and 74% for grade IV. Median respective costs of identifying a single surgical case per increasing hydronephrosis grade 0 to IV were infinite, $37,600, $11,741 and $2,124 (p costs. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  9. Soil metaproteomics - Comparative evaluation of protein extraction protocols.

    Science.gov (United States)

    Keiblinger, Katharina M; Wilhartitz, Inés C; Schneider, Thomas; Roschitzki, Bernd; Schmid, Emanuel; Eberl, Leo; Riedel, Kathrin; Zechmeister-Boltenstern, Sophie

    2012-11-01

    Metaproteomics and its potential applications are very promising to study microbial activity in environmental samples and to obtain a deeper understanding of microbial interactions. However, due to the complexity of soil samples the exhaustive extraction of proteins is a major challenge. We compared soil protein extraction protocols in terms of their protein extraction efficiency for two different soil types. Four different protein extraction procedures were applied based on (a) SDS extraction without phenol, (b) NaOH and subsequent phenol extraction, (c) SDS-phenol extraction and (d) SDS-phenol extraction with prior washing steps. To assess the suitability of these methods for the functional analysis of the soil metaproteome, they were applied to a potting soil high in organic matter and a forest soil. Proteins were analyzed by two-dimensional liquid chromatography/tandem mass spectrometry (2D-LC-MS/MS) and the number of unique spectra as well as the number of assigned proteins for each of the respective protocols was compared. In both soil types, extraction with SDS-phenol (c) resulted in "high" numbers of proteins. Moreover, a spiking experiment was conducted to evaluate protein recovery. To this end sterilized forest soil was amended with proteins from pure cultures of Pectobacterium carotovorum and Aspergillus nidulans. The protein recovery in the spiking experiment was almost 50%. Our study demonstrates that a critical evaluation of the extraction protocol is crucial for the quality of the metaproteomics data, especially in highly complex samples like natural soils.

  10. A Comparative Evaluation of Microleakage in Class V Composite Restorations

    Directory of Open Access Journals (Sweden)

    Sujatha Gopal Sooraparaju

    2014-01-01

    Full Text Available Aim. To compare and evaluate the microleakage in class V lesions restored with composite resin with and without liner and injectable nanohybrid composite resin. Materials and Methodology. 60 class V cavities were prepared in 30 freshly extracted teeth. After etching and application of bonding agents these cavities were divided into three groups: Group A (n=20—restored with composite resin, Group B (n=20—flowable composite resin liner + composite resin, and Group C (n=20—restored with injectable composite resin. After curing all the specimens were subjected to thermocycling and cyclic loading. Specimens were stained with 0.5% basic fuchsin and evaluated for dye penetration. Results. Results are subjected to Kruskal Wallis and Wilcoxon test. Conclusion. Within the limitations of this study, none of the three materials were free from microleakage. All the three materials showed more microleakage at gingival margins compared to occlusal margins. Among all the groups G-ænial Flo showed the least microleakage at the gingival wall.

  11. The Costs and Benefits of Substance Abuse Treatment: Findings from the National Treatment Improvement Evaluation Study (NTIES).

    Science.gov (United States)

    Koenig, Lane; Denmead, Gabrielle; Nguyen, Robert; Harrison, Margaret; Harwood, Henrick

    This study seeks to quantify the costs and benefits of alcohol and drug abuse treatment and the resulting economic benefits to society. Using data from the National Treatment Improvement Evaluation Study (NTIES), and client questionnaires, estimates were made of the average costs per client in terms of crime-related costs, health care costs, and…

  12. Evaluating the effectiveness of low cost UAV generated topography for geomorphic change detection

    Science.gov (United States)

    Cook, K. L.

    2014-12-01

    With the recent explosion in the use and availability of unmanned aerial vehicle platforms and development of easy to use structure from motion software, UAV based photogrammetry is increasingly being adopted to produce high resolution topography for the study of surface processes. UAV systems can vary substantially in price and complexity, but the tradeoffs between these and the quality of the resulting data are not well constrained. We look at one end of this spectrum and evaluate the effectiveness of a simple low cost UAV setup for obtaining high resolution topography in a challenging field setting. Our study site is the Daan River gorge in western Taiwan, a rapidly eroding bedrock gorge that we have monitored with terrestrial Lidar since 2009. The site presents challenges for the generation and analysis of high resolution topography, including vertical gorge walls, vegetation, wide variation in surface roughness, and a complicated 3D morphology. In order to evaluate the accuracy of the UAV-derived topography, we compare it with terrestrial Lidar data collected during the same survey period. Our UAV setup combines a DJI Phantom 2 quadcopter with a 16 megapixel Canon Powershot camera for a total platform cost of less than $850. The quadcopter is flown manually, and the camera is programmed to take a photograph every 5 seconds, yielding 200-250 pictures per flight. We measured ground control points and targets for both the Lidar scans and the aerial surveys using a Leica RTK GPS with 1-2 cm accuracy. UAV derived point clouds were obtained using Agisoft Photoscan software. We conducted both Lidar and UAV surveys before and after a summer typhoon season, allowing us to evaluate the reliability of the UAV survey to detect geomorphic changes in the range of one to several meters. We find that this simple UAV setup can yield point clouds with an average accuracy on the order of 10 cm compared to the Lidar point clouds. Well-distributed and accurately located ground

  13. Cost evaluation of therapeutic drug monitoring of gentamicin at a teaching hospital in Malaysia

    Directory of Open Access Journals (Sweden)

    Ibrahim MI

    2014-03-01

    Full Text Available Background: Therapeutic drug monitoring (TDM makes use of serum drug concentrations as an adjunct to decision-making. Preliminary data in our hospital showed that approximately one-fifth of all drugs monitored by TDM service were gentamicin. Objective: In this study, we evaluated the costs associated with providing the service in patients with bronchopneumonia and treated with gentamicin. Methods: We retrospectively collected data from medical records of patients admitted to the Hospital Universiti Sains Malaysia over a 5-year period. These patients were diagnosed with bronchopneumonia and were on gentamicin as part of their treatment. Five hospitalisation costs were calculated; (i cost of laboratory and clinical investigations, (ii cost associated with each gentamicin dose, (iii fixed and operating costs of TDM service, (iv cost of providing medical care, and (v cost of hospital stay during gentamicin treatment. Results: There were 1920 patients admitted with bronchopneumonia of which 67 (3.5% had TDM service for gentamicin. Seventy-three percent (49/67 patients were eligible for final analysis. The duration of gentamicin therapy ranged from 3 to 15 days. The cost of providing one gentamicin assay was MYR25, and the average cost of TDM service for each patient was MYR104. The average total hospitalisation cost during gentamicin treatment for each patient was MYR442 (1EUR approx. MYR4.02. Conclusion: Based on the hospital perspective, in patients with bronchopneumonia and treated with gentamicin, the provision of TDM service contributes to less than 25% of the total cost of hospitalization.

  14. [An evaluation of costs in nephrology by means of analytical accounting system].

    Science.gov (United States)

    Hernández-Jaras, J; García Pérez, H; Pons, R; Calvo, C

    2005-01-01

    The analytical accounting is a countable technique directed to the evaluation, by means of pre-established criteria of distribution, of the internal economy of the hospital, in order to know the effectiveness and efficiency of Clinical Units. The aim of this study was to analyze the activity and costs of the Nephrology Department of General Hospital of Castellón. Activity of Hospitalization and Ambulatory Care, during 2003 was analysed. Hospitalization discharges were grouped in DGR and the costs per DGR were determinated. Total costs Hospitalisation and Ambulatory Care were 560.434,9 and 146.317,8 Euros, respectively. And the costs of one stay, one first outpatient visit and maintenance visit were 200, 63, and 31,6 Euros, respectively. Eighty per cent of the discharges were grouped in 9 DGR and DRG number 316 (Renal Failure) represented 30% of the total productivity. Costs of DGR 316 were 3.178,2 Euros and 16% represented laboratory cost and costs of diagnostic or therapeutic procedures. With introduction of analytical accounting and DGR system, the Nephrology Departments can acquire more full information on the results and costs of treatment. These techniques permits to improve the financial and economic performance.

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

    Science.gov (United States)

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

    2011-06-01

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

  16. Evaluation of trade-offs in costs and environmental impacts for returnable packaging implementation

    Science.gov (United States)

    Jarupan, Lerpong; Kamarthi, Sagar V.; Gupta, Surendra M.

    2004-02-01

    The main thrust of returnable packaging these days is to provide logistical services through transportation and distribution of products and be environmentally friendly. Returnable packaging and reverse logistics concepts have converged to mitigate the adverse effect of packaging materials entering the solid waste stream. Returnable packaging must be designed by considering the trade-offs between costs and environmental impact to satisfy manufacturers and environmentalists alike. The cost of returnable packaging entails such items as materials, manufacturing, collection, storage and disposal. Environmental impacts are explicitly linked with solid waste, air pollution, and water pollution. This paper presents a multi-criteria evaluation technique to assist decision-makers for evaluating the trade-offs in costs and environmental impact during the returnable packaging design process. The proposed evaluation technique involves a combination of multiple objective integer linear programming and analytic hierarchy process. A numerical example is used to illustrate the methodology.

  17. Trial-based cost-effectiveness analysis comparing surgical and endoscopic drainage in patients with obstructive chronic pancreatitis

    Science.gov (United States)

    Laramée, Philippe; Wonderling, David; Cahen, Djuna L; Dijkgraaf, Marcel G; Gouma, Dirk J; Bruno, Marco J; Pereira, Stephen P

    2013-01-01

    Objective Published evidence indicates that surgical drainage of the pancreatic duct was more effective than endoscopic drainage for patients with chronic pancreatitis. This analysis assessed the cost-effectiveness of surgical versus endoscopic drainage in obstructive chronic pancreatitis. Design This trial-based cost-utility analysis (ISRCTN04572410) was conducted from a UK National Health Service (NHS) perspective and during a 79-month time horizon. During the trial the details of the diagnostic and therapeutic procedures, and pancreatic insufficiency were collected. The resource use was varied in the sensitivity analysis based on a review of the literature. The health outcome was the Quality-Adjusted Life Year (QALY), generated using EQ-5D data collected during the trial. There were no pancreas-related deaths in the trial. All-cause mortality from the trial was incorporated into the QALY estimates in the sensitivity analysis. Setting Hospital. Participants Patients with obstructive chronic pancreatitis. Primary and secondary outcome measures Costs, QALYs and cost-effectiveness. Results The result of the base-case analysis was that surgical drainage dominated endoscopic drainage, being both more effective and less costly. The sensitivity analysis varied mortality and resource use and showed that the surgical option remained dominant in all scenarios. The probability of cost-effectiveness for surgical drainage was 100% for the base case and 82% in the assessed most conservative case scenario. Conclusions In obstructive chronic pancreatitis, surgical drainage is highly cost-effective compared with endoscopic drainage from a UK NHS perspective. PMID:24065699

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

    Directory of Open Access Journals (Sweden)

    Laura Pirhonen

    2014-06-01

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

  19. A comparative analysis of revenue and cost-management strategies of not-for-profit and for-profit hospitals.

    Science.gov (United States)

    Shukla, R K; Pestian, J; Clement, J

    1997-01-01

    Not-for-profit (NFP) and for-profit (FP) hospitals were compared on several performance indicators including revenues, costs, productivity/efficiency, and profitability. The indicators were adjusted, where appropriate, for outpatient activity and a case-mix index for all patients. FP hospitals had higher profit margins as well as higher gross and net revenues per case-mix adjusted admission. On the other hand, NFP hospitals had lower total cost per case-mix adjusted admission even after subtracting taxes from FP hospital costs. There were no significant differences between the two groups on efficiency and productivity indicators--paid hours per case-mix adjusted admissions, occupancy levels, and case-mix adjusted ALOS. The higher profits of FP hospitals were attributed to revenue management rather than cost and efficiency management.

  20. Unrelated medical costs in life-years gained : should they be included in economic evaluations of healthcare interventions?

    NARCIS (Netherlands)

    Rappange, David R; van Baal, Pieter H M; van Exel, N Job A; Feenstra, Talitha L; Rutten, Frans F H; Brouwer, Werner B F

    2008-01-01

    Which costs and benefits to consider in economic evaluations of healthcare interventions remains an area of much controversy. Unrelated medical costs in life-years gained is an important cost category that is normally ignored in economic evaluations, irrespective of the perspective chosen for the an

  1. Comparing Usage and Cost- Effectiveness Analysis of English Printed and Electronic Books for University of Tehran

    Directory of Open Access Journals (Sweden)

    Davoud Haseli

    2014-09-01

    The result showed that the use of English printed books has different in four subject areas of Engineering, Sciences, Social and Behavioral Sciences, and Humanities, unlike English ebooks. The average of use of the printed books in Social and behavioral sciences Was 1.09, and it shows the most among all, and for Sciences, was only 0.14, this is the minimum among. 20 percent of English printed books have been used and the mean for total printed books was 0.77. 52 percent of ebooks have been used, and the average of use of ebooks was 5.16, respectively. So the use and cost- effectiveness analysis of English ebooks are more than English print books. The uses statistics and cost analysis showed that cost per use for English printed books is 787168 Rial and for ebooks is 80,388.

  2. Health economic evaluations comparing insulin glargine with NPH insulin in patients with type 1 diabetes: a systematic review

    Directory of Open Access Journals (Sweden)

    Dippel Franz-Werner

    2011-10-01

    Full Text Available Abstract Background Compared to conventional human basal insulin (neutral protamine Hagedorn; NPH the long-acting analogue insulin glargine (GLA is associated with a number of advantages regarding metabolic control, hypoglycaemic events and convenience. However, the unit costs of GLA exceed those of NPH. This study aims to systematically review the economic evidence comparing GLA with NPH in basal-bolus treatment (intensified conventional therapy; ICT of type 1 diabetes in order to facilitate informed decision making in clinical practice and health policy. Methods A systematic literature search was performed for the period of January 1st 2000 to December 1st 2009 via Embase, Medline, the Cochrane Library, the databases GMS (German Medical Science and DAHTA (Deutsche Agentur für Health Technology Assessment, and the abstract books of relevant international scientific congresses. Retrieved studies were reviewed based on predefined inclusion criteria, methodological and quality aspects. In order to allow comparison between studies, currencies were converted using purchasing power parities (PPP. Results A total of 7 health economic evaluations from 4 different countries fulfilled the predefined criteria: 6 modelling studies, all of them cost-utility analyses, and one claims data analysis with a cost-minimisation design. One cost-utility analysis showed dominance of GLA over NPH. The other 5 cost-utility analyses resulted in additional costs per quality adjusted life year (QALY gained for GLA, ranging from € 3,859 to € 57,002 (incremental cost effectiveness ratio; ICER. The cost-minimisation analysis revealed lower annual diabetes-specific costs in favour of NPH from the perspective of the German Statutory Health Insurance (SHI. Conclusions The incremental cost-utility-ratios (ICER show favourable values for GLA with considerable variation. If a willingness-to-pay threshold of £ 30,000 (National Institute of Clinical Excellence, UK is adopted

  3. Organ donation as an outcome of traumatic cardiopulmonary arrest: A cost evaluation.

    Science.gov (United States)

    Love, Katie M; Brown, Joshua B; Harbrecht, Brian G; Muldoon, Susan B; Miller, Keith R; Benns, Matthew V; Smith, Jason W; Baker, Christopher E; Franklin, Glen A

    2016-05-01

    Survival after traumatic cardiopulmonary arrest (TCPA) is rare and requires significant resource expenditure. Organ donation as an outcome of TCPA resuscitation has not yet been included in a cost analysis. The aims of this study were to identify variables associated with survival and organ donation after TCPA, and to estimate the cost of achieving these outcomes. We hypothesized that the inclusion of organ donation as a potential outcome would make TCPA resuscitation more cost-effective. Adult patients who required resuscitation for TCPA at a level I trauma center were retrospectively reviewed over 36 months. Data were obtained from medical records, hospital accounting records, and the local organ procurement agency. Outcomes included survival to discharge, neurologic function, and organ donor eligibility. An individual-level state-transition cost-effectiveness model was used to evaluate the cost of TCPA resuscitation with and without organ donation included as an outcome. Incremental cost-effectiveness ratio was calculated to determine additional cost per life saved when organ donation is included. Over the study period, 8,932 subjects were evaluated. Traumatic cardiopulmonary arrest occurred in 237 patients (3%). The mortality rate was 97%. Variables associated with survival included emergency department disposition to the operating room (p organ donation with a procurement rate of 2%. Organ donor eligibility was associated with arrest after arrival to the emergency department (p donation was $538,000. The incremental cost-effectiveness ratio was $76,816 per additional life saved including donation as an outcome. The decision to pursue resuscitation should continue to be based on the presence of signs of life, especially pupil reactivity and duration of arrest. If the primary objective is survival, organ procurement will be maximized without conflict of interest. Early fresh frozen plasma transfusion may increase successful organ donation. The financial burden

  4. Patient level cost of diabetes self-management education programmes: an international evaluation.

    Science.gov (United States)

    Doyle, Gerardine; O'Donnell, Shane; Quigley, Etáin; Cullen, Kate; Gibney, Sarah; Levin-Zamir, Diane; Ganahl, Kristin; Müller, Gabriele; Muller, Ingrid; Maindal, Helle Terkildsen; Chang, Wushou Peter; Van Den Broucke, Stephan

    2017-06-04

    The objective of this study was to examine the value of time-driven activity-based costing (TDABC) in understanding the process and costs of delivering diabetes self-management education (DSME) programmes in a multicountry comparative study. Outpatient settings in five European countries (Austria, Denmark, Germany, Ireland, UK) and two countries outside Europe, Taiwan and Israel. Providers of DSME programmes across participating countries (N=16) including healthcare professionals, administrators and patients taking part in DSME programmes. Primary measure: time spent by providers in the delivery of DSME and resources consumed in order to compute programme costs. Secondary measures: self-report measures of behavioural self-management and diabetes disease/health-related outcomes. We found significant variation in costs and the processes of how DSME programmes are provided across and within countries. Variations in costs were driven by a combination of price variances, mix of personnel skill and efficiency variances. Higher cost programmes were not found to have achieved better relative outcomes. The findings highlight the value of TDABC in calculating a patient level cost and potential of the methodology to identify process improvements in guiding the optimal allocation of scarce resources in diabetes care, in particular for DSME that is often underfunded. This study is the first to measure programme costs using estimates of the actual resources used to educate patients about managing their medical condition and is the first study to map such costs to self-reported behavioural and disease outcomes. The results of this study will inform clinicians, managers and policy makers seeking to enhance the delivery of DSME programmes. The findings highlight the benefits of adopting a TDABC approach to understanding the drivers of the cost of DSME programmes in a multicountry study to reveal opportunities to bend the cost curve for DSME. © Article author(s) (or their employer

  5. Cost analysis of the surgical treatment of fractures of the proximal humerus: an evaluation of the determinants of cost and comparison of the institutional cost of treatment with the national tariff.

    Science.gov (United States)

    Sabharwal, S; Carter, A W; Rashid, A; Darzi, A; Reilly, P; Gupte, C M

    2016-02-01

    The aims of this study were to estimate the cost of surgical treatment of fractures of the proximal humerus using a micro-costing methodology, contrast this cost with the national reimbursement tariff and establish the major determinants of cost. A detailed inpatient treatment pathway was constructed using semi-structured interviews with 32 members of hospital staff. Its content validity was established through a Delphi panel evaluation. Costs were calculated using time-driven activity-based costing (TDABC) and sensitivity analysis was performed to evaluate the determinants of cost The mean cost of the different surgical treatments was estimated to be £3282. Although this represented a profit of £1138 against the national tariff, hemiarthroplasty as a treatment choice resulted in a net loss of £952. Choice of implant and theatre staffing were the largest cost drivers. Operating theatre delays of more than one hour resulted in a loss of income Our findings indicate that the national tariff does not accurately represent the cost of treatment for this condition. Effective use of the operating theatre and implant discounting are likely to be more effective cost containment approaches than control of bed-day costs. This cost analysis of fractures of the proximal humerus reinforces the limitations of the national tariff within the English National Health Service, and underlines the importance of effective use of the operating theatre, as well as appropriate implant procurement where controlling costs of treatment is concerned. ©2016 The British Editorial Society of Bone & Joint Surgery.

  6. On the evaluation of expected performance cost for partially observed closed-loop stochastic systems

    Science.gov (United States)

    Bayard, D. S.; Eslami, M.

    1985-01-01

    New methods are presented for evaluating the expected performance cost of partially observed closed-loop stochastic systems. When the variances of the process statistics are small, a linearized model of the closed-loop stochastic system is defined for which the expected cost can be evaluated by recursion on a set of purely deterministic difference equations. When the variances of the process statistics are large, the linearized model can be used in the control variate method of variance reduction for reducing the number of sample paths required for effective Monte Carlo estimation.

  7. Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland.

    Science.gov (United States)

    Retèl, Valesca P; van den Boer, Cindy; Steuten, Lotte M G; Okła, Sławomir; Hilgers, Frans J; van den Brekel, Michiel W

    2015-09-01

    The beneficial physical and psychosocial effects of heat and moisture exchangers (HMEs) for pulmonary rehabilitation of laryngectomy patients are well evidenced. However, cost-effectiveness in terms of costs per additional quality-adjusted life years (QALYs) has not yet been investigated. Therefore, a model-based cost-effectiveness analysis of using HMEs versus usual care (UC) (including stoma covers, suction system and/or external humidifier) for patients after laryngectomy was performed. Primary outcomes were costs, QALYs and incremental cost-effectiveness ratio (ICER). Secondary outcomes were pulmonary infections, and sleeping problems. The analysis was performed from a health care perspective of Poland, using a time horizon of 10 years and cycle length of 1 year. Transition probabilities were derived from various sources, amongst others a Polish randomized clinical trial. Quality of life data was derived from an Italian study on similar patients. Data on frequencies and mortality-related tracheobronchitis and/or pneumonia were derived from a Europe-wide survey amongst head and neck cancer experts. Substantial differences in quality-adjusted survival between the use of HMEs (3.63 QALYs) versus UC (2.95 QALYs) were observed. Total health care costs/patient were 39,553 PLN (9465 Euro) for the HME strategy and 4889 PLN (1168 Euro) for the UC strategy. HME use resulted in fewer pulmonary infections, and less sleeping problems. We could conclude that given the Polish threshold of 99,000 PLN/QALY, using HMEs is cost-effective compared to UC, resulting in 51,326 PLN/QALY (12,264 Euro/QALY) gained for patients after total laryngectomy. For the hospital period alone (2 weeks), HMEs were cost-saving: less costly and more effective.

  8. Bias within economic evaluations – the impact of considering the future entry of lower-cost generics on currently estimated incremental cost-effectiveness ratios of a new drug

    Directory of Open Access Journals (Sweden)

    Guertin JR

    2015-10-01

    Full Text Available Jason R Guertin,1,2 Dominic Mitchell,1,3 Farzad Ali,4 Jacques LeLorier1 1CHUM Research Center, Montréal, QC, 2Programs for Assessment of Health Technology in Health Research Institute, Hamilton, ON, 3Logimétrix Inc., Repentigny, 4Pfizer Canada Inc., Kirkland, QC, Canada Background: Most economic evaluation models compare a new patented drug (NPRx to a generic comparator. Drug costs within these models are usually limited to the retail cost of both drugs at the time of model conception. However, the retail cost of the NPRx is expected to drop once generic versions of this molecule are introduced following the expiration of the NPRx’s patent. The objective of this study was to examine the impact on the incremental cost-effectiveness ratio (ICER of the future introduction of lower-cost generic versions of the NPRx within the model’s time horizon. Methods: We examined the impact of this parameter with the use of two approaches: 1 a mathematical proof identifying its impact on the NPRx’s ICER; and 2 applying this parameter to a previously published economic model comparing a NPRx to a generic comparator and identifying what would have been the NPRx’s ICER had this model considered this parameter. Results: As expected, both the mathematical proof and the application to the previously published economic model showed that considering the future introduction of lower-cost generic versions of the NPRx within the model’s time horizon lowers the NPRx’s ICER. The timing of the future entry of lower-cost generic molecules, their relative price compared to that of the patented version, and the discount rate applied to future costs all influenced the results. Conclusion: An ICER estimated within economic evaluations comparing NPRx to generic comparators which ignore the future introduction of lower-cost generic versions of the NPRx within the model’s time horizon will tend to be overestimated. Inclusion of this parameter should be considered

  9. What cost components are relevant for economic evaluations of palliative care, and what approaches are used to measure these costs? A systematic review.

    Science.gov (United States)

    Gardiner, Clare; Ingleton, Christine; Ryan, Tony; Ward, Sue; Gott, Merryn

    2017-04-01

    It is important to understand the costs of palliative and end-of-life care in order to inform decisions regarding cost allocation. However, economic research in palliative care is very limited and little is known about the range and extent of the costs that are involved in palliative care provision. To undertake a systematic review of the health and social care literature to determine the range of financial costs related to a palliative care approach and explore approaches used to measure these costs. A systematic review of empirical literature with thematic synthesis. Study quality was evaluated using the Weight of Evidence Framework. The databases CINAHL, Cochrane, PsycINFO and Medline were searched from 1995 to November 2015 for empirical studies which presented data on the financial costs associated with palliative care. A total of 38 papers met our inclusion criteria. Components of palliative care costs were incurred within four broad domains: hospital care, community or home-based care, hospice care and informal care. These costs could be considered from the economic viewpoint of three providers: state or government, insurers/third-party/not-for-profit organisations and patient and family and/or society. A wide variety of costing approaches were used to derive costs. The evidence base regarding the economics of palliative care is sparse, particularly relating to the full economic costs of palliative care. Our review provides a framework for considering these costs from a variety of economic viewpoints; however, further research is required to develop and refine methodologies.

  10. Cost Analyses in the US and Japan: A Cross-Country Comparative Analysis Applied to the PRONOUNCE Trial in Non-Squamous Non-Small Cell Lung Cancer.

    Science.gov (United States)

    Hess, Lisa M; Rajan, Narayan; Winfree, Katherine; Davey, Peter; Ball, Mark; Knox, Hediyyih; Graham, Christopher

    2015-12-01

    Health technology assessment is not required for regulatory submission or approval in either the United States (US) or Japan. This study was designed as a cross-country evaluation of cost analyses conducted in the US and Japan based on the PRONOUNCE phase III lung cancer trial, which compared pemetrexed plus carboplatin followed by pemetrexed (PemC) versus paclitaxel plus carboplatin plus bevacizumab followed by bevacizumab (PCB). Two cost analyses were conducted in accordance with International Society For Pharmacoeconomics and Outcomes Research good research practice standards. Costs were obtained based on local pricing structures; outcomes were considered equivalent based on the PRONOUNCE trial results. Other inputs were included from the trial data (e.g., toxicity rates) or from local practice sources (e.g., toxicity management). The models were compared across key input and transferability factors. Despite differences in local input data, both models demonstrated a similar direction, with the cost of PemC being consistently lower than the cost of PCB. The variation in individual input parameters did affect some of the specific categories, such as toxicity, and impacted sensitivity analyses, with the cost differential between comparators being greater in Japan than in the US. When economic models are based on clinical trial data, many inputs and outcomes are held consistent. The alterable inputs were not in and of themselves large enough to significantly impact the results between countries, which were directionally consistent with greater variation seen in sensitivity analyses. The factors that vary across jurisdictions, even when minor, can have an impact on trial-based economic analyses. Eli Lilly and Company.

  11. Is it Worth it? A Comparative Analysis of Cost-Benefit Projectionsfor State Renewables Portfolio Standards

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Cliff; Wiser, Ryan; Bolinger, Mark

    2006-06-05

    State renewables portfolio standards (RPS) have emerged as one of the most important policy drivers of renewable energy capacity expansion in the U.S. Collectively, these policies now apply to almost 40% of U.S. electricity load, and may have substantial impacts on electricity markets, ratepayers, and local economies. As RPS policies have been proposed or adopted in an increasing number of states, a growing number of studies have attempted to quantify the potential impacts of these policies, focusing primarily on projecting cost impacts, but sometimes also estimating macroeconomic and environmental effects. This report synthesizes and analyzes the results and methodologies of twenty-six distinct state or utility-level RPS cost impact analyses completed since 1998 (see Figure 1 and Appendix for a complete list of the studies). Together, these studies model proposed or adopted RPS policies in seventeen different states. We highlight the key findings of these studies on the costs and benefits of RPS policies, examine the sensitivity of projected costs to model assumptions, assess the attributes of different modeling approaches, and suggest possible areas of improvement for future RPS analysis.

  12. Comparing Service Use and Costs among Adolescents with Autism Spectrum Disorders, Special Needs and Typical Development

    Science.gov (United States)

    Barrett, Barbara; Mosweu, Iris; Jones, Catherine R. G.; Charman, Tony; Baird, Gillian; Simonoff, Emily; Pickles, Andrew; Happé, Francesca; Byford, Sarah

    2015-01-01

    Autism spectrum disorder is a complex condition that requires specialised care. Knowledge of the costs of autism spectrum disorder, especially in comparison with other conditions, may be useful to galvanise policymakers and leverage investment in education and intervention to mitigate aspects of autism spectrum disorder that negatively impact…

  13. External costs of silicon carbide fusion power plants compared to other advanced generation technologies

    Energy Technology Data Exchange (ETDEWEB)

    Lechon, Y. E-mail: yolanda.lechon@ciemat.es; Cabal, H.; Saez, R.M.; Hallberg, B.; Aquilonius, K.; Schneider, T.; Lepicard, S.; Ward, D.; Hamacher, T.; Korhonen, R

    2003-09-01

    This study was performed in the framework of the Socio-Economic Research on Fusion (SERF3), which is jointly conducted by Euratom and the fusion associations. Assessments of monetarized external impacts of the fusion fuel-cycle were previously performed (SERF1 and SERF2). Three different power plant designs were studied, with the main difference being the structural materials and cooling system used. In this third phase of the SERF project the external costs of three additional fusion power plant models using silicon carbide as structural material have been analysed. A comparison with other advanced generation technologies expected to be in use around 2050, when the first fusion power plant would be operative, has also been performed. These technologies include advanced fossil technologies, such as Natural Gas Combined Cycle, Pressurised Fluidised Bed Combustion and Integrated Gasification Combined Cycle with carbon sequestration technologies; fuel cells and renewable technologies including geothermal energy, wind energy and photovoltaic systems with energy storage devices. Fusion power plants using silicon carbide as structural material have higher efficiencies than plants using steel and this fact has a very positive effect on the external costs per kW h. These external costs are in the lowest range of the external costs of advanced generation technologies indicating the outstanding environmental performance of fusion power.

  14. Comparative evaluation of methods to quantify dissolution of nanomaterials

    DEFF Research Database (Denmark)

    Hartmann, Nanna B.; Kruse, Susanne; Baun, Anders

    2015-01-01

    dissolved concentration or by the solubility constant (Ksp). For nanomaterials it is essential to also assess solubility kinetics as nanomaterials will often not dissolve instantaneously upon contact with artificial aqueous media or natural waters. Dissolution kinetics will thereby influence their short...... and long-term environmental fate as well as laboratory test results. This highlights the need to evaluate and improve the reliability of methods applied to assess the solubility kinetics of nanomaterials. Based on existing OECD guidelines and guidance documents on aqueous dissolution of metals and metal....... Preliminary results showed that by using the DGT method the measured dissolved fraction was 5-7 times higher compared to using ultracentrifugation and dialysis membranes. Possible explanations include metal-specific interactions with the dialysis membranes as well as the DGT unit influencing the dissolution...

  15. Evaluation of Cost and Effectiveness of Decontamination Scenarios on External Radiation Exposure in Fukushima

    Energy Technology Data Exchange (ETDEWEB)

    Yasutaka, T.; Naito, W. [National Institute of Advanced Industrial Science and Technology (Japan)

    2014-07-01

    Despite the enormous cost associated with radiation decontamination, almost no quantitative assessment has been performed on the relationship between the potential reduction in long-term radiation exposure and the costs of the various decontamination strategies considered for the decontamination areas in Fukushima. In order to establish effective and pragmatic decontamination strategies for use in the radiation contaminated areas in Fukushima, a holistic approach for assessing decontamination strategies, their costs, and long-term external radiation doses is needed. The objective of the present study is to evaluate the cost and effectiveness of decontamination scenarios in the decontamination areas in Fukushima in regard to external radiation exposure. The choice of decontamination strategies in the decontamination areas should be based on a comprehensive analysis of multiple attributes such as radiological, economic, and socio-psychological attributes. The cost and effectiveness of the different decontamination strategies is not sole determinant of the decontamination strategies of the special decontamination area but is one of the most important attributes when making the policy decision. In the current study, we focus on radiological and economic attributes in determining decontamination strategies. A geographical information system (GIS) was used to relate the predicted external dose in the affected areas to the number of potential inhabitants and the land use in the areas. A comprehensive review of the costs of various decontamination methods was conducted as part of the analysis. The results indicate that aerial decontamination in the special decontamination areas in Fukushima would be effective for reducing the air dose rate to the target level in a short period of time in some but not all of the areas. In a standard scenario, the analysis of cost suggests that decontamination costs of decontamination in Fukushima was estimated to be up to approximately 5

  16. Comparative Evaluation of Biofunctional Compounds Content from Different Herbal Infusions

    Directory of Open Access Journals (Sweden)

    Anca C. Fărcaş

    2015-11-01

    Full Text Available Tea is the most important non-alcoholic beverage in the world being appreciated for its stimulant properties and health benefits. The aim of the present study was to evaluate the content in caffeine, phenolic compounds, flavonoids, as well as the antioxidant activity of five different herbal infusion samples in oder to compare the amount of these bioactive compounds from traditional Romanian medicinal plants and Chinese tea plants. Green tea, black tea, linden (lime tea, mint, and St. John's wort were chosen as materials for the preparation of infusion and laboratory analyses. The caffeine was extracted with dichloromethane and then was quantified by measuring the absorbance of the extract at 260 nm. The quantification of total phenolic compounds was achieved by Folin-Ciocalteu method, while the flavonoid content was determined using a chromogenic system of NaNO2-(Al(NO33-NaOH based on spectrophotometric method. The antioxidant capacity of each tea sample was assessed by evaluating their radical scavenging  activity on DPPH radical. The largest content in antioxidant compounds was found in green, but also in the mint infusion sample, while black tea has registered the highest caffeine content. Following the results obtained it can be stated that all the analysed samples contain remarkable amounts of biologically active compounds essential for the human body healt.

  17. Comparative analysis of used car price evaluation models

    Science.gov (United States)

    Chen, Chuancan; Hao, Lulu; Xu, Cong

    2017-05-01

    An accurate used car price evaluation is a catalyst for the healthy development of used car market. Data mining has been applied to predict used car price in several articles. However, little is studied on the comparison of using different algorithms in used car price estimation. This paper collects more than 100,000 used car dealing records throughout China to do empirical analysis on a thorough comparison of two algorithms: linear regression and random forest. These two algorithms are used to predict used car price in three different models: model for a certain car make, model for a certain car series and universal model. Results show that random forest has a stable but not ideal effect in price evaluation model for a certain car make, but it shows great advantage in the universal model compared with linear regression. This indicates that random forest is an optimal algorithm when handling complex models with a large number of variables and samples, yet it shows no obvious advantage when coping with simple models with less variables.

  18. New lipophilic tyrosyl esters. Comparative antioxidant evaluation with hydroxytyrosyl esters.

    Science.gov (United States)

    Mateos, Raquel; Trujillo, Mariana; Pereira-Caro, Gema; Madrona, Andrés; Cert, Arturo; Espartero, José Luis

    2008-11-26

    New lipophilic esters of tyrosol, a naturally occurring phenol with interesting biological properties, have been synthesized in good yields by a chemoselective procedure, using lipase from Candida antarctica or p-toluenesulfonic acid as catalysts. Their antioxidant activities have been evaluated by the Rancimat test in lipophilic food matrices, as well as by FRAP and ABTS assays in methanolic solutions, and compared with those of previously synthesized hydroxytyrosyl esters. Free tyrosol, hydroxytyrosol, butylhydroxytoluene, and alpha-tocopherol were used as standards. All methods used for the antioxidant activity evaluation emphasized the high influence of the ortho-diphenolic structure on the antioxidant capacity, tyrosol and its derivatives being less active than hydroxytyrosol and its analogues and even less than BHT and alpha-tocopherol. In addition, the Rancimat test revealed a lower activity for ester derivatives than for their respective reference compounds (HTy or Ty), in agreement with the polar paradox. On the other hand, FRAP and ABTS methods reported an opposite behavior between the synthetic esters and their respective references. Thus, hydroxytyrosyl esters were more active than HTy, whereas tyrosyl esters were less active than Ty. The length and nature of the acyl side chain did not seem to play an important role in the antioxidant activity of either the hydroxytyrosyl or tyrosyl ester series, since no significant differences were observed among them.

  19. Evaluation of Contrail Reduction Strategies Based on Environmental and Operational Costs

    Science.gov (United States)

    Chen, Neil Y.; Sridhar, Banavar; Ng, Hok K.; Li, Jinhua

    2013-01-01

    This paper evaluates a set of contrail reduction strategies based on environmental and operational costs. A linear climate model was first used to convert climate effects of carbon dioxide emissions and aircraft contrails to changes in Absolute Global Temperature Potential, a metric that measures the mean surface temperature change due to aircraft emissions and persistent contrail formations. The concept of social cost of carbon and the carbon auction price from recent California's cap-and-trade system were then used to relate the carbon dioxide emissions and contrail formations to an environmental cost index. The strategy for contrail reduction is based on minimizing contrail formations by altering the aircraft's cruising altitude. The strategy uses a user-defined factor to trade off between contrail reduction and additional fuel burn and carbon dioxide emissions. A higher value of tradeoff factor results in more contrail reduction but also more fuel burn and carbon emissions. The strategy is considered favorable when the net environmental cost benefit exceeds the operational cost. The results show how the net environmental benefit varies with different decision-making time-horizon and different carbon cost. The cost models provide a guidance to select the trade-off factor that will result in the most net environmental benefit.

  20. Evaluating the cost-effectiveness of cancer patient navigation programs: conceptual and practical issues.

    Science.gov (United States)

    Ramsey, Scott; Whitley, Elizabeth; Mears, Victoria Warren; McKoy, June M; Everhart, Rachel M; Caswell, Robert J; Fiscella, Kevin; Hurd, Thelma C; Battaglia, Tracy; Mandelblatt, Jeanne

    2009-12-01

    Patient navigators-individuals who assist patients through the healthcare system to improve access to and understanding of their health and healthcare-are increasingly used for underserved individuals at risk for or with cancer. Navigation programs can improve access, but it is unclear whether they improve the efficiency and efficacy of cancer diagnostic and therapeutic services at a reasonable cost, such that they would be considered cost-effective. In the current study, the authors outline a conceptual model for evaluating the cost-effectiveness of cancer navigation programs. They describe how this model is being applied to the Patient Navigation Research Program, a multicenter study supported by the National Cancer Institute's Center to Reduce Cancer Health Disparities. The Patient Navigation Research Program is testing navigation interventions that aim to reduce time to delivery of quality cancer care (noncancer resolution or cancer diagnosis and treatment) after identification of a screening abnormality. Examples of challenges to evaluating cost-effectiveness of navigation programs include the heterogeneity of navigation programs, the sometimes distant relation between navigation programs and outcome of interest (eg, improving access to prompt diagnostic resolution and life-years gained), and accounting for factors in underserved populations that may influence both access to services and outcomes. In this article, the authors discuss several strategies for addressing these barriers. Evaluating the costs and impact of navigation will require some novel methods, but will be critical in recommendations concerning dissemination of navigation programs.

  1. Evaluation of syngas production unit cost of bio-gasification facility using regression analysis techniques

    Energy Technology Data Exchange (ETDEWEB)

    Deng, Yangyang; Parajuli, Prem B.

    2011-08-10

    Evaluation of economic feasibility of a bio-gasification facility needs understanding of its unit cost under different production capacities. The objective of this study was to evaluate the unit cost of syngas production at capacities from 60 through 1800Nm 3/h using an economic model with three regression analysis techniques (simple regression, reciprocal regression, and log-log regression). The preliminary result of this study showed that reciprocal regression analysis technique had the best fit curve between per unit cost and production capacity, with sum of error squares (SES) lower than 0.001 and coefficient of determination of (R 2) 0.996. The regression analysis techniques determined the minimum unit cost of syngas production for micro-scale bio-gasification facilities of $0.052/Nm 3, under the capacity of 2,880 Nm 3/h. The results of this study suggest that to reduce cost, facilities should run at a high production capacity. In addition, the contribution of this technique could be the new categorical criterion to evaluate micro-scale bio-gasification facility from the perspective of economic analysis.

  2. Development of geological disposal system; localization of element cost data and cost evaluation on the HLW repository

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Byung Sik; Kim, Kil Jung; Yang, Young Jin; Kim, Sung Chun [KOPEC, Taejeon (Korea)

    2002-03-01

    To estimate Total Life Cycle Cost (TSLCC) for Korea HLW Repository through localization of element cost data, we review and re-organize each basic element cost data for reference repository system, localize various element cost and finally estimate TSLCC considering economic parameters. As results of the study, TSLCC is estimated as 17,167,689 million won, which includes costs for site preparation, surface facilities, underground facilities and management/integration. Since HLW repository Project is an early stage of pre-conceptual design at present, the information of design and project information are not enough to perform cost estimate and cost localization for the Project. However, project cost structure is re-organized based on the local condition and Total System Life Cycle Cost is estimated using the previous cost data gathered from construction experience of the local nuclear power plant. Project results can be used as basic reference data to assume total construction cost for the local HLW repository and should be revised to more reliable cost data with incorporating detail project design information into the cost estimate in a future. 20 refs. (Author)

  3. Comparative evaluation and its implications for mate choice.

    Science.gov (United States)

    Bateson, Melissa; Healy, Susan D

    2005-12-01

    Experiments on decision making by humans show that the choices that we make can be very labile. The magnitude of our preferences, and even our rank ordering of options, can vary according to the number and type of alternatives available for comparison. This apparent irrationality has been argued to result from our use of decision heuristics that have evolved to enable us to choose quickly and efficiently between options differing in multiple attributes. Here, we argue that, because there is also selective pressure for animals to make mating decisions quickly, and because potential mates also differ in multiple attributes, similar decision heuristics might have evolved for mate choice. Following this reasoning, the attractiveness of a given mate will depend on the others with whom he or she is being compared, rather than being an absolute function of his or her underlying quality. We describe some of the ramifications of such comparative evaluation, and argue that it could offer new insights into some of the biggest outstanding problems in mate choice and sexual selection.

  4. Epidural Steroids for Lumbosacral Radicular Syndrome Compared to Usual Care : Quality of Life and Cost Utility in General Practice

    NARCIS (Netherlands)

    Spijker-Huiges, Antje; Vermeulen, Karin; Winters, Jan C.; van Wijhe, Marten; van der Meer, Klaas

    Objective: To investigate the effect of adding segmental epidural steroid injections (SESIs) to usual care compared with usual care alone on quality of life and cost utility in lumbosacral radicular syndrome (LRS) in general practice. Design: A pragmatic randomized controlled trial. Results were

  5. Cost-effectiveness of metformin plus vildagliptin compared with metformin plus sulphonylurea for the treatment of patients with type 2 diabetes mellitus: a Portuguese healthcare system perspective.

    Science.gov (United States)

    Viriato, Daniel; Calado, Frederico; Gruenberger, Jean-Bernard; Ong, Siew Hwa; Carvalho, Davide; Silva-Nunes, José; Johal, Sukhvinder; Viana, Ricardo

    2014-07-01

    To evaluate the cost-effectiveness of vildagliptin plus metformin vs generic sulphonylurea plus metformin in patients with type 2 diabetes mellitus, not controlled with metformin, from a Portuguese healthcare system perspective. A cost-effectiveness model was constructed using risk equations from the UK Prospective Diabetes Study Outcomes Model with a 10,000-patient cohort and a lifetime horizon. The model predicted microvascular and macrovascular complications and mortality in yearly cycles. Patients entered the model as metformin monotherapy failures and switched to alternative treatments (metformin plus basal-bolus insulin and subsequently metformin plus intensive insulin) when glycated hemoglobin A1c >7.5% was reached. Baseline patient characteristics and clinical variables were derived from a Portuguese epidemiological study. Cost estimates were based on direct medical costs only. One-way and probabilistic sensitivity analyses were conducted to test the robustness of the model. There were fewer non-fatal diabetes-related adverse events (AEs) in patients treated with metformin plus vildagliptin compared with patients treated with metformin plus sulphonylurea (6752 vs 6815). Addition of vildagliptin compared with sulphonylurea led to increased drug acquisition costs but reduced costs of AEs, managing morbidities, and monitoring patients. Treatment with metformin plus vildagliptin yielded a mean per-patient gain of 0.1279 quality-adjusted life years (QALYs) and a mean per-patient increase in total cost of €1161, giving an incremental cost-effectiveness ratio (ICER) of €9072 per QALY. Univariate analyses showed that ICER values were robust and ranged from €4195 to €16,052 per QALY when different parameters were varied. The model excluded several diabetes-related morbidities, such as peripheral neuropathy and ulceration, and did not model second events. Patients were presumed to enter the model with no diabetes-related complications. Treatment with

  6. Comparative evaluation of oculometric variables in graves' ophthalmopathy

    Directory of Open Access Journals (Sweden)

    Hélio Amante Miot

    2009-01-01

    Full Text Available OBJECTIVES: To estimate oculometric parameters of Graves' ophthalmopathy in comparison to healthy eyes using digital photography and digital image analysis. INTRODUCTION: Graves' ophthalmopathy is the main cause of eye proptosis. Because these protrusions cause clinically perceived distortions in orbital architecture, digital photographs can be used to detect and quantify these changes. METHODS: We carried out a cross-sectional study comprising 12 healthy volunteers and 15 Graves' ophthalmopathy patients with the purpose of evaluating the use of simple, non-invasive digital photography to estimate oculometric parameters of Graves' ophthalmopathy and compare them with the parameters of unaffected eyes. Facial photographs of cases and controls were taken in a standardized manner. Oculometric parameters were compared between the groups and then correlated to proptometer measures. RESULTS: All estimated oculometric variables showed significant differences between the groups, in particular with regard to mediopupilar aperture, lateral height, distance from the iris edge to the lateral boundary of the palpebral fissure, and distance from the higher point of the iris to the lateral limit of the palpebral fissure. The product of medial aperture and horizontal palpebral fissure also revealed greater discrepancy between the groups. Proptometer measures showed significant linear correlation between the distance from the iris edge to the lateral boundary of the palpebral fissure and between the distance from the higher point of the iris to the lateral limit of palpebral fissure (p<0.05. CONCLUSIONS: Comparative analysis of oculometric parameters in Graves' ophthalmopathy suggests that eye proptosis is related to an asymmetric increase in lateral oculometric measures. Standardized digital photographs can be used in clinical practice to objectively estimate oculometric parameters of Graves' ophthalmopathy patients.

  7. Evaluating and comparing algorithms for respiratory motion prediction

    Science.gov (United States)

    Ernst, F.; Dürichen, R.; Schlaefer, A.; Schweikard, A.

    2013-06-01

    In robotic radiosurgery, it is necessary to compensate for systematic latencies arising from target tracking and mechanical constraints. This compensation is usually achieved by means of an algorithm which computes the future target position. In most scientific works on respiratory motion prediction, only one or two algorithms are evaluated on a limited amount of very short motion traces. The purpose of this work is to gain more insight into the real world capabilities of respiratory motion prediction methods by evaluating many algorithms on an unprecedented amount of data. We have evaluated six algorithms, the normalized least mean squares (nLMS), recursive least squares (RLS), multi-step linear methods (MULIN), wavelet-based multiscale autoregression (wLMS), extended Kalman filtering, and ε-support vector regression (SVRpred) methods, on an extensive database of 304 respiratory motion traces. The traces were collected during treatment with the CyberKnife (Accuray, Inc., Sunnyvale, CA, USA) and feature an average length of 71 min. Evaluation was done using a graphical prediction toolkit, which is available to the general public, as is the data we used. The experiments show that the nLMS algorithm—which is one of the algorithms currently used in the CyberKnife—is outperformed by all other methods. This is especially true in the case of the wLMS, the SVRpred, and the MULIN algorithms, which perform much better. The nLMS algorithm produces a relative root mean square (RMS) error of 75% or less (i.e., a reduction in error of 25% or more when compared to not doing prediction) in only 38% of the test cases, whereas the MULIN and SVRpred methods reach this level in more than 77%, the wLMS algorithm in more than 84% of the test cases. Our work shows that the wLMS algorithm is the most accurate algorithm and does not require parameter tuning, making it an ideal candidate for clinical implementation. Additionally, we have seen that the structure of a patient

  8. Cost analysis of the Hemodialysis Reliable Outflow (HeRO) Graft compared to the tunneled dialysis catheter.

    Science.gov (United States)

    Al Shakarchi, Julien; Inston, Nicholas; Jones, Robert G; Maclaine, Grant; Hollinworth, David

    2016-04-01

    In end-stage renal disease patients with central venous obstruction, who have limited vascular access options, the Hemodialysis Reliable Outflow (HeRO) Graft is a new alternative with a lower incidence of complications and longer effective device life compared to tunneled dialysis catheters (TDCs). We undertook an economic analysis of introducing the HeRO Graft in the UK. A 1-year cost-consequence decision analytic model was developed comparing management with the HeRO Graft to TDCs from the perspective of the National Health Service in England. The model comprises four 3-month cycles during which the vascular access option either remains functional for hemodialysis or fails, patients can experience access-related infection and device thrombosis, and they can also accrue associated costs. Clinical input data were sourced from published studies and unit cost data from National Health Service 2014-15 Reference Costs. In the base case, a 100-patient cohort managed with the HeRO Graft experienced 6 fewer failed devices, 53 fewer access-related infections, and 67 fewer device thromboses compared to patients managed with TDCs. Although the initial device and placement costs for the HeRO Graft are greater than those for TDCs, savings from the lower incidence of device complications and longer effective device patency reduces these costs. Overall net annual costs are £2600 for each HeRO Graft-managed patient compared to TDC-managed patients. If the National Health Service were to reimburse hemodialysis at a uniform rate regardless of the type of vascular access, net 1-year savings of £1200 per patient are estimated for individuals managed with the HeRO Graft. The base case results showed a marginal net positive cost associated with vascular access with the HeRO Graft compared with TDCs for the incremental clinical benefit of reductions in patency failures, device-related thrombosis, and access-related infection events in a patient population with limited options for

  9. Impact and Cost Evaluation of Electric Vehicle Integration on Medium Voltage Distribution Networks

    DEFF Research Database (Denmark)

    Wu, Qiuwei; Cheng, Lin; Pineau, Ulysse;

    2013-01-01

    This paper presents the analysis of the impact of electric vehicle (EV) integration on medium voltage (MV) distribution networks and the cost evaluation of replacing the overloaded grid components. A number of EV charging scenarios have been studied. A 10 kV grid from the Bornholm Island...... in the city area has been used to carry out case studies. The case study results show that the secondary transformers are the bottleneck of the MV distribution networks and the increase of EV penetration leads to the overloading of secondary transformers. The cost of the transformer replacement has been...... evaluated. The transformer replacement cost reaches 72% of the total transformers value with 50% EV penetration and 3 Phase charging....

  10. Mandible reconstruction with free fibula flaps: Outcome of a cost-effective individual planning concept compared with virtual surgical planning.

    Science.gov (United States)

    Rommel, Niklas; Kesting, Marco Rainer; Rohleder, Nils Hagen; Bauer, Florian Martin Josef; Wolff, Klaus-Dietrich; Weitz, Jochen

    2017-08-01

    The free osteomyocutaneous fibular flap has become one of the primary options for mandibular reconstruction, because of the later introduction and development of virtual surgical planning (VSP). However, VSP is associated with high additional pre-operative effort and costs. Therefore, the purpose of the study was to develop a new individual cost-effective pre-operative planning concept for free fibula mandible reconstruction and to compare it with VSP regarding clinical parameters and post-operative outcome. 31 patients undergoing mandibular reconstruction with a microvascular free fibular flap were divided into two groups and retrospectively reviewed. For the first group A (18 of 31 patients), an individual method with stererolithographic (STL) models, silicon templates and hand-made cutting guides was used (about 250 € planning costs/patient). For the second group B (13 of 31 patients), VSP including pre-fabricated cutting guides was used (about 2500 € planning costs/patient). We found no statistically significant differences with respect to intra-operative time of mandibular reconstruction, duration of hospitalisation or post-operative complications between the two groups (p ≥ 0.05). The surgical outcomes and operative efficiency of this individual and cost-effective planning concept are comparable with the much more expensive complete VSP concept. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  11. Cost-Effectiveness of a Biodegradable Compared to a Titanium Fixation System in Maxillofacial Surgery: A Multicenter Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    N B van Bakelen

    Full Text Available Biodegradable fixation systems could reduce/delete the problems associated with titanium plate removal. This means less surgical discomfort, and a reduction in costs.The aim of the present study was to compare the cost-effectiveness between a biodegradable and a titanium system in Maxillofacial surgery.This multicenter RCT was performed in the Netherlands from December 2006 to July 2009. Included were 230 patients who underwent a bilateral sagittal split osteotomy (BSSO, a Le Fort-I osteotomy, or a bi-maxillary osteotomy and those treated for fractures of the mandible, maxilla, or zygoma. The patients were randomly assigned to a titanium group (KLS Martin or to a biodegradable group (Inion CPS. Costs were assessed from a societal perspective. Health outcomes in the incremental cost-effectiveness ratio (ICER were bone healing (8 weeks and plate removal (2 years.In 25 out of the 117 patients who were randomized to the biodegradable group, the maxillofacial surgeon made the decision to switch to the titanium system intra-operatively. This resulted in an Intention-To-Treat (ITT-analysis and a Treatment-Received (TR- analysis. Both analyses indicated that operations performed with titanium plates and screws had better health outcomes. In the TR-analysis the costs were lower in the biodegradable group, in the ITT-analysis costs were lower in the titanium group.The difference in costs between the ITT and the TR analyses can be explained by the intra-operative switches: In the TR-analysis the switches were analysed in the titanium group. In the ITT-analysis they were analysed in the biodegradable group. Considering the cost-effectiveness the titanium system is preferable to the biodegradable system in the regular treatment spectrum of mandibular, Le Fort-I, and zygomatic fractures, and BSSO's, Le Fort-I osteotomies and bimaxillary osteotomies.Controlled-Trials.com ISRCTN 44212338.

  12. Accuracy of self-reports of mental health care utilization and calculated costs compared to hospital records.

    Science.gov (United States)

    Heinrich, Sven; Deister, Arno; Birker, Thomas; Hierholzer, Cornelia; Weigelt, Ina; Zeichner, Dirk; Angermeyer, Matthias C; Roick, Christiane; König, Hans-Helmut

    2011-01-30

    Assessments of service utilization is often based on self-reports. Concerns regarding the accuracy of self-reports are raised especially in mental health care. The purpose of this study was to analyze the accuracy of self-reports and calculated costs of mental health services. In a prospective cohort study in Germany, self-reports regarding psychiatric inpatient and day-care use collected by telephone interviews based on the Client Socio-Demographic and Service Receipt Inventory (CSSRI) as well as calculated costs were compared to computerized hospital records. The sample consisted of patients with mental and behavioral disorders resulting from alcohol (ICD-10 F10, n=84), schizophrenia, schizophrenic and delusional disturbances (F2, n=122) and affective disorders (F3, n=124). Agreement was assessed using the concordance correlation coefficient (CCC), mean difference (95% confidence intervals (CI)) and the 95% limits of agreement. Predictors for disagreement were derived. Overall agreement of mean total costs was excellent (CCC=0.8432). Costs calculated based on self-reports were higher than costs calculated based on hospital records (15 EUR (95% CI -434 to 405)). Overall agreement of total costs for F2 patients was CCC=0.8651, for F3 CCC=0.7850 and for F10 CCC=0.6180. Depending on type of service, measure of service utilization and costs agreement ranged from excellent to poor and varied substantially between individuals. The number of admissions documented in hospital records was significantly associated with disagreement. Telephone interviews can be an accurate data collection method for calculating mean total costs in mental health care. In the future more standardization is needed.

  13. Has increased clinical experience with methotrexate reduced the direct costs of medical management of ectopic pregnancy compared to surgery?

    Directory of Open Access Journals (Sweden)

    Westaby Daniel T

    2012-09-01

    Full Text Available Abstract Background There is a debate about the cost-efficiency of methotrexate for the management of ectopic pregnancy (EP, especially for patients presenting with serum human chorionic gonadotrophin levels of >1500 IU/L. We hypothesised that further experience with methotrexate, and increased use of guideline-based protocols, has reduced the direct costs of management with methotrexate. Methods We conducted a retrospective cost analysis on women treated for EP in a large UK teaching hospital to (1 investigate whether the cost of medical management is less expensive than surgical management for those patients eligible for both treatments and (2 to compare the cost of medical management for women with hCG concentrations 1500–3000 IU/L against those with similar hCG concentrations that elected for surgery. Three distinct treatment groups were identified: (1 those who had initial medical management with methotrexate, (2 those who were eligible for initial medical management but chose surgery (‘elected’ surgery and (3 those who initially ‘required’ surgery and did not meet the eligibility criteria for methotrexate. We calculated the costs from the point of view of the National Health Service (NHS in the UK. We summarised the cost per study group using the mean, standard deviation, median and range and, to account for the skewed nature of the data, we calculated 95% confidence intervals for differential costs using the nonparametric bootstrap method. Results Methotrexate was £1179 (CI 819–1550 per patient cheaper than surgery but there were no significant savings with methotrexate in women with hCG >1500 IU/L due to treatment failures. Conclusions Our data support an ongoing unmet economic need for better medical treatments for EP with hCG >1500 IU/L.

  14. Evaluation of Arizona Health Care Cost Containment System, 1984-85

    OpenAIRE

    1987-01-01

    In this article, we describe the evaluation of the Arizona Health Care Cost Containment System (AHCCCS), Arizona's alternative to the acute care portion of Medicaid. We provide an assessment of implementation of the program's innovative features during its second 18 months of operation, from April 1984 through September 1985. Included in the evaluation are assessments of the administration of the program, provider relations, eligibility, enrollment and marketing, information systems, quality ...

  15. The methodological convention 2,0 for the estimation of environmental costs. An economic evaluation of environmental damages; Methodenkonvention 2.0 zur Schaetzung von Umweltkosten. Oekonomische Bewertung von Umweltschaeden

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-08-15

    The reliable estimation of environmental damage costs requires a high degree of transparency of the objectives, assumptions and methods of assessment in order to ensure a correct classification and comparability of the cost factors. The methods convention under consideration aims to develop uniform standards for the technical evaluation of environmental costs and to improve the transparency of the estimates.

  16. TRICARE versus FEHBP: a pilot study of comparative inpatient costs in region 10.

    OpenAIRE

    Hone, Anne Burke.

    1997-01-01

    Approved for public release; distribution is unlimited Approximately 3.5 billion dollars of the Defense Budget for Fiscal Year 1997 was allocated for the care of non-active duty beneficiaries. This thesis is a pilot study exploring one option to restructure the military beneficiary health system. Two methods of health care delivery are examined: traditional fee-for-service plans, and health maintenance organizations (HMO) . The advantages, disadvantages, and cost implications associated wi...

  17. Evaluation of a low-cost open-source gaze tracker

    DEFF Research Database (Denmark)

    San Agustin, Javier; Jensen, Henrik Tomra Skovsgaard Hegner; Møllenbach, Emilie;

    2010-01-01

    This paper presents a low-cost gaze tracking system that is based on a webcam mounted close to the user's eye. The performance of the gaze tracker was evaluated in an eye-typing task using two different typing applications. Participants could type between 3.56 and 6.78 words per minute, depending...

  18. Evaluation of cost-effective aeration technology solutions to address total trihalomethane (TTHM) compliance

    Science.gov (United States)

    The primary objective of this project was to evaluate cost-effective aeration technology solutions to address TTHM compliance at a water treatment plant clearwell. The project team worked closely with EPA Region 6 and the EPA Office of Research and Development (ORD) to identify a...

  19. Evaluation of cost-effective aeration technology solutions to address total trihalomethane (TTHM) compliance

    Science.gov (United States)

    The primary objective of this project was to evaluate cost-effective aeration technology solutions to address TTHM compliance at a water treatment plant clearwell. The project team worked closely with EPA Region 6 and the EPA Office of Research and Development (ORD) to identify a...

  20. Economic evaluation: Concepts, selected studies, system costs, and a proposed program

    Science.gov (United States)

    Osterhoudt, F. H. (Principal Investigator)

    1979-01-01

    The more usual approaches to valuing crop information are reviewed and an integrated approach is recommended. Problems associated with implementation are examined. What has already been accomplished in the economic evaluation of LACIE-type information is reported including various studies of benefits. The costs of the existing and proposed systems are considered. A method and approach is proposed for further studies.

  1. Cost-effectiveness evaluation of initial HAART regimens for managing HIV-infected patients according to real clinical practice

    Directory of Open Access Journals (Sweden)

    A Castagna

    2012-11-01

    Full Text Available We evaluated the single-tablet regimen (STR versus multiple-tablet regimen (MTR strategies through an incremental cost-effectiveness analysis in a large cohort of patients starting their first HAART. Adult HIV-1-naïve patients, followed at the San Raffaele Hospital, starting their first-line regimen from June 2008 to April 2012, were included in the analysis. First-line HAART regimens more frequently used (>10% were grouped into two classes as follows: a single-tablet regimen (STR of TDF + FTC + EFV; b multiple-tablet regimen (MTR including TDF + FTC + EFV, TDF + FTC + ATV/r, TDF + FTC + DRV/r TDF + FTC + LPV/r. The incremental cost-effectiveness analysis was carried out by means of a Markov model calculating quality of life and costs for each patient, according to the given regimen (including any subsequent switch if occurred, through 1-year cycles. The outcome measure was quality-adjusted life-years (QALYs. Data were analysed from the point of view of the Lombardy Regional Health Service (RHS: HAART, hospitalisations, visits, examinations and other concomitant non-HAART drugs costs were evaluated, price variations included. 474 naïve patients: 90% males, mean age 42.2 years, mean baseline HIV-RNA 4.50 log10copies/ml and CD4+ count of 310 cells/µL with a mean follow-up of 28 months. Patients starting with an STR treatment were less frequently HCVAb positive (4% vs 11%, P=0.040, had higher mean CD4+ values [351 vs 297, P=0.004] as compared to MTR patients. The mean year cost/patient was €9,213 (range: €6,574.71–€33,570.00 with a mean per patient QALYs of 0.986 (range: 0.878–0.999 among STR patients; the mean year cost/patient was €14,277 (range: €5,908.89–€82,310.30 with a mean QALY of 0.933 (0.830–0.976 among MTR patients. STR dominates (i.e. is more effective and less costly compared to MTR. (Fig. 1 At multivariable analysis, after adjustment for age, gender, HCVAb status, HIV risk

  2. A systematic review of observational studies evaluating costs of adverse drug reactions

    Directory of Open Access Journals (Sweden)

    Batel Marques F

    2016-08-01

    Full Text Available Francisco Batel Marques,1,2 Ana Penedones,1,2 Diogo Mendes,1,2 Carlos Alves,1,2 1CHAD – Centre for Health Technology Assessment and Drug Research, AIBILI – Association for Innovation and Biomedical Research on Light and Image, 2School of Pharmacy, University of Coimbra, Coimbra, Portugal Introduction: The growing evidence of the increased frequency and severity of adverse drug events (ADEs, besides the negative impact on patient’s health status, indicates that costs due to ADEs may be steadily rising. Observational studies are an important tool in pharmacovigilance. Despite these studies being more susceptible to bias than experimental designs, they are more competent in assessing ADEs and their associated costs.Objective: To identify and characterize the best available evidence on ADE-associated costs.Methods: MEDLINE, Cochrane Library, and Embase were searched from 1995 to 2015. Observational studies were included. The methodological quality of selected studies was assessed by Cochrane Collaboration tool for experimental and observational studies. Studies were classified according to the setting analyzed in “ambulatory”, “hospital”, or both. Costs were classified as “direct” and “indirect”. Data were analyzed using descriptive statistics. The total incremental cost per patient with ADE was estimated.Results: Twenty-nine (94% longitudinal observational studies and two (7% cross-sectional studies were included. Twenty-three (74% studies were assessed with the highest methodological quality score. The studies were mainly conducted in the US (61%. Twenty (65% studies evaluated any therapeutic group. Twenty (65% studies estimated costs of ADEs leading to or prolonging hospitalization. The “direct costs” were evaluated in all studies, whereas only two (7% also estimated the “indirect costs”. The “direct costs” in ambulatory ranged from €702.21 to €40,273.08, and the in hospital from €943.40 to €7

  3. [Cost-effectiveness analysis of etanercept compared with other biologic therapies in the treatment of rheumatoid arthritis].

    Science.gov (United States)

    Salinas-Escudero, Guillermo; Vargas-Valencia, Juan; García-García, Erika Gabriela; Munciño-Ortega, Emilio; Galindo-Suárez, Rosa María

    2013-01-01

    to conduct cost-effectiveness analysis of etanercept compared with other biologic therapies in the treatment of moderate or severe rheumatoid arthritis in patients with previous unresponse to immune selective anti-inflammatory derivatives failure. a pharmacoeconomic model based on decision analysis to assess the clinical outcome after giving etanercept, infliximab, adalimumab or tocilizumab to treat moderate or severe rheumatoid arthritis was employed. Effectiveness of medications was assessed with improvement rates of 20 % or 70 % of the parameters established by the American College of Rheumatology (ACR 20 and ACR 70). the model showed that etanercept had the most effective therapeutic response rate: 79.7 % for ACR 20 and 31.4 % for ACR 70, compared with the response to other treatments. Also, etanercept had the lowest cost ($149,629.10 per patient) and had the most cost-effective average ($187,740.40 for clinical success for ACR 20 and $476,525.80 for clinical success for ACR 70) than the other biologic therapies. we demonstrated that treatment with etanercept is more effective and less expensive compared to the other drugs, thus making it more efficient therapeutic option both in terms of means and incremental cost-effectiveness ratios for the treatment of rheumatoid arthritis.

  4. An evaluation of stress responses, simplicity and cost of pinhole castration as an alternative technique for male dog sterilization

    Directory of Open Access Journals (Sweden)

    J. Okwee-Acai,

    2012-01-01

    Full Text Available Pinhole castration is a novel minimally invasive procedure for calf or kid castration. We evaluated stress, simplicity and costs of the technique in mongrel puppies (N=15. The puppies were divided into three groups: control i.e. not treated; second surgical castration and third pinhole castration. Stress was monitored by daily recording of rectal temperatures and assay of plasma cortisol concentration. Testicular histopathology was used to evaluate effectiveness of the method. Material requirements, costs and length of pinhole or surgical castration cases were compared. Surgery provoked higher febrile and cortisol responses than pinhole castration, however, the responses took longer to resolve in the pinhole treated animals. Each pinhole procedure required: xylazine 2% (0.2ml, syringe, needle and suture (10cm. Surgery meanwhile, required: xylazine 2% (0.2ml, 2 syringes, suture (15cm, razor, surgical blade, antibiotics, antiseptics, cotton and 1 ml ketamine (50mg/ml. Material cost for a surgery case was about thrice a pinhole case. Average time for pinhole was 14 minutes while surgery took about 35 minutes. We concluded that, compared to standard surgical castration, the pinhole technique is, less stressful, quicker, simpler and is a cheaper alternative for male dog sterilization. The technique should, therefore, be popularized in veterinary schools and practices for wider application.

  5. Comparative evaluation of healing after gingivectomy with electrocautery and laser

    Science.gov (United States)

    Kumar, Praveen; Rattan, Vidya; Rai, Sachin

    2015-01-01

    Purpose of the study To evaluate whether laser has got any advantage over electrocautery in performing gingivectomy procedure. Method This was randomized split mouth prospective study where 17 patients having symmetrical gingival hyperplasia were treated with electrocautery and laser on each side. Intra- and postoperative parameters assessed were duration of surgery, bleeding, tissue sticking, postoperative pain and healing. The results were statistically analyzed and compared. Result There were 7 Females and 10 Males with a mean age of 28.2 ± 11.6 years. The mean time taken on the laser and electrocautery was 16 (±8.05) and 16.7 min (±9.86) respectively and the difference was not significant. On laser side, there was no bleeding in 3 (17.6%) and self limiting in 14 patients (82.4%) whereas electrocautery side, there was no bleeding in 2 (11.8%) and self limiting in 15 patients (88.2%). Both electrocautery and laser were comparable regarding ease of use during gingivectomy procedure. Charring was observed on both sides although there was more charring on the laser side. Fibrinous slough was present on both sides at 24 h. Difference in healing was not significant at various time intervals. There were no significant difference in postoperative pain experienced by the patients among the laser and cautery group at different time intervals. Conclusion Both techniques with proper adhesion to safeguards, can be used to remove gingival overgrowth with equal efficiency and wound healing capacity. There is no advantage of diode laser over electrocautery in performing gingivectomy. PMID:26258017

  6. A Comparative Evaluation of Automatic Rock Detection Methods

    Science.gov (United States)

    Thompson, D. R.; Castano, R.

    2006-12-01

    Enabling rock detection allows rovers to make the most of each command cycle by performing autonomous site characterization, and prioritization of the most important data for downlink. On Earth these algorithms assist data analysis by automating laborious image annotation tasks. We compare the performance of several detection algorithms on a representative set of Mars Exploration Rover data. Tested algorithms include strategies based on pixel intensity (Castano et al., 2004), filter cascades (Viola et al., 2002), shading models (Gulick et al., 2001) and stereo range data (Gor et al., 2001). The test dataset consists of 13 navigation images and 104 panoramic camera images under various terrain and lighting conditions. Together these images contain over 50,000 manually-labeled rocks. We assess detectors' performance on autonomous geology tasks: identifying targets for spectroscopy, estimating the fractional area of terrain covered by rocks, and identifying the contour outlines of rocks above 4cm in length. While detection performance varied considerably across different detection strategies, images, and tasks, some general trends are apparent. All rock detection algorithms underestimated fractional coverage area to varying degrees. Accurate identification of contour outlines was especially difficult; most detectors exhibit low recall and various biases in rock shape and size. However, all detectors performed significantly better than random on the target selection task, paralleling recent successes in autonomous spectrometer targeting. Comparative evaluation on field-typical datasets will remain important as rock detection technologies continue to mature. References: Castano et al, Intensity-based Rock Detection for Acquiring Onboard Rover Science, LPSC 2004. Gor et al, Autonomous rock detection for Mars terrain, AIAA Space 2001. Gulick et al, Autonomous image analysis during the 1999 Marsokhod rover field test, JGR 2001. Viola et al, Robust Real-Time Object

  7. An Evaluation of the Consumer Costs and Benefits of Energy Efficiency Resource Standards

    Science.gov (United States)

    Lessans, Mark D.

    Of the modern-day policies designed to encourage energy efficiency, one with a significant potential for impact is that of Energy Efficiency Resource Standards (EERS). EERS policies place the responsibility for meeting an efficiency target on the electric and gas utilities, typically setting requirements for annual reductions in electricity generation or gas distribution to customers as a percentage of sales. To meet these requirements, utilities typically implement demand-side management (DSM) programs, which encourage energy efficiency at the customer level through incentives and educational initiatives. In Maryland, a statewide EERS has provided for programs which save a significant amount of energy, but is ultimately falling short in meeting the targets established by the policy. This study evaluates residential DSM programs offered by Pepco, a utility in Maryland, for cost-effectiveness. However, unlike most literature on the topic, analysis focuses on the costs-benefit from the perspective of the consumer, and not the utility. The results of this study are encouraging: the majority of programs analyzed show that the cost of electricity saved, or levelized cost of saved energy (LCSE), is less expensive than the current retail cost of electricity cost in Maryland. A key goal of this study is to establish a metric for evaluating the consumer cost-effectiveness of participation in energy efficiency programs made available by EERS. In doing so, the benefits of these programs can be effectively marketed to customers, with the hope that participation will increase. By increasing consumer awareness and buy-in, the original goals set out through EERS can be realized and the policies can continue to receive support.

  8. Comparative life cycle assessment and life cycle costing of lodging in the Himalaya

    DEFF Research Database (Denmark)

    Bhochhibhoya, Silu; Pizzol, Massimo; Achten, Wouter M J;

    2016-01-01

    , maintenance and material replacement. The study includes a sensitivity analysis focusing on the lifespan of buildings, occupancy rate and discount and inflation rates. The functional unit was formulated as the ‘Lodging of one additional guest per night’, and the time horizon is 50 years of building lifespan....... Both primary and secondary data were used in the life cycle inventory. Results and discussion The modern building has the highest global warming potential (kg CO2-eq) as well as higher costs over 50 years of building lifespan. The results show that the use stage is responsible for the largest share...

  9. Comparative biomechanical evaluation of different wheelchair seat cushions.

    Science.gov (United States)

    Ferrarin, M; Andreoni, G; Pedotti, A

    2000-01-01

    The aim of the present study was to perform a comparative biomechanical analysis of four antidecubitus wheelchair cushions. Thirty wheelchair users were considered divided into three groups: paraplegic subjects (with no cutaneous sensation), neurologic subjects (with intact cutaneous sensation), and elderly subjects. The biomechanical evaluation was performed using a piezoresistive sensor matrix system to quantify parameters referred to pressure distribution, seating surface and posture. Dedicated software was developed for the automatic elaboration of the raw data and the computation of the parameters of interest. Differences among cushion types and subject groups were analyzed. An analysis of time-transient behaviors was also performed. Results showed that no significant differences in pressure peak reduction were found among the four cushions. Moreover, no time-transient behavior was shown by any cushions. However, both the location of pressure peaks and posture were dependent on cushion types. Comparison of the three subject groups showed that elderly subjects had the highest mean pressure and the lowest contact surface, while paraplegics presented the highest pressure peaks. This procedure appears indicated for individualizing the prescription of a wheelchair cushion and even for customizing a cushion to induce a specific posture.

  10. Translation Evaluation: A Comparative Study of an Oblique Translation

    Directory of Open Access Journals (Sweden)

    / Esmail Zare Behtash

    2017-06-01

    Full Text Available Translation is of an absolute necessity in today’s world. Robinson (1997 states that the study of translation is an integral part of intercultural relations and of conveying scientific and technological knowledge. He further mentions that “translators need to be able to process linguistic materials quickly and efficiently; but they also need to be able to recognize problem areas and to slow down to solve them in complex analytical ways” (p. 2. This study is an attempt to explore and evaluate an oblique translation of a text from English into Persian to find the most frequent translation strategy. To reach the goal of the study, the researchers selected one hundred and ten sentences of an original English text which had been translated freely at random and compared them with their Persian counterparts. The findings of the study indicated that Persian translator used equivalent strategy with the highest percentage (45% in the translated corpus. After that, modulation, and transposition had the highest percentages respectively.

  11. Comparative evaluation of a newly developed 13-valent pneumococcal conjugate vaccine in a mouse model.

    Science.gov (United States)

    Park, Chulmin; Kwon, Eun-Young; Choi, Su-Mi; Cho, Sung-Yeon; Byun, Ji-Hyun; Park, Jung Yeon; Lee, Dong-Gun; Kang, Jin Han; Shin, Jinhwan; Kim, Hun

    2016-12-14

    Animal models facilitate evaluation of vaccine efficacy at relatively low cost. This study was a comparative evaluation of the immunogenicity and protective efficacy of a new 13-valent pneumococcal conjugate vaccine (PCV13) with a control vaccine in a mouse model. After vaccination, anti-capsular antibody levels were evaluated by pneumococcal polysaccharide (PnP) enzyme-linked immunosorbent assay (ELISA) and opsonophagocytic killing assay (OPA). Also, mice were challenged intraperitoneally with 100-fold of the 50% lethal dose of Streptococcus pneumoniae. The anti-capsular IgG levels against serotypes 1, 4, 7F, 14, 18C, 19A, and 19F were high (quartile 2 >1,600), while those against the other serotypes were low (Q2 ≤ 800). Also, the OPA titres were similar to those determined by PnP ELISA. Comparative analysis between new PCV13 and control vaccination group in a mouse model exhibited significant differences in serological immunity of a few serotypes and the range of anti-capsular IgG in the population. Challenge of wild-type or neutropenic mice with serotypes 3, 5, 6A, 6B, and 9V showed protective immunity despite of induced relatively low levels of anti-capsular antibodies. With comparison analysis, a mouse model should be adequate for evaluating serological efficacy and difference in the population level as preclinical trial.

  12. Cost-effectiveness analysis of sofosbuvir compared to current standard treatment in Swiss patients with chronic hepatitis C.

    Directory of Open Access Journals (Sweden)

    Alena M Pfeil

    Full Text Available In clinical trials, sofosbuvir showed high antiviral activity in patients infected with hepatitis C virus (HCV across all genotypes. We aimed to determine the cost-effectiveness of sofosbuvir-based treatment compared to current standard treatment in mono-infected patients with chronic hepatitis C (CHC genotypes 1-4 in Switzerland. Cost-effectiveness was modelled from the perspective of the Swiss health care system using a lifetime Markov model. Incremental cost-effectiveness ratios (ICERs used an endpoint of cost per quality-adjusted life year (QALY gained. Treatment characteristics, quality of life, and transition probabilities were obtained from published literature. Country-specific model inputs such as patient characteristics, mortality and costs were obtained from Swiss sources. We performed extensive sensitivity analyses. Costs and effects were discounted at 3% (range: 0-5% per year. Sofosbuvir-containing treatment in mixed cohorts of cirrhotic and non-cirrhotic patients with CHC genotypes 1-4 showed ICERs between CHF 10,337 and CHF 91,570 per QALY gained. In subgroup analyses, sofosbuvir dominated telaprevir- and boceprevir-containing treatment in treatment-naïve genotype 1 cirrhotic patients. ICERs of sofosbuvir were above CHF 100,000 per QALY in treatment-naïve, interferon eligible, non-cirrhotic patients infected with genotypes 2 or 3. In deterministic and probabilistic sensitivity analyses, results were generally robust. From a Swiss health care system perspective, treatment of mixed cohorts of cirrhotic and non-cirrhotic patients with CHC genotypes 1-4 with sofosbuvir-containing treatment versus standard treatment would be cost-effective if a threshold of CHF 100,000 per QALY was assumed.

  13. Cost-effectiveness analysis of sofosbuvir compared to current standard treatment in Swiss patients with chronic hepatitis C.

    Science.gov (United States)

    Pfeil, Alena M; Reich, Oliver; Guerra, Ines M; Cure, Sandrine; Negro, Francesco; Müllhaupt, Beat; Lavanchy, Daniel; Schwenkglenks, Matthias

    2015-01-01

    In clinical trials, sofosbuvir showed high antiviral activity in patients infected with hepatitis C virus (HCV) across all genotypes. We aimed to determine the cost-effectiveness of sofosbuvir-based treatment compared to current standard treatment in mono-infected patients with chronic hepatitis C (CHC) genotypes 1-4 in Switzerland. Cost-effectiveness was modelled from the perspective of the Swiss health care system using a lifetime Markov model. Incremental cost-effectiveness ratios (ICERs) used an endpoint of cost per quality-adjusted life year (QALY) gained. Treatment characteristics, quality of life, and transition probabilities were obtained from published literature. Country-specific model inputs such as patient characteristics, mortality and costs were obtained from Swiss sources. We performed extensive sensitivity analyses. Costs and effects were discounted at 3% (range: 0-5%) per year. Sofosbuvir-containing treatment in mixed cohorts of cirrhotic and non-cirrhotic patients with CHC genotypes 1-4 showed ICERs between CHF 10,337 and CHF 91,570 per QALY gained. In subgroup analyses, sofosbuvir dominated telaprevir- and boceprevir-containing treatment in treatment-naïve genotype 1 cirrhotic patients. ICERs of sofosbuvir were above CHF 100,000 per QALY in treatment-naïve, interferon eligible, non-cirrhotic patients infected with genotypes 2 or 3. In deterministic and probabilistic sensitivity analyses, results were generally robust. From a Swiss health care system perspective, treatment of mixed cohorts of cirrhotic and non-cirrhotic patients with CHC genotypes 1-4 with sofosbuvir-containing treatment versus standard treatment would be cost-effective if a threshold of CHF 100,000 per QALY was assumed.

  14. Comparative study of cost-benefit integrated system of water spary with industrial ventilation and bag filters in a minerals processing company

    Directory of Open Access Journals (Sweden)

    Morteza Babaei

    2016-06-01

    Full Text Available Introduction: Control of fugitative dust from mining process and application of an appropriate and economical system for dust collecting is essential. The goal of this study was cost-benefit analysis of an integrated systems and compare to bag filter in a crushing plant of a mining company. Methods: A local exhaust ventilation system for capture of emitted particlees, a water spray for dust suppresion at sources and parallel Stairmand model cyclones as dust colletor were designed and installed based on the standards and guidelines. Then, efficiency of wetting and industrial ventilation system for control of ambient dust personal exposure and environmental emission have evaluated as integrated and alone. Finally, cost-benefit analysis of this system was compared to bag filter. Results: The efficiency of this system for control personal exposure repairable particles and emitted dust to ambient air was 87% and 95% for plant 1 and 88% and 95% for plant 2, respectively. The concentration of emitted emitted dust from stack to environment were 121.28 mg/m3 and 112/68 mg/m3 for plant 1 and 2, respectively. The capital, operational and maintence costs of this option was 217 and 0.992 billion rials lower than bag filter. Also, annuall collected dust by cyclones was worth 518 million rial. Conclusion: According to results, integrated system had a significant impact on emitted dust in workplace and environment. The economical analysis domonstrated 73% and 80% savings in capital and operational costs compared to bag filter. Total costs of implented project will be compensated at 220 day with recovered dusts, therefore, in the same condition, it can be suggested as the favourable and economical solution.

  15. Guide for Conducting Benefit-Cost Evaluation of Realized Impacts of Public R&D Programs

    Energy Technology Data Exchange (ETDEWEB)

    Ruegg, Rosalie [TIA Consulting, Inc., Emerald Isle, NC (United States); Jordan, Gretchen B. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2011-08-01

    This document provides guidance for evaluators who conduct impact assessments to determine the “realized” economic benefits and costs, energy, environmental benefits, and other impacts of the Office of Energy Efficiency and Renewable Energy’s (EERE) R&D programs. The focus of this Guide is on realized outcomes or impacts of R&D programs actually experienced by American citizens, industry, and others. Retrospective evaluations may be contrasted to prospective evaluations that reflect expected or potential outcomes only if assumptions hold. The retrospective approach described in this Guide is based on realized results only and the extent they can be attributed to the efforts of an R&D program. While it has been prepared specifically to guide retrospective benefit-cost analysis of EERE R&D Programs, this report may be used for similar analysis of other public R&D organizations.

  16. Discounting in the evaluation of the cost-effectiveness of a vaccination programme: A critical review.

    Science.gov (United States)

    Jit, Mark; Mibei, Walter

    2015-07-31

    Discounting future costs and health benefits usually has a large effect on results of cost-effectiveness evaluations of vaccination because of delays between the initial expenditure in the programme and the health benefits from averting disease. Most guidelines currently recommend discounting both costs and health effects at a positive, constant, common rate back to a common point in time. A review of 84 published economic evaluations of vaccines found that most of them apply these recommendations. However, both technical and normative arguments have been presented for discounting health at a different rate to consumption (differential discounting), discounting at a rate that changes over time (non-constant discounting), discounting intra-generational and inter-generational effects at a different rate (two-stage discounting), and discounting the health gains from an intervention to a different discount year from the time of intervention (delayed discounting). These considerations are particularly acute for vaccines, because their effects can occur in a different generation from the one paying for them, and because the time of vaccination, of infection aversion, and of disease aversion usually differ. Using differential, two-stage or delayed discounting in model-based cost-effectiveness evaluations of vaccination raises technical challenges, but mechanisms have been proposed to overcome them.

  17. The comparative and cost-effectiveness of HPV-based cervical cancer screening algorithms in El Salvador.

    Science.gov (United States)

    Campos, Nicole G; Maza, Mauricio; Alfaro, Karla; Gage, Julia C; Castle, Philip E; Felix, Juan C; Cremer, Miriam L; Kim, Jane J

    2015-08-15

    Cervical cancer is the leading cause of cancer death among women in El Salvador. Utilizing data from the Cervical Cancer Prevention in El Salvador (CAPE) demonstration project, we assessed the health and economic impact of HPV-based screening and two different algorithms for the management of women who test HPV-positive, relative to existing Pap-based screening. We calibrated a mathematical model of cervical cancer to epidemiologic data from El Salvador and compared three screening algorithms for women aged 30-65 years: (i) HPV screening every 5 years followed by referral to colposcopy for HPV-positive women (Colposcopy Management [CM]); (ii) HPV screening every 5 years followed by treatment with cryotherapy for eligible HPV-positive women (Screen and Treat [ST]); and (iii) Pap screening every 2 years followed by referral to colposcopy for Pap-positive women (Pap). Potential harms and complications associated with overtreatment were not assessed. Under base case assumptions of 65% screening coverage, HPV-based screening was more effective than Pap, reducing cancer risk by ∼ 60% (Pap: 50%). ST was the least costly strategy, and cost $2,040 per year of life saved. ST remained the most attractive strategy as visit compliance, costs, coverage, and test performance were varied. We conclude that a screen-and-treat algorithm within an HPV-based screening program is very cost-effective in El Salvador, with a cost-effectiveness ratio below per capita GDP. © 2015 UICC.

  18. Evaluation of the IEP Costing Procedures: A Pilot Study by Six Major Research Universities.

    Science.gov (United States)

    Topping, Jim

    The Information Exchange Procedures (IEP) cost study project of the National Center for Higher Education Management Systems is described and its applicability to six major research universities (MRU) is assessed in this pilot study. The IEP enables peer institutions to compare information about their resources, activities, and educational…

  19. Enhanced First Trimester Screening for Trisomy 21 with Contingent Cell-Free Fetal DNA: A Comparative Performance and Cost Analysis.

    Science.gov (United States)

    Huang, Tianhua; Meschino, Wendy S; Teitelbaum, Mari; Dougan, Shelley; Okun, Nan

    2017-09-01

    Prenatal screening for trisomy 21 is a standard of care. Emerging cell-free fetal DNA (cffDNA) technologies can improve screening performance, but they are expensive. This study was conducted to propose a contingent screening model that would incorporate cffDNA technology, would remain affordable, and could be applied equitably in a publically funded system. Using performance and cost parameters from published literature, four prenatal screening strategies were compared. Scenario 1 modelled integrated prenatal screening (first trimester nuchal translucency and biochemical markers from both the first and second trimesters) with no cffDNA. Scenarios 2 and 3 modelled first trimester combined screening (FTS) and "enhanced FTS" (adding serum placental growth factor and alpha fetoprotein to FTS), respectively, with contingent cffDNA following a positive result. Scenario 4 modelled cffDNA as the primary screening test. Scenario 1 provides a known detection rate (DR) of 88%, with a false positive rate (FPR) of 3.3%. Scenarios 2 and 3 result in a DR of 94% and overall FPR of 0.59% and 0.33%, respectively, comparable to the DR of 96% and FPR of 0.1% with primary cffDNA (assuming the published test failure rate of 3%). The total cost, cost per woman screened, and cost per case of trisomy 21 detected were lower with scenario 3 (enhanced FTS with contingent cffDNA) compared with primary cffDNA or scenario 2 (FTS with contingent cffDNA). Enhanced FTS with contingent cffDNA following a positive result provides a similar performance to that of primary cffDNA at a substantially lower cost. Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  20. Comparative analysis of wood chips and bundles - Costs, carbon dioxide emissions, dry-matter losses and allergic reactions

    Energy Technology Data Exchange (ETDEWEB)

    Eriksson, Lisa; Gustavsson, Leif [Ecotechnology, Department of Engineering and Sustainable Development, Mid Sweden University, SE-831 25 Oestersund (Sweden)

    2010-01-15

    There are multiple systems for the collection, processing, and transport of forest residues for use as a fuel. We compare two systems in use in Sweden to analyze differences in fuel cost, CO{sub 2} emissions, dry-matter loss, and potential for allergic reactions. We compare a bundle system with the traditional Swedish chip system, and then do an in-depth comparison of a Finnish bundle system with the Swedish bundle system. Bundle systems have lower costs, while the allergic reactions do not differ significantly between the systems. The bundle machine is expensive, but results in high productivity and in an overall cost-effective system. The bundle system has higher primary energy use and CO{sub 2} emissions, but the lower dry-matter losses in the bundle system chain give CO{sub 2} emissions per delivered MWh almost as low as for the chip system. Also, lower dry-matter losses mean that more biomass per hectare can be extracted from the clear-cut area. This leads to a higher possible substitution of fossil fuels per hectare with the bundle system, and that more CO{sub 2} emissions from fossil fuel can be avoided per hectare than in the chip system. The Finnish bundle system with its more effective compressing and forwarding is more cost- and energy-effective than the Swedish bundle system, but Swedish bundle systems can be adapted to be more effective in both aspects. (author)

  1. Comparative spectral analysis of commercial fuel-ethanol blends using a low-cost prototype FT-Raman spectrometer

    Science.gov (United States)

    Ortega Clavero, Valentin; Weber, Andreas; Schröder, Werner; Meyrueis, Patrick; Javahiraly, Nicolas

    2012-06-01

    The use of bio-fuels and fuel blends, specially in automotive industry, has been increasing substantially in recent years due to market prices and trends on sustainable development policies. Different spectral analysis techniques for quality control, production, purity, and counterfeit detection have been reported as non-invasive, fast, and price accessible. Raman spectra from three different commercial binary E10 fuel-ethanol blends has been obtained by using a low-cost Fourier-Transform Raman spectrometer (FT-Raman). Qualitative comparison between the commercial fuel blends and a laboratory-prepared fuel blend have been performed. The characteristic Raman lines from some additives contained in the commercial gasoline have been also observed. The spectral information is presented in the range of 0 cm-1 to 3500 cm-1 with a resolution of 1.66 cm-1. These Raman spectra shows reduced frequency deviation (less than 0.4 cm-1 when compared to standard Raman spectra from cyclohexane and toluene without compensation for instrumental response). Higher resolution values are possible, since the greater optical path lengths of the FT-Raman are achievable before the instrumental physical effects appear. The robust and highly flexible FT-Raman prototype proposed for the spectral analysis, consisting mainly of a Michelson interferometer and a self-designed photon counter, is able to deliver high resolution and precise Raman spectra with no additional complex hardware or software control. The mechanical and thermal disturbances affecting the FT-Raman system are mathematically compensated by extracting the optical path information from the generated interference pattern of a λ=632.8 nm Helium-Neon laser (HeNe laser), which is used at the spectrum evaluation.

  2. Comparative Ergonomic Evaluation of Spacesuit and Space Vehicle Design

    Science.gov (United States)

    England, Scott; Cowley, Matthew; Benson, Elizabeth; Harvill, Lauren; Blackledge, Christopher; Perez, Esau; Rajulu, Sudhakar

    2012-01-01

    With the advent of the latest human spaceflight objectives, a series of prototype architectures for a new launch and reentry spacesuit that would be suited to the new mission goals. Four prototype suits were evaluated to compare their performance and enable the selection of the preferred suit components and designs. A consolidated approach to testing was taken: concurrently collecting suit mobility data, seat-suit-vehicle interface clearances, and qualitative assessments of suit performance within the volume of a Multi-Purpose Crew Vehicle mockup. It was necessary to maintain high fidelity in a mockup and use advanced motion-capture technologies in order to achieve the objectives of the study. These seemingly mutually exclusive goals were accommodated with the construction of an optically transparent and fully adjustable frame mockup. The construction of the mockup was such that it could be dimensionally validated rapidly with the motioncapture system. This paper describes the method used to create a space vehicle mockup compatible with use of an optical motion-capture system, the consolidated approach for evaluating spacesuits in action, and a way to use the complex data set resulting from a limited number of test subjects to generate hardware requirements for an entire population. Kinematics, hardware clearance, anthropometry (suited and unsuited), and subjective feedback data were recorded on 15 unsuited and 5 suited subjects. Unsuited subjects were selected chiefly based on their anthropometry in an attempt to find subjects who fell within predefined criteria for medium male, large male, and small female subjects. The suited subjects were selected as a subset of the unsuited medium male subjects and were tested in both unpressurized and pressurized conditions. The prototype spacesuits were each fabricated in a single size to accommodate an approximately average-sized male, so select findings from the suit testing were systematically extrapolated to the extremes

  3. Comparative life cycle assessment and life cycle costing of lodging in the Himalaya

    DEFF Research Database (Denmark)

    Bhochhibhoya, Silu; Pizzol, Massimo; Achten, Wouter M J

    2016-01-01

    and economic burden in future construction projects. Methods The study consists of the life cycle assessment and life cycle costing of lodging in three building types: traditional, semi-modern and modern. The life cycle stages under analysis include raw material acquisition, manufacturing, construction, use......, a breakdown of the building components shows that the roof and wall of the building are the largest contributors to the production-related environmental impact. Conclusions The findings suggest that the main improvement opportunities in the lodging sector lie in the reduction of impacts on the use stage......Purpose The main aim of the study is to assess the environmental and economic impacts of the lodging sector located in the Himalayan region of Nepal, from a life cycle perspective. The assessment should support decision making in technology and material selection for minimal environmental...

  4. Comparative evaluation of various cytomorphological grading systems in breast carcinoma

    Directory of Open Access Journals (Sweden)

    P Arul

    2016-01-01

    Full Text Available Background: The diagnosis of breast carcinoma can be reliably made by fine needle aspiration cytology (FNAC. Grading usually done in histological samples for the selection of therapy but not in cytology. Various cytological grading systems have been proposed; however, none of them is presently considered the gold standard to predict the prognosis. Aim: This study was undertaken to evaluate various 3-tier cytological grading systems and to determine the best possible system corresponds to the histological grading proposed by Elston and Ellis based on the method by Nottingham modification of Scarff-Bloom-Richardson (SBR method. Materials and Methods: In this retrospective study, 94 cases of breast carcinoma FNACs were graded using six cytological grading systems and compared with SBR method. Concordance, association, and correlation studies were done to select best possible cytological grading system. The interobserver reproducibility among the six grading systems was also assessed. Results: Robinson method showed best correlation (r = 0.801; P = 0.0001 and t = 0.783; P = 0.0001, maximum percent agreement (83/94 cases; 88.3%, and a substantial kappa value of agreement (k = 0.737 with the Nottingham modification of SBR grading system followed by Mouriguand method. Taniguchi system showed better interobserver agreement (87.2%; k= 0.738. Conclusions: This study showed that all six cytological grading systems correlated positively with SBR method. However, Robinson's grading system demonstrated the best concordance, correlation, and substantial Kappa value of the agreement with the histological grading by SBR method in comparison to other 3-tier cytological grading systems. Hence, in conclusion, this grading should be routinely incorporated in the cytology reports as it correlates well with histological grade. Despite various cytological grading systems, Robinson's method is simple, more objective, and reproducible, hence being preferable for routine

  5. Upgrading Supply Chain Management Systems to Improve Availability of Medicines in Tanzania: Evaluation of Performance and Cost Effects.

    Science.gov (United States)

    Mwencha, Marasi; Rosen, James E; Spisak, Cary; Watson, Noel; Kisoka, Noela; Mberesero, Happiness

    2017-09-27

    To address challenges in public health supply chain performance, Tanzania invested in a national logistics management unit (LMU) and a national electronic logistics management information system (eLMIS). This evaluation examined the impact of those 2 key management upgrades approximately 1 year after they were introduced. We used a nonexperimental pre-post study design to compare the previous system with the upgraded management system. We collected baseline data from August to November 2013. We conducted round 1 of post-implementation data collection during April and May 2015, about 1 year after implementation of the upgrades. We evaluated key indicators of data use and reporting; supply chain management practices such as storage and supervision; supply chain performance including stock-out and expiry rates; and supply chain cost and savings. We analyzed the data using a range of techniques including statistical testing of baseline and round-1 results, and cost, cost-effectiveness, and return on investment analysis. The upgrades were associated with improvements in data use, accessibility, visibility, and transparency; planning, control, and monitoring; support for quantification; stock-out rates; stock-out duration; commodity expiry; and forecast error. The upgraded system was more costly, but it was also more efficient, particularly when adjusting for the performance improvements. The upgrades also generated substantial savings that defrayed some, but not all, of the investment costs. Upgrades to Tanzania's supply chain management systems created multiple and complex pathways to impact. One year after implementation, the LMU and eLMIS brought about performance improvements through better data use and through improvements in some, but not all, management practices. Furthermore, the upgrades-while not inexpensive-contributed to greater system efficiency and modest savings. © Mwencha et al.

  6. Upgrading Supply Chain Management Systems to Improve Availability of Medicines in Tanzania: Evaluation of Performance and Cost Effects

    Science.gov (United States)

    Mwencha, Marasi; Rosen, James E; Spisak, Cary; Watson, Noel; Kisoka, Noela; Mberesero, Happiness

    2017-01-01

    ABSTRACT Background: To address challenges in public health supply chain performance, Tanzania invested in a national logistics management unit (LMU) and a national electronic logistics management information system (eLMIS). This evaluation examined the impact of those 2 key management upgrades approximately 1 year after they were introduced. Methods: We used a nonexperimental pre-post study design to compare the previous system with the upgraded management system. We collected baseline data from August to November 2013. We conducted round 1 of post-implementation data collection during April and May 2015, about 1 year after implementation of the upgrades. We evaluated key indicators of data use and reporting; supply chain management practices such as storage and supervision; supply chain performance including stock-out and expiry rates; and supply chain cost and savings. We analyzed the data using a range of techniques including statistical testing of baseline and round-1 results, and cost, cost-effectiveness, and return on investment analysis. Results: The upgrades were associated with improvements in data use, accessibility, visibility, and transparency; planning, control, and monitoring; support for quantification; stock-out rates; stock-out duration; commodity expiry; and forecast error. The upgraded system was more costly, but it was also more efficient, particularly when adjusting for the performance improvements. The upgrades also generated substantial savings that defrayed some, but not all, of the investment costs. Conclusion: Upgrades to Tanzania's supply chain management systems created multiple and complex pathways to impact. One year after implementation, the LMU and eLMIS brought about performance improvements through better data use and through improvements in some, but not all, management practices. Furthermore, the upgrades—while not inexpensive—contributed to greater system efficiency and modest savings. PMID:28877933

  7. The Consolidated Automated Support System (CASS): A Comparative Evaluation

    Science.gov (United States)

    1990-06-01

    Example Data for Computing Average Availabilty (A.,g) .............. 90 X. 1987 Cost-Benefit Analysis of Procurement of CASS versus AFOT ...... 94 XI...function, station usage , operator identification, and the results of UUT testing. [Ref. 191 The Operational Management System (OMS) aids I level...69)1 = .72. (.002 * 3) + (.005 * 2) + (.003 * 3) 89 Table IX. Example Data for Computing Average Availabilty (A.,,) UUT Sta A Sta B Sta C Sta D 1

  8. Comparison of genomic DNA extraction techniques from whole blood samples: a time, cost and quality evaluation study.

    Science.gov (United States)

    Chacon-Cortes, Diego; Haupt, Larisa M; Lea, Rod A; Griffiths, Lyn R

    2012-05-01

    Genomic DNA obtained from patient whole blood samples is a key element for genomic research. Advantages and disadvantages, in terms of time-efficiency, cost-effectiveness and laboratory requirements, of procedures available to isolate nucleic acids need to be considered before choosing any particular method. These characteristics have not been fully evaluated for some laboratory techniques, such as the salting out method for DNA extraction, which has been excluded from comparison in different studies published to date. We compared three different protocols (a traditional salting out method, a modified salting out method and a commercially available kit method) to determine the most cost-effective and time-efficient method to extract DNA. We extracted genomic DNA from whole blood samples obtained from breast cancer patient volunteers and compared the results of the product obtained in terms of quantity (concentration of DNA extracted and DNA obtained per ml of blood used) and quality (260/280 ratio and polymerase chain reaction product amplification) of the obtained yield. On average, all three methods showed no statistically significant differences between the final result, but when we accounted for time and cost derived for each method, they showed very significant differences. The modified salting out method resulted in a seven- and twofold reduction in cost compared to the commercial kit and traditional salting out method, respectively and reduced time from 3 days to 1 hour compared to the traditional salting out method. This highlights a modified salting out method as a suitable choice to be used in laboratories and research centres, particularly when dealing with a large number of samples.

  9. Cost effectiveness of angiotensin receptor blocker monotherapy in patients with hypertension in the Netherlands : a comparative analysis using clinical trial and drug utilization data

    NARCIS (Netherlands)

    Boersma, C.; Voors, A.A.; Visser, Sipke; de Jong-van den Berg, L.T.W.; Postma, M.J.

    2010-01-01

    Background and Objective: Health gains and related cost savings achieved by optimizing treatment in hypertensive patients is highly important. The aim of this study was to evaluate the costs and cost effectiveness of treatment with angiotensin II receptor antagonists (angiotensin II receptor

  10. Cost effectiveness of angiotensin receptor blocker monotherapy in patients with hypertension in the Netherlands : a comparative analysis using clinical trial and drug utilization data

    NARCIS (Netherlands)

    Boersma, C.; Voors, A.A.; Visser, Sipke; de Jong-van den Berg, L.T.W.; Postma, M.J.

    2010-01-01

    Background and Objective: Health gains and related cost savings achieved by optimizing treatment in hypertensive patients is highly important. The aim of this study was to evaluate the costs and cost effectiveness of treatment with angiotensin II receptor antagonists (angiotensin II receptor blocker

  11. Evaluating the cost utility of racecadotril for the treatment of acute watery diarrhea in children: the RAWD model

    Directory of Open Access Journals (Sweden)

    Rautenberg TA

    2012-04-01

    Full Text Available Tamlyn Anne Rautenberg1,2, Ute Zerwes1, Douglas Foerster3,4, Rick Aultman51Assessment in Medicine GmbH, Lörrach, Germany; 2Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; 3Abbott Products Operations AG, Allschwil, Switzerland; 4University of Bielefeld, School of Public Health, Bielefeld, Germany; 5Semalytics, Arizona, United States of AmericaBackground: The safety and efficacy of racecadotril to treat acute watery diarrhea (AWD in children is well established, however its cost effectiveness for infants and children in Europe has not yet been determined.Objective: To evaluate the cost utility of racecadotril adjuvant with oral rehydration solution (ORS compared to ORS alone for the treatment of AWD in children younger than 5 years old. The analysis is performed from a United Kingdom National Health Service (NHS perspective.Methods: A decision tree model has been developed in Microsoft® Excel. The model is populated with the best available evidence. Deterministic and probabilistic sensitivity analyses (PSA have been performed. Health effects are measured as quality-adjusted life years (QALYs and the model output is cost (2011 GBP per QALY. The uncertainty in the primary outcome is explored by probabilistic analysis using 1000 iterations of a Monte Carlo simulation.Results: Deterministic analysis results in a total incremental cost of –£379 in favor of racecadotril and a total incremental QALY gain in favor of racecadotril of +0.0008. The observed cost savings with racecadotril arise from the reduction in primary care reconsultation and secondary referral. The difference in QALYs is largely attributable to the timely resolution of symptoms in the racecadotril arm. Racecadotril remains dominant when base case parameters are varied. Monte Carlo simulation and PSA confirm that racecadotril is the dominant treatment strategy and is almost certainly cost effective, under the central assumptions of the model, at a

  12. Comparing the cost-effectiveness of disease-modifying drugs for the first-line treatment of relapsing-remitting multiple sclerosis.

    Science.gov (United States)

    Goldberg, Lawrence D D; Edwards, Natalie C; Fincher, Contessa; Doan, Quan V; Al-Sabbagh, Ahmad; Meletiche, Dennis M

    2009-09-01

    Multiple sclerosis (MS) is an inflammatory autoimmune disorder of the central nervous system that primarily afflicts young adults. Approximately 400,000 people in the United States are affected by MS. Although several forms of MS exist, the most common course is known as relapsing-remitting MS (RRMS), which affects about 85% of MS patients. This form of MS is characterized by relapses of neurologic symptoms followed by periods of recovery. Progression of disease can lead to increasingly severe disability. Since the introduction of immunomodulatory biologic agents, such as interferon betas and glatiramer acetate, treatment has helped to change the course of the disease. Under budgetary constraints, health services payers are challenged to differentiate the economic value of these agents for formulary selection and/or placement. The primary objective of this analysis was to evaluate the 2-year cost-effectiveness of 4 disease modifying drugs (DMDs) used as first-line treatment of RRMS: glatiramer acetate, interferon (IFN) Beta-1a IM injection, IFN Beta-1a SC injection, and IFN Beta-1b SC injection. An Excel-based model was developed to compare the relative effectiveness and cost components of relapses, disability progression, and DMDs in the treatment of RRMS over a 2-year time horizon. The relative risk reduction (RRR) method was used to compare reduction in relapse rates and disease progression data from pivotal randomized double-blind placebo-controlled clinical trials of the DMDs. RRRs for relapses and disability progression, respectively, were calculated as the relative difference (treatment vs. placebo) in relapse rates and disease progression rates from placebo-controlled clinical trials. These RRRs were applied to the weighted average rates of relapse and number of disability progression steps seen in the placebo arms of the pivotal studies. The evaluation was conducted from the perspective of a U.S. health care payer (only direct medical costs considered

  13. Comparative Cost Analysis of Increasing Registered Nursing Staff on the Labor and Delivery Unit at the National Naval Medical Center.

    Science.gov (United States)

    1991-07-01

    recognized L&D Nurses 9 the central role of the registered nurse. In its most recent Accreditation Manual for Hospitals, JCAHO requires that "a...far beyond that of a L&D Nurses 60 comparably-sized civilian instituCion . Above all else NNMC is a Navy hospital, with responsibilities far beyond...1990). Accreditation Manual for Hospitals, 1990. Chicago: Author. Klarman, H. E. (1974). Application of cost-benefit analysis to the health services and

  14. Cost-Effectiveness of Capsaicin 8% Patch Compared with Pregabalin for the Treatment of Patients with Peripheral Neuropathic Pain in Scotland.

    Science.gov (United States)

    Mankowski, Colette; Patel, Sachin; Trueman, David; Bentley, Anthony; Poole, Chris

    2016-01-01

    We evaluated the cost-effectiveness of capsaicin 8% patch (QUTENZA™) versus pregabalin in patients with PNP from the perspective of the National Health Service (NHS) and Personal and Social Services in Scotland, UK. A decision-tree cost-effectiveness model was developed for non-diabetic patients with peripheral neuropathic pain (PNP) who were pregabalin-naïve and had not achieved adequate pain relief or tolerated conventional first- or second-line treatments. Patients entering the model received either a single application of capsaicin 8% patch or titrated daily dosing with pregabalin; after 8 weeks patients were classified as responders, non-responders, or were assumed to discontinue treatment due to intolerable adverse events. Responders continued to receive baseline treatment at intervals observed in clinical practice. Non-responders and those who discontinued treatment were assumed to receive last-line therapy (duloxetine). The base-case time horizon was 2 years. Model inputs for effectiveness, discontinuations and health-state utilities were taken from a head-to-head non-inferiority study (ELEVATE, NCT01713426). Other inputs were obtained from published sources or clinical expert opinion. Costs were expressed in GBP 2013/14. Results were presented as incremental cost-effectiveness ratios (ICER), i.e. cost per quality-adjusted life-year (QALY) gained. Model assumptions were tested with scenario analyses. Parameter uncertainty was tested using one-way and probabilistic sensitivity analyses. Compared with dose-optimized pregabalin, capsaicin 8% patch was the dominant treatment strategy (total cost difference, -£11; total QALY gain, 0.049). Capsaicin 8% patch was also the dominant treatment strategy versus pregabalin in 6 out of 7 scenario analyses. The model was most sensitive to variation in time to capsaicin 8% patch retreatment (maximum ICER, £7,951/QALY at lower-bound 95% confidence interval). At a willingness-to-pay threshold of £20,000/QALY, the

  15. Cost-Effectiveness of Capsaicin 8% Patch Compared with Pregabalin for the Treatment of Patients with Peripheral Neuropathic Pain in Scotland.

    Directory of Open Access Journals (Sweden)

    Colette Mankowski

    Full Text Available We evaluated the cost-effectiveness of capsaicin 8% patch (QUTENZA™ versus pregabalin in patients with PNP from the perspective of the National Health Service (NHS and Personal and Social Services in Scotland, UK. A decision-tree cost-effectiveness model was developed for non-diabetic patients with peripheral neuropathic pain (PNP who were pregabalin-naïve and had not achieved adequate pain relief or tolerated conventional first- or second-line treatments. Patients entering the model received either a single application of capsaicin 8% patch or titrated daily dosing with pregabalin; after 8 weeks patients were classified as responders, non-responders, or were assumed to discontinue treatment due to intolerable adverse events. Responders continued to receive baseline treatment at intervals observed in clinical practice. Non-responders and those who discontinued treatment were assumed to receive last-line therapy (duloxetine. The base-case time horizon was 2 years. Model inputs for effectiveness, discontinuations and health-state utilities were taken from a head-to-head non-inferiority study (ELEVATE, NCT01713426. Other inputs were obtained from published sources or clinical expert opinion. Costs were expressed in GBP 2013/14. Results were presented as incremental cost-effectiveness ratios (ICER, i.e. cost per quality-adjusted life-year (QALY gained. Model assumptions were tested with scenario analyses. Parameter uncertainty was tested using one-way and probabilistic sensitivity analyses. Compared with dose-optimized pregabalin, capsaicin 8% patch was the dominant treatment strategy (total cost difference, -£11; total QALY gain, 0.049. Capsaicin 8% patch was also the dominant treatment strategy versus pregabalin in 6 out of 7 scenario analyses. The model was most sensitive to variation in time to capsaicin 8% patch retreatment (maximum ICER, £7,951/QALY at lower-bound 95% confidence interval. At a willingness-to-pay threshold of £20,000/QALY

  16. [Evaluation of drug cost reduction resulting from the free supply of investigational drugs].

    Science.gov (United States)

    Corvaisier, Stéphane; Ferry, Serge; Rochefort, Françoise

    2003-01-01

    Excluding all other costs or benefits of participation in clinical trials, the objective of this study was to evaluate and analyse the cost avoidance represented by the free supply of the investigational drug in place of paying for a marketed drug. The cost avoided was defined as money that would most likely have been spent, but not because of inclusion of the patient in the clinical study. Only studies for which a marketed alternative drug was available with a standard dosage have been analysed. The numbers of delivered doses or the treatment durations were tabulated from pharmacy dispensing records for each study, and were used to calculate the medication cost avoided. No marketed alternative drug was available for 10 of 56 clinical studies. In total, in 2000, the cost avoidance was estimated between [symbol: see text] 585,492 and [symbol: see text] 603,674, with a wide variability between studies or between patients (CV: 120-520%). The two disease categories associated with the largest cost avoidance were multiple sclerosis and growth hormone deficiency. The cost avoidance was essentially of benefit to the medical insurance or the patient (98%) and was lower than [symbol: see text] 10,000 for the hospital, because 91% of patients are not hospitalised. So, why are clinical studies involving ambulatory patients performed in hospital? Of the 56 studies analysed, 46 could be shown to be non-innovative, because a marketed alternative drug was available. Few studies appeared to permit free access to treatment with non-reimbursable marketed drugs.

  17. A self-made, low-cost infrared system for evaluating the sciatic functional index in mice

    Institute of Scientific and Technical Information of China (English)

    Lukas Fricker; Vincenzo Penna; Florian Lampert; G Bjoern Stark; Christian Witzel; Georgios Koulaxouzidis

    2016-01-01

    The sciatic functional index (SFI) is a popular parameter for peripheral nerve evaluation that relies on footprints obtained with ink and paper. Drawbacks include smearing artefacts and a lack of dynamic in-formation during measurement. Modern applications use digitized systems that can deliver results with less analytical effort and fewer mice. However, the systems are expensive (€40,000). This study aimed to evaluate the applicability and precision of a self-made, low-cost infrared system for evaluating SFI in mice. Mice were subjected to unilateral sciatic nerve crush injury (crush group;n = 7) and sham operation (sham group;n = 4). They were evaluated on the day before surgery, the 2nd, 4th and 6th days after injury, and then every day up to the 23rd day after injury. We compared two SFI evaluation methods,i.e., conventional ink-and-paper SFI (C-SFI) and our infrared system (I-SFI). Our apparatus visualized footprints with totally internally relfected infrared light (950 nm) and a camera that can only detect this wavelength. Additionally we performed an analysis with the ladder beam walking test (LBWT) as a reference test. I-SFI assessment reduced the standard deviation by about 33 percent, from 11.6 to 7.8, and cut the variance around the base-line to 21 percent. The system thus requires fewer measurement repetitions and fewer animals, and cuts the cost of keeping the animals. The apparatus cost€321 to build. Our results show that the process of obtain-ing the SFI can be made more precise via digitization with a self-made, low-cost infrared system.

  18. Accounting for the inaccuracies in demand forecasts and construction cost estimations in transport project evaluation

    DEFF Research Database (Denmark)

    Salling, Kim Bang; Leleur, Steen

    2014-01-01

    For decades researchers have claimedthat particularly demand forecasts and construction cost estimations are assigned with/affected by a large degree of uncertainty. Massively, articles,research documents and reports agree that there exists a tendencytowards underestimating the costs and overesti......For decades researchers have claimedthat particularly demand forecasts and construction cost estimations are assigned with/affected by a large degree of uncertainty. Massively, articles,research documents and reports agree that there exists a tendencytowards underestimating the costs...... and overestimating the demand for transport infrastructure projects. It is therefore claimed that ex-anteevaluations of trans- port-related projects are often based on inaccurate material, which ultimately can lead to severe socio- economic misperformance. This paper seeks to bridge the gap between the inaccuracies...... in demand and cost estimations and hence the evaluation of transport infrastructure projects. Currently, research within this area is scarce and scattered with no commonagreement on how to embed and operationalise the huge amount of empiricaldata that exist within the frame of Optimism Bias. Therefore...

  19. Evaluating the cost-effectiveness of ecosystem-based adaptation: Kamiesberg wetlands case study

    Directory of Open Access Journals (Sweden)

    David Black

    2016-12-01

    Full Text Available Ecosystem-based adaptation (EbA is increasingly being promoted as a cost-effective means of adaptation to climate change. However, in spite of considerable international press, there is still little evidence to substantiate this claim. This study proposes a method through which the cost-effectiveness of EbA strategies can be evaluated against alternative adaptation options, and contributes to South African literature on the subject. The potential cost-effectiveness of wetland restoration is assessed as a means of securing the carrying capacity of land for pastoralist communities of the Kamiesberg communal area in South Africa under projected future climate conditions. The conventional alternatives would be to respond to increasingly dry conditions by drilling boreholes and using supplemental feed for livestock. It was assumed that the EbA interventions would occur upfront, whereas the alternatives are more likely to be implemented in reaction to droughts over a longer time period. The study found the implementation of conventional alternatives to be more cost-effective than EbA as a means to sustaining livestock stocking rates, with EbA being twice as costly. However, this is framed from the perspective of those directly affected (the landowners, and does not include the benefits to broader society.

  20. [Evaluation of financial status of public hospitals considering the updated costs of their services].

    Science.gov (United States)

    Cid P, Camilo; Bastías S, Gabriel

    2014-02-01

    In 2011 the Chilean National Health Fund (FONASA) commissioned a study to assess the costs of the 120 most relevant hospital care services with an established fee, in a large sample of public hospitals. We herein report the cost evaluation results of such study, considering the financial condition of those hospitals in the year of the study. Based on the premise that the expenses derived from the provision of institutional and appraised hospital services should be identical to the billing of hospitals to FONASA, the prices are undervalued, since they cover only 56% of billing, generating a gap between expenses and invoicing. This gap shows an important limitation of tariffs, since their prices do not cover the real costs. However not all hospitals behave in the same way. While the provision of services of some hospitals is even higher than their billing, most hospitals do not completely justify their invoicing. These assumptions would imply that, generally speaking, hospital debts are justified by the costs incurred. However, hospitals have heterogeneous financial situations that need to be analyzed carefully. In particular, nothing can be said about their relative efficiency if cost estimations are not adjusted by the complexity of patients attended and comparison groups are not defined.

  1. Practical evaluation of standard-based low-cost video conferencing in telemedicine and epidemiological applications.

    Science.gov (United States)

    Klutke, P J; Gostomzyk, J G; Mattioli, P; Baruffaldi, F; Plasencia, A; Borrell, C; Pasarin, M; Di Crescenzo, E; Pipitone, E; Mancini, C; Toschi, A; Morshedi, M; Strintzis, M G; Englmeier, K H

    1999-01-01

    The results of the evaluation of use of low-cost video conferencing systems (VCSs) in telemedicine is presented. Applications sharing, a new feature of these systems, recently has allowed high-quality computer-supported collaborative work (CSCW). The video conferencing (VCing) equipment used was Intel ProShare 200 v2.0a. It is representative of other low-cost VCSs. The areas of application are epidemiology and telemedicine (orthopaedics and radiology). Potential end users filled out 58 evaluation questionnaires concerning user profiles, contents and benefits of the sessions, organizational aspects, user friendliness, user acceptance, cost effectiveness, technical and multipoint related aspects. Although the end users had a lot of computer experience, their knowledge in VCSs was rather limited. The users assessed the system capable of being integrated into routine work, despite a high organizational impact. The VCS is user friendly, application sharing being used in almost every session. Audio quality was not always sufficient. The remote video was sufficient, as was the quality of medical images such as CT, MRI or X-ray. The user acceptance of the system was high. Multipoint sessions require a structured protocol to be effective. Some technical problems with MCUs (Multipoint Control Units) occurred. The use of low-cost standard VCSs in telemedicine is advisable and is a good substitute for real meetings.

  2. Ultrasound and clinical evaluation of soft-tissue versus hardware biceps tenodesis: is hardware tenodesis worth the cost?

    Science.gov (United States)

    Elkousy, Hussein; Romero, Jose A; Edwards, T Bradley; Gartsman, Gary M; O'Connor, Daniel P

    2014-02-01

    This study assesses the failure rate of soft-tissue versus hardware fixation of biceps tenodesis by ultrasound to determine if the expense of a hardware tenodesis technique is warranted. Seventy-two patients that underwent arthroscopic biceps tenodesis over a 3-year period were evaluated using postoperative ultrasonography and clinical examination. The tenodesis technique employed was either a soft-tissue technique with sutures or an interference screw technique using hardware based on surgeon preference. Patient age was 57.9 years on average with ultrasound and clinical examination done at an average of 9.3 months postoperatively. Thirty-one patients had a hardware technique and 41 a soft-tissue technique. Overall, 67.7% of biceps tenodesis done with hardware were intact, compared with 75.6% for the soft-tissue technique by ultrasound (P = .46). Clinical evaluation indicated that 80.7% of hardware techniques and 78% of soft-tissue techniques were intact. Average material cost to the hospital for the hardware technique was $514.32, compared with $32.05 for the soft-tissue technique. Biceps tenodesis success, as determined by clinical deformity and ultrasound, was not improved using hardware as compared to soft-tissue techniques. Soft-tissue techniques are equally efficacious and more cost effective than hardware techniques.

  3. Costs and effects of long-acting risperidone compared with oral atypical and conventional depot formulations in Germany.

    Science.gov (United States)

    Laux, Gerd; Heeg, Bart; van Hout, Ben A; Mehnert, Angelika

    2005-01-01

    Schizophrenia is one of the most expensive psychiatric conditions because of high direct and indirect costs associated with the nature of the illness, its resistance to treatment and the consequences of relapse. Long-acting risperidone is a new formulation of an atypical antipsychotic drug that also offers the improvements in compliance associated with haloperidol depot. The aim of this simulation study was to compare the benefits and costs of three pharmacological treatment strategies comprising first-line treatment with long-acting risperidone injection, a haloperidol depot or an oral atypical antipsychotic agent, over a 5-year period in Germany. A discrete event simulation model was developed to compare three treatment scenarios from the perspective of major third-party payers (sickness funds and social security 'Sozialversicherung'). The scenarios comprised first-line treatment with haloperidol depot (scenario 1), long-acting risperidone (scenario 2) and oral olanzapine (scenario 3). Switches to second or third-line options were allowed when side-effects occurred or a patient suffered more than a fixed number of relapses. The model accounted for fixed patient characteristics, and on the basis of these, simulated patient histories according to several time-dependent variables. The time horizon for this model was limited to 5 years, and in accordance with German guidelines, costs and effects were discounted by between 3 and 10%. Direct costs included medication, type of physician visits and treatment location. Indirect costs were not included. Information on treatment alternatives, transition probabilities, model structure and healthcare utilization were derived from the literature and an expert panel. Outcomes were expressed in terms of the number and duration of psychotic episodes, cumulative symptom scores, costs, and quality-adjusted life-years (QALY). Univariate sensitivity analyses were carried out, as were subgroup analyses based on disease severity and

  4. Comparative evaluation of maintenance performance using subsurvival functions

    DEFF Research Database (Denmark)

    Paulsen, J.L.; Cooke, R.; Nyman, R.

    1997-01-01

    Subsurvival functions are applied to operational data for the control rod drive systems of Nordic nuclear reactors to evaluate maintenance performance. Competing failure modes are preventive and corrective maintenance. Maintenance indicators are defined and evaluated for 8 plants. (C) 1997 Elsevier...

  5. The Evaluation of Vocational Training: A Comparative Analysis.

    Science.gov (United States)

    Tome, Eduardo

    2001-01-01

    Comparison of vocational training evaluation in the United States, Organization for Economic Cooperation and Development states, and the European Union identified certain advantages to the U.S. model of microeconometric impact evaluation, including better policy and expenditure of public money. (Contains 49 references.) (SK)

  6. ``Low-cost Electronic nose evaluated on Thai-herb of Northern-Thailand samples using multivariate analysis methods''

    Science.gov (United States)

    na ayudhaya, Paisarn Daungjak; Klinbumrung, Arrak; Jaroensutasinee, Krisanadej; Pratontep, Sirapat; Kerdcharoen, Teerakiat

    2009-05-01

    In case of species of natural and aromatic plant originated from the northern Thailand, sensory characteristics, especially odours, have unique identifiers of herbs. The instruments sensory analysis have performed by several of differential of sensing, so call `electronic nose', to be a significantly and rapidly for chemometrics. The signal responses of the low cost electronic nose were evaluated by principal component analysis (PCA). The aims of this paper evaluated various of Thai-herbs grown in Northern of Thailand as data preprocessing tools of the Low-cost electronic nose (enNU-PYO1). The essential oil groups of Thai herbs such as Garlic, Lemongrass, Shallot (potato onion), Onion, Zanthoxylum limonella (Dennst.) Alston (Thai name is Makaen), and Kaffir lime leaf were compared volatilized from selected fresh herbs. Principal component analysis of the original sensor responses did clearly distinguish either all samples. In all cases more than 97% for cross-validated group were classified correctly. The results demonstrated that it was possible to develop in a model to construct a low-cost electronic nose to provide measurement of odoriferous herbs.

  7. Comparative approaches from empirical to mechanistic simulation modelling in Land Evaluation studies

    Science.gov (United States)

    Manna, P.; Basile, A.; Bonfante, A.; Terribile, F.

    2009-04-01

    The Land Evaluation (LE) comprise the evaluation procedures to asses the attitudes of the land to a generic or specific use (e.g. biomass production). From local to regional and national scale the approach to the land use planning should requires a deep knowledge of the processes that drive the functioning of the soil-plant-atmosphere system. According to the classical approaches the assessment of attitudes is the result of a qualitative comparison between the land/soil physical properties and the land use requirements. These approaches have a quick and inexpensive applicability; however, they are based on empirical and qualitative models with a basic knowledge structure specifically built for a specific landscape and for the specific object of the evaluation (e.g. crop). The outcome from this situation is the huge difficulties in the spatial extrapolation of the LE results and the rigidity of the system. Modern techniques instead, rely on the application of mechanistic and quantitative simulation modelling that allow a dynamic characterisation of the interrelated physical and chemical processes taking place in the soil landscape. Moreover, the insertion of physical based rules in the LE procedure may make it less difficult in terms of both extending spatially the results and changing the object (e.g. crop species, nitrate dynamics, etc.) of the evaluation. On the other side these modern approaches require high quality and quantity of input data that cause a significant increase in costs. In this scenario nowadays the LE expert is asked to choose the best LE methodology considering costs, complexity of the procedure and benefits in handling a specific land evaluation. In this work we performed a forage maize land suitability study by comparing 9 different methods having increasing complexity and costs. The study area, of about 2000 ha, is located in North Italy in the Lodi plain (Po valley). The range of the 9 employed methods ranged from standard LE approaches to

  8. Cognitive skills and bacterial load: comparative evidence of costs of cognitive proficiency in birds

    Science.gov (United States)

    Soler, Juan José; Peralta-Sánchez, Juan Manuel; Martín-Vivaldi, Manuel; Martín-Platero, Antonio Manuel; Flensted-Jensen, Einar; Møller, Anders Pape

    2012-02-01

    Parasite-mediated selection may affect the evolution of cognitive abilities because parasites may influence development of the brain, but also learning capacity. Here, we tested some predictions of this hypothesis by analyzing the relationship between complex behaviours (feeding innovations (as a measure of behavioural flexibility) and ability to detect foreign eggs in their nests (i.e. a measure of discriminatory ability)) and abundance of microorganisms in different species of birds. A positive relationship would be predicted if these cognitive abilities implied a larger number of visited environments, while if these skills favoured detection and avoidance of risky environments, a negative relationship would be the prediction. Bacterial loads of eggshells, estimated for mesophilic and potentially pathogenic bacteria (i.e. Enterococcus, Staphylococcus and Enterobacteriaceae), were used as a surrogate of probability of contact with pathogenic bacteria. We found that bird species with higher feeding innovation rates and rejection rates of experimental brood parasitic eggs had higher density of bacteria on their eggshells than the average species. Since the analysed groups of microorganisms include pathogenic bacteria, these results suggest that both feeding innovation and ability to recognize foreign eggs are costly and highlight the importance of parasite-mediated selection in explaining the evolution of cognitive abilities in animals.

  9. Comparative Analysis of HVAC System Based on Life Cycle Cost Analysis

    Directory of Open Access Journals (Sweden)

    Jignesh M. Barot

    2014-07-01

    Full Text Available A heating, ventilating, and air conditioning (HVAC system is designed to satisfy the environmental requirements of comfort or a process, in a specific building or portion of a building and in a particular geographic locale. Efficient design of heating, ventilating and air-conditioning (HVAC systems is a primary concern in building projects. The objectives of the HVAC system design are to provide a thermal comfort, good indoor quality and energy conservation. For the typical commercial building projects, it is not difficult to acquire the reference settings for efficient operation. However, for some special projects, due to the specific design and control of the HVAC system, conventional settings may not be necessarily energy-efficient in daily operation. The HVAC system design and equipment selection for a commercial building (376 TR is included as a case study in this paper. The outcomes of this paper are efficient design of HVAC system with minimum energy consumption and equipment selection based on operating and life cycle cost analysis.

  10. Moulding techniques in lipstick manufacture: a comparative evaluation.

    Science.gov (United States)

    Dweck, A C; Burnham, C A

    1980-06-01

    Synopsis This paper examines two methods of lipstick bulk manufacture: one via a direct method and the other via stock concentrates. The paper continues with a comparison of two manufactured bulks moulded in three different ways - first by split moulding, secondly by Rotamoulding, and finally by Ejectoret moulding. Full consideration is paid to time, labour and cost standards of each approach and the resultant moulding examined using some novel physical testing methods. The results of these tests are statistically analysed. Finally, on the basis of the gathered data and photomicrographical work a theoretical lipstick structure is proposed by which the results may be explained.

  11. Engineering Evaluation/Cost Analysis for Decommissioning of the Engineering Test Reactor Complex

    Energy Technology Data Exchange (ETDEWEB)

    A. B. Culp

    2006-10-01

    Preparation of this Engineering Evaluation/Cost Analysis is consistent with the joint U.S. Department of Energy and U.S. Environmental Protection Agency Policy on Decommissioning of Department of Energy Facilities Under the Comprehensive Environmental Response, Compensation, and Liability Act, which establishes the Comprehensive Environmental Response, Compensation, and Liability Act non-time-critical remova