Tan Torres Edejer, Tessa
... . . . . . . . . . . . . . . . . . . . . . . . XXI PART ONE: METHODS COST-EFFECTIVENESS FOR GENERALIZED ANALYSIS 1. 2. What is Generalized Cost-Effectiveness Analysis? . . . . . . . . . . . . 3 Undertaking...
Tan Torres Edejer, Tessa
... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 6. Uncertainty in cost-effectiveness analysis . . . . . . . . . . . . . . . . . . 73 7. 8. Policy uses of Generalized CEA...
Full Text Available Maritime freight shipping has increased significantly and air pollution from international ships has grown accordingly, having serious environmental effects all over the world. This paper analyzes the effects of the emission cost on ocean route choices, focusing on international container ships. First, the paper formulates a freight network model that captures decisions and interactions of ocean carriers and port terminal operators in the maritime freight transport system. Then, the emission cost is calculated based on an activity-based approach as a component of the ocean transportation cost function. A case study is examined to find if the emission cost affects ocean route choices. The results indicate that the optimal ocean route and transportation cost are changed distinctively due to the emission cost. The research discusses how the emission cost plays a role in route changes and why ocean carriers have to consider these costs in their routing decisions.
Magalhães, Paula; White, K Geoffrey
We investigated suboptimal choice between different work requirements in pigeons (Columba livia), namely the sunk cost effect, an irrational tendency to persist with an initial investment, despite the availability of a better option. Pigeons chose between two keys, one with a fixed work requirement to food of 20 pecks (left key), and the other with a work requirement to food which varied across conditions (center key). On some trials within each session, such choices were preceded by an investment of 35 pecks on the center key, whereas on others they were not. On choice trials preceded by the investment, the pigeons tended to stay and complete the schedule associated with the center key, even when the number of pecks to obtain reward was greater than for the concurrently available left key. This result indicates that pigeons, like humans, commit the sunk cost effect. With higher work requirements, this preference was extended to trials where there was no initial investment, so an overall preference for the key associated with more work was evident, consistent with the work ethic effect. We conclude that a more general work ethic effect is amplified by the effect of the prior investment, that is, the sunk cost effect. Copyright © 2013 Elsevier B.V. All rights reserved.
Hall, Rasheeda K; Myers, Evan R; Rosas, Sylvia E; O'Hare, Ann M; Colón-Emeric, Cathleen S
Although arteriovenous fistulas have been found to be the most cost-effective form of hemodialysis access, the relative benefits of placing an arteriovenous fistula versus an arteriovenous graft seem to be least certain for older adults and when placed preemptively. However, older adults' life expectancy is heterogeneous, and most patients do not undergo permanent access creation until after dialysis initiation. We evaluated cost-effectiveness of arteriovenous fistula placement after dialysis initiation in older adults as a function of age and life expectancy. Using a hypothetical cohort of patients on incident hemodialysis with central venous catheters, we constructed Markov models of three treatment options: ( 1 ) arteriovenous fistula placement, ( 2 ) arteriovenous graft placement, or ( 3 ) continued catheter use. Costs, utilities, and transitional probabilities were derived from existing literature. Probabilistic sensitivity analyses were performed by age group (65-69, 70-74, 75-79, 80-84, and 85-89 years old) and quartile of life expectancy. Costs, quality-adjusted life-months, and incremental cost-effectiveness ratios were evaluated for up to 5 years. The arteriovenous fistula option was cost effective compared with continued catheter use for all age and life expectancy groups, except for 85-89 year olds in the lowest life expectancy quartile. The arteriovenous fistula option was more cost effective than the arteriovenous graft option for all quartiles of life expectancy among the 65- to 69-year-old age group. For older age groups, differences in cost-effectiveness between the strategies were attenuated, and the arteriovenous fistula option tended to only be cost effective in patients with life expectancy >2 years. For groups for which the arteriovenous fistula option was not cost saving, the cost to gain one quality-adjusted life-month ranged from $2294 to $14,042. Among older adults, the cost-effectiveness of an arteriovenous fistula placed within the first
This document from OECD deals with the choices between the different means of producing electricity: supply and demand trends, power generation choices, management of development and technologies, environmental impacts and costs around energy sources. Separate abstracts were prepared for all the papers of this volume. (TEC)
Harms, Job; Rosenkranz, S.; Sanders, M.W.J.L.
In this study we investigate how two types of information interventions, providing a benchmark and providing costly information on option ranking, can improve decision-making in complex choices. In our experiment subjects made a series of incentivized choices between four hypothetical financial
Fitzgerald, Sarah; Murphy, Aileen; Kirby, Ann; Geaney, Fiona; Perry, Ivan J
To evaluate the costs, benefits and cost-effectiveness of complex workplace dietary interventions, involving nutrition education and system-level dietary modification, from the perspective of healthcare providers and employers. Single-study economic evaluation of a cluster-controlled trial (Food Choice at Work (FCW) study) with 1-year follow-up. Four multinational manufacturing workplaces in Cork, Ireland. 517 randomly selected employees (18-65 years) from four workplaces. Cost data were obtained from the FCW study. Nutrition education included individual nutrition consultations, nutrition information (traffic light menu labelling, posters, leaflets and emails) and presentations. System-level dietary modification included menu modification (restriction of fat, sugar and salt), increase in fibre, fruit discounts, strategic positioning of healthier alternatives and portion size control. The combined intervention included nutrition education and system-level dietary modification. No intervention was implemented in the control. The primary outcome was an improvement in health-related quality of life, measured using the EuroQoL 5 Dimensions 5 Levels questionnaire. The secondary outcome measure was reduction in absenteeism, which is measured in monetary amounts. Probabilistic sensitivity analysis (Monte Carlo simulation) assessed parameter uncertainty. The system-level intervention dominated the education and combined interventions. When compared with the control, the incremental cost-effectiveness ratio (€101.37/quality-adjusted life-year) is less than the nationally accepted ceiling ratio, so the system-level intervention can be considered cost-effective. The cost-effectiveness acceptability curve indicates there is some decision uncertainty surrounding this, arising from uncertainty surrounding the differences in effectiveness. These results are reiterated when the secondary outcome measure is considered in a cost-benefit analysis, whereby the system
Fitzgerald, Sarah; Murphy, Aileen; Kirby, Ann; Geaney, Fiona; Perry, Ivan J
Objective To evaluate the costs, benefits and cost-effectiveness of complex workplace dietary interventions, involving nutrition education and system-level dietary modification, from the perspective of healthcare providers and employers. Design Single-study economic evaluation of a cluster-controlled trial (Food Choice at Work (FCW) study) with 1-year follow-up. Setting Four multinational manufacturing workplaces in Cork, Ireland. Participants 517 randomly selected employees (18–65 years) from four workplaces. Interventions Cost data were obtained from the FCW study. Nutrition education included individual nutrition consultations, nutrition information (traffic light menu labelling, posters, leaflets and emails) and presentations. System-level dietary modification included menu modification (restriction of fat, sugar and salt), increase in fibre, fruit discounts, strategic positioning of healthier alternatives and portion size control. The combined intervention included nutrition education and system-level dietary modification. No intervention was implemented in the control. Outcomes The primary outcome was an improvement in health-related quality of life, measured using the EuroQoL 5 Dimensions 5 Levels questionnaire. The secondary outcome measure was reduction in absenteeism, which is measured in monetary amounts. Probabilistic sensitivity analysis (Monte Carlo simulation) assessed parameter uncertainty. Results The system-level intervention dominated the education and combined interventions. When compared with the control, the incremental cost-effectiveness ratio (€101.37/quality-adjusted life-year) is less than the nationally accepted ceiling ratio, so the system-level intervention can be considered cost-effective. The cost-effectiveness acceptability curve indicates there is some decision uncertainty surrounding this, arising from uncertainty surrounding the differences in effectiveness. These results are reiterated when the secondary outcome measure is
With the Patient Protection and Affordable Care Act ("ACA") set to dramatically increase access to medical care, the problem of rising costs will move center stage in health law and policy discussions. "Consumer directed health care" proposals, which provide patients with financial incentives to equate marginal costs and benefits of care at the point of treatment, demand more decisionmaking ability from consumers than is plausible due to bounded rationality. Proposals that seek to change the incentives of health care providers threaten to create conflicts of interest between doctors and patients. New approaches are desperately needed. This Article proposes a government-facilitated but market-based approach to improving efficiency in the private market for medical care that I call "relative value health insurance." This approach focuses on the "choice architecture" necessary to enable even boundedly rational patients to contract for an efficient level of health care services through their health insurance purchase decisions. It uses comparative effectiveness research, which the ACA funds at a significant level for the first time, to rate medical treatments on a scale of one to ten based on their relative value, taking into account expected costs and benefits. These relative value ratings would enable consumers to contract with insurers for different levels of medical care at different prices, reflecting different cost-quality trade-offs. The Article describes both the benefits of relative value health insurance and the impediments to its implementation. It concludes with a brief discussion of how relative value ratings could also help to rationalize expenditures on public health insurance programs.
Full Text Available The act of making a choice, apart from any outcomes the choice may yield, has, paradoxically, been linked to both the enhancement and the detriment of intrinsic motivation. Research has implicated two factors in potentially mediating these contradictory effects: the personal control conferred by a choice and the costs associated with a choice. Across four experiments, utilizing a physical effort task disguised as a simple video game, we systematically varied costs across two levels of physical effort requirements (Low-Requirement, High-Requirement and control over effort costs across three levels of choice (Free-Choice, Restricted-Choice, and No-Choice to disambiguate how these factors affect the motivational consequences of choosing within an effortful task. Together, our results indicated that, in the face of effort requirements, illusory control alone may not sufficiently enhance perceptions of personal control to boost intrinsic motivation; rather, the experience of actual control may be necessary to overcome effort costs and elevate performance. Additionally, we demonstrated that conditions of illusory control, while otherwise unmotivating, can through association with the experience of free-choice, be transformed to have a positive effect on motivation.
Glenn P Jenkins
Full Text Available The purpose of this study is to develop a model to arrive at a joint optimising strategy for capital budgeting for the construction of new school buildings and for the renovation of existing schools. This model provides a practical tool for ranking construction projects so as to yield the maximum positive impact on the education system. A key aspect of the model is that it provides the optimal mix of renovation and new construction that should be undertaken under a fixed budget constraint.The model is applied to a sample dataset from the education sector of Limpopo province, South Africa, in order to quantify the benefits of using the model. The benefits from using this model for decision making on the evaluation of new and renovation investments in school infrastructure is estimated to increase the effectiveness of these investments by up to 300 percent over the counterfactual system for making these decisions.
French, Simone A
Individual dietary choices are primarily influenced by such considerations as taste, cost, convenience and nutritional value of foods. The current obesity epidemic has been linked to excessive consumption of added sugars and fat, as well as to sedentary lifestyles. Fat and sugar provide dietary energy at very low cost. Food pricing and marketing practices are therefore an essential component of the eating environment. Recent studies have applied economic theories to changing dietary behavior. Price reduction strategies promote the choice of targeted foods by lowering their cost relative to alternative food choices. Two community-based intervention studies used price reductions to promote the increased purchase of targeted foods. The first study examined lower prices and point-of-purchase promotion on sales of lower fat vending machine snacks in 12 work sites and 12 secondary schools. Price reductions of 10%, 25% and 50% on lower fat snacks resulted in an increase in sales of 9%, 39% and 93%, respectively, compared with usual price conditions. The second study examined the impact of a 50% price reduction on fresh fruit and baby carrots in two secondary school cafeterias. Compared with usual price conditions, price reductions resulted in a four-fold increase in fresh fruit sales and a two-fold increase in baby carrot sales. Both studies demonstrate that price reductions are an effective strategy to increase the purchase of more healthful foods in community-based settings such as work sites and schools. Results were generalizable across various food types and populations. Reducing prices on healthful foods is a public health strategy that should be implemented through policy initiatives and industry collaborations.
Fleck, Leonard M
Meeting healthcare needs is a matter of social justice. Healthcare needs are virtually limitless; however, resources, such as money, for meeting those needs, are limited. How then should we (just and caring citizens and policymakers in such a society) decide which needs must be met as a matter of justice with those limited resources? One reasonable response would be that we should use cost effectiveness as our primary criterion for making those choices. This article argues instead that cost-effectiveness considerations must be constrained by considerations of healthcare justice. The goal of this article will be to provide a preliminary account of how we might distinguish just from unjust or insufficiently just applications of cost-effectiveness analysis to some healthcare rationing problems; specifically, problems related to extraordinarily expensive targeted cancer therapies. Unconstrained compassionate appeals for resources for the medically least well-off cancer patients will be neither just nor cost effective.
Anell, Anders; Dietrichson, Jens; Maria Ellegård, Lina
Consumers of services that are financed by a third party, such as publicly financed health care or firm-sponsored health plans, are often allowed to freely choose provider. The rationale is that consumer choice may improve the matching of consumers and providers and spur quality competition...... by individuals living reasonably close to alternative providers....
Drewnowski, Adam; Darmon, Nicole
Obesity in the United States is a socioeconomic issue. It is related to limited social and economic resources and may be linked to disparities in access to healthy foods. Added sugars and added fats are far more affordable than are the recommended "healthful" diets based on lean meats, whole grains, and fresh vegetables and fruit. There is an inverse relationship between energy density of foods (kJ/g) and energy cost ($/MJ), such that energy-dense grains, fats, and sweets represent the lowest-cost dietary options to the consumer. Good taste, high convenience, and the low cost of energy-dense foods, in conjunction with large portions and low satiating power, may be the principal reasons for overeating and weight gain. Financial disparities in access to healthier diets may help explain why the highest rates of obesity and diabetes are found among minorities and the working poor. If so, then encouraging low-income households to consume more costly foods is not an effective strategy for public health. What is needed is a comprehensive policy approach that takes behavioral nutrition and the economics of food choice into account.
Maren N Vitousek
Full Text Available Although the cost of mate choice is an essential component of the evolution and maintenance of sexual selection, the energetic cost of female choice has not previously been assessed directly. Here we report that females can incur high energetic costs as a result of discriminating among potential mates. We used heart rate biologging to quantify energetic expenditure in lek-mating female Galápagos marine iguanas (Amblyrhynchus cristatus. Receptive females spent 78.9+/-23.2 kJ of energy on mate choice over a 30-day period, which is equivalent to approximately (3/4 of one day's energy budget. Females that spent more time on the territories of high-quality, high-activity males displayed greater energetic expenditure on mate choice, lost more mass, and showed a trend towards producing smaller follicles. Choosy females also appear to face a reduced probability of survival if El Niño conditions occur in the year following breeding. These findings indicate that female choice can carry significant costs, and suggest that the benefits that lek-mating females gain through mating with a preferred male may be higher than previously predicted.
Power generation in Germany is dealing with social acceptability, cost considerations, governmental decisions and protection legislation. In the future, political and sociological factors will become more and more important: social acceptability of the energy sources choice is the most significant factor decision as the future pattern of power generation. (TEC)
Hongxin Zhao; Yadong Luo; Taewon Suh
Entry mode choice is a critical ingredient of international entry strategies, and has been voluminously examined in the field. The findings, however, are very mixed, especially with respect to transaction-cost-related factors in determining the ownership-based entry mode choice. This study conducted a meta-analysis to quantitatively summarize the literature and empirically generalize more conclusive findings. Based on the 106 effect sizes of 38 empirical studies, the meta-analysis shows that ...
Manser, Andri; Lindholm, Anna K; Weissing, Franz J
The evolution of female preference for male genetic quality remains a controversial topic in sexual selection research. One well-known problem, known as the lek paradox, lies in understanding how variation in genetic quality is maintained in spite of natural selection and sexual selection against low-quality alleles. Here, we theoretically investigate a scenario where females pay a direct fitness cost to avoid males carrying an autosomal segregation distorter. We show that preference evolution is greatly facilitated under such circumstances. Because the distorter is transmitted in a non-Mendelian fashion, it can be maintained in the population despite directional sexual selection. The preference helps females avoid fitness costs associated with the distorter. Interestingly, we find that preference evolution is limited if the choice allele induces a very strong preference or if distortion is very strong. Moreover, the preference can only persist in the presence of a signal that reliably indicates a male's distorter genotype. Hence, even in a system where the lek paradox does not play a major role, costly preferences can only spread under specific circumstances. We discuss the importance of distorter systems for the evolution of costly female choice and potential implications for the use of artificial distorters in pest control. © 2017 The Author(s). Evolution © 2017 The Society for the Study of Evolution.
Effectiveness and Cost-Effectiveness of Occupation-Based Occupational Therapy Using the Aid for Decision Making in Occupation Choice (ADOC) for Older Residents: Pilot Cluster Randomized Controlled Trial
Nagayama, Hirofumi; Tomori, Kounosuke; Ohno, Kanta; Takahashi, Kayoko; Ogahara, Kakuya; Sawada, Tatsunori; Uezu, Sei; Nagatani, Ryutaro; Yamauchi, Keita
Background Care-home residents are mostly inactive, have little interaction with staff, and are dependent on staff to engage in daily occupations. We recently developed an iPad application called the Aid for Decision-making in Occupation Choice (ADOC) to promote shared decision-making in activities and occupation-based goal setting by choosing from illustrations describing daily activities. This study aimed to evaluate if interventions based on occupation-based goal setting using the ADOC could focus on meaningful activities to improve quality of life and independent activities of daily living, with greater cost-effectiveness than an impairment-based approach as well as to evaluate the feasibility of conducting a large cluster, randomized controlled trial. Method In this single (assessor)-blind pilot cluster randomized controlled trial, the intervention group (ADOC group) received occupational therapy based on occupation-based goal setting using the ADOC, and the interventions were focused on meaningful occupations. The control group underwent an impairment-based approach focused on restoring capacities, without goal setting tools. In both groups, the 20-minute individualized intervention sessions were conducted twice a week for 4 months. Main Outcome Measures Short Form-36 (SF-36) score, SF-6D utility score, quality adjusted life years (QALY), Barthel Index, and total care cost. Results We randomized and analyzed 12 facilities (44 participants, 18.5% drop-out rate), with 6 facilities each allocated to the ADOC (n = 23) and control (n = 21) groups. After the 4-month intervention, the ADOC group had a significantly greater change in the BI score, with improved scores (P = 0.027, 95% CI 0.41 to 6.87, intracluster correlation coefficient = 0.14). No other outcome was significantly different. The incremental cost-effectiveness ratio, calculated using the change in BI score, was $63.1. Conclusion The results suggest that occupational therapy using the ADOC for older
Provides insights regarding the possible procedures for assessing welfare, efficiency, and equity effects of value chain development (VCD) programs, taking advantage of available analytical tools derived from impact analysis, transaction cost theory, and contract choice approaches and briefly
Rooderkerk, Robert P.; Van Heerde, Harald J.; Bijmolt, Tammo H. A.
The behavioral literature provides ample evidence that consumer preferences are partly driven by the context provided by the set of alternatives. Three important context effects are the compromise, attraction, and similarity effects. Because these context effects affect choices in a systematic and
Bijmolt, T.H.A.; van Heerde, H.J.; Rooderkerk, R.P.
The behavioral literature provides ample evidence that consumer preferences are partly driven by the context provided by the set of alternatives. three important context effects are the compromise, attraction, and similarity effects. because these context effects affect choices in a systematic and
Fawcett, TW; Johnstone, RA
Studies of mate choice commonly ignore variation in preferences and assume that all individuals should favor the highest-quality mate available. However, individuals may differ in their mate preferences according to their own age, experience, size, or genotype. In the present study, we highlight
Mandel, David R
Framing effects have long been viewed as compelling evidence of irrationality in human decision making, yet that view rests on the questionable assumption that numeric quantifiers used to convey the expected values of choice options are uniformly interpreted as exact values. Two experiments show that when the exactness of such quantifiers is made explicit by the experimenter, framing effects vanish. However, when the same quantifiers are given a lower bound (at least) meaning, the typical framing effect is found. A 3rd experiment confirmed that most people spontaneously interpret the quantifiers in standard framing tests as lower bounded and that their interpretations strongly moderate the framing effect. Notably, in each experiment, a significant majority of participants made rational choices, either choosing the option that maximized expected value (i.e., lives saved) or choosing consistently across frames when the options were of equal expected value. PsycINFO Database Record (c) 2014 APA, all rights reserved.
Full Text Available Using five variants of the Asian Disease Problem, we dissected the risky-choice framing effect by requiring each participant to provide preference ratings for the full decision problem and also to provide attractiveness ratings for each of the component parts, i.e., the sure-thing option and the risky option. Consistent with previous research, more risky choices were made by respondents receiving negatively framed versions of the decision problems than by those receiving positively framed versions. However, different processes were evident for those scoring high and low on numeracy. Whereas the choices of the less numerate showed a large effect of frame above and beyond any influence of their evaluations of the separate options, the choices of the highly numerate were almost completely accounted for by their attractiveness ratings of the separate options. These results are consistent with an increased tendency of the highly numerate to integrate complex numeric information in the construction of their preferences and a tendency for the less numerate to respond more superficially to non-numeric sources of information.
This paper looks at horizontal sex segregation in education as a factor contributing to gender segregation in the labor market. Economic theories fail to explain why women with the same years of schooling and educational attainment as men are under-represented in many technical degrees, which typically lead to better paid occupations. Following Akerlof and Kranton (2000), I research whether gender identity affects boys' and girls' educational choices and when the gendered pattern appears firs...
Assembled in 8 continuous segments of approximately 2.7 km length each, the He II cryostats for the 1232 cryodipoles and 474 Short Straight Sections (SSS housing the quadrupoles) must fulfil tight technical requirements. They have been produced by industry in large series according to cost-effective industrial production methods to keep expenditure within the financial constraints of the project and assembled under contract at CERN. The specific technical requirements of the generic systems of the cryostat (vacuum, cryogenic, electrical distribution, magnet alignment) are briefly recalled, as well as the basic design choices leading to the definition of their components (vacuum vessels, thermal shielding, supporting systems). Early in the design process emphasis was placed on the feasibility of manufacturing techniques adequate for large series production of components, optimal tooling for time-effective assembly methods, and reliable quality assurance systems. An analytical review of the costs of the cryosta...
The theoretical predictions of transaction cost economics were tested based on primary data collected from 230 cattle farm households in 13 communities of the Okhahlamba Local Municipality. The results of a multinomial logit regression revealed some unique insights. They showed that the probability of selling at auction ...
Guziel, K.A.; South, D.W.
This paper reports that the current outlook for new capacity additions by electric utilities is uncertain and tenuous. Regardless of the amount, it is inevitable that new capacity will be needed in the 1990s and beyond. The fundamental question about the additional capacity requirements centers on technology choice and the factors influencing the decision process. Under current market conditions, utilities have become capital aversive due to rate base disallowances by state regulatory commissions, difficulties in funding long-term capital-intensive projects, uncertainties about future demand, and the ability to purchase power from sources such as independent power producers (IPPs) and cogenerators. Instead of building capital-intensive power plants, utilities have begun relying on natural gas technologies, which permit rapid construction/deployment and low capital investment
Ladenburg, Jacob; Olsen, Søren Bøye
of preferences in Choice Experiments resembles the Dichotomous Choice format, there is reason to suspect that Choice Experiments are equally vulnerable to anchoring bias. Employing different sets of price levels in a so-called Instruction Choice Set presented prior to the actual choice sets, the present study...... subjectivity in the present study is gender dependent, pointing towards, that female respondents are prone to be affected by the price levels employed. Male respondents, on the other hand, are not sensitive towards these prices levels. Overall, this implicates that female respondents, when employing a low......-priced Instruction Choice Set, tend to express lower willingness-to-pay than when higher prices are employed....
The comparison of various protection options in order to determine which is the best compromise between cost of protection and residual risk is the purpose of the ALARA procedure. The use of decision-aiding techniques is valuable as an aid to selection procedures. The purpose of this study is to introduce two rather simple and well known decision aiding techniques: the cost-effectiveness analysis and the cost-benefit analysis. These two techniques are relevant for the great part of ALARA decisions which need the use of a quantitative technique. The study is based on an hypothetical case of 10 protection options. Four methods are applied to the data
Full Text Available Many studies examine information sharing in an uncertain demand environment in a supply chain. However there is little literature on cost information sharing in a dual-channel structure consisting of a retail channel and a direct sales channel. Assuming that the retail sale cost and direct sale cost are random variables with a general distribution, the paper investigates the retailer’s choice on cost information sharing in a Bertrand competition model. Based on the equilibrium outcome of information sharing, the manufacturer’s channel choice is discussed in detail. Our paper provides several interesting conclusions. In both single- and dual-channel structures, the retailer has little motivation to share its private cost information which is verified to be valuable for the manufacturer. When the cost correlation between the two channels increases, our analyses show that the manufacturer’s profit improves. However, when channel choice is involved, the value of information could play a different role. The paper finds that a dual-channel structure can benefit the manufacturer only when the cost correlation is sufficiently low. In addition, if the cost correlation is weak, the cost fluctuation will bring out the advantage of a dual-channel structure and adding a new direct channel will help in risk pooling.
Tillema, T.; van Wee, B.; Ettema, D.
In this paper, we investigate the impact of travel costs, in particular toll costs, on the residential location choice of households, using a stated choice survey. Within the stated choice experiment, car drivers that frequently face traffic congestion, traded-off several trip-related (including
Davis, Morris A.; Gregory, Jesse; Hartley, Daniel A.; Tan, Kegon T. K.
We study how households choose neighborhoods, how neighborhoods affect child ability, and how housing vouchers influence neighborhood choices and child outcomes. We use two new panel data sets with tract-level detail for Los Angeles county to estimate a dynamic model of optimal tract-level location choice for renting households and, separately, the impact of living in a given tract on child test scores (which we call "child ability" throughout). We simulate optimal location choices and change...
Olivola, Christopher Y
The sunk-cost fallacy-pursuing an inferior alternative merely because we have previously invested significant, but nonrecoverable, resources in it-represents a striking violation of rational decision making. Whereas theoretical accounts and empirical examinations of the sunk-cost effect have generally been based on the assumption that it is a purely intrapersonal phenomenon (i.e., solely driven by one's own past investments), the present research demonstrates that it is also an interpersonal effect (i.e., people will alter their choices in response to other people's past investments). Across eight experiments ( N = 6,076) covering diverse scenarios, I documented sunk-cost effects when the costs are borne by someone other than the decision maker. Moreover, the interpersonal sunk-cost effect is not moderated by social closeness or whether other people observe their sunk costs being "honored." These findings uncover a previously undocumented bias, reveal that the sunk-cost effect is a much broader phenomenon than previously thought, and pose interesting challenges for existing accounts of this fascinating human tendency.
Prato, Carlo Giacomo
are applied for model estimation and results are compared to the ‘true model estimates’. Last, predictions from the simulation of models estimated with objective choice sets are compared to the ‘postulated predicted routes’. A meta-analytical approach allows synthesizing the effect of judgments......Large scale applications of behaviorally realistic transport models pose several challenges to transport modelers on both the demand and the supply sides. On the supply side, path-based solutions to the user assignment equilibrium problem help modelers in enhancing the route choice behavior...... modeling, but require them to generate choice sets by selecting a path generation technique and its parameters according to personal judgments. This paper proposes a methodology and an experimental setting to provide general indications about objective judgments for an effective route choice set generation...
Carpentier, N.; Verbeke, S.; Ducloux, T.
Objective: to evaluate the cost effectiveness of radiopharmaceuticals and their quality control. Materials and methods: this retrospective study was made in the Nuclear Medicine Department of the University Hospital of Limoges. Radiopharmaceutical costs were obtained with adding the price of the radiotracer, the materials, the equipments, the labour, the running expenses and the radioisotope. The costs of quality control were obtained with adding the price of labour, materials, equipments, running expenses and the cost of the quality control of 99m Tc eluate. Results: during 1998, 2106 radiopharmaceuticals were prepared in the Nuclear Medicine Department. The mean cost effectiveness of radiopharmaceutical was 1430 francs (846 to 4260). The mean cost effectiveness of quality control was 163 francs (84 to 343). The rise of the radiopharmaceutical cost induced by quality control was 11%. Conclusion: the technical methodology of quality control must be mastered to optimize the cost of this operation. (author)
Evers, Ellen R K; Inbar, Yoel; Zeelenberg, Marcel
In 4 experiments, we investigate how the "fit" of an item with a set of similar items affects choice. We find that people have a notion of a set that "fits" together--one where all items are the same, or all items differ, on salient attributes. One consequence of this notion is that in addition to preferences over the set's individual items, choice reflects set-fit. This leads to predictable shifts in preferences, sometimes even resulting in people choosing normatively inferior options over superior ones.
This article discusses a cost-effective approach to flipping the calculus classroom. In particular, the emphasis is on low-cost choices, both monetarily and with regards to faculty time, that make the daunting task of flipping a course manageable for a single instructor. Student feedback and overall impressions are also presented.
Kassapoglou, C.; Rangelov, K.; Rangelov, S.
The fabrication cost of composite aircraft structures is revisited and the effect of part size on cost is examined with emphasis on design decisions which affect the ease of (bonded) repair and the total cost of the part and subsequent repairs. The case of moderately loaded stiffened fuselage or
Bereby-Meyer, Yoella; Assor, Avi; Katz, Idit
Two experiments examined the effect of age and cognitive demands on children's choice strategies. Children aged 8-9 and 12-13 years were asked to choose among either two or four products that differed in several attributes of varying importance to them. Choice tasks were designed to differentiate between the lexicographic and the equal-weighting…
An analysis of alternative options for the recycle of discharged makeup U-235 (''residual'' makeup) in HTGRs shows that the three-particle system which has been the reference plan remains optimal. This result considers both the resource utilization and the handling costs attendant to the alternative strategies (primarily in the recycle facility and in waste disposal). Furthermore, this result appears to be true under all forseeable economic conditions. A simple risk assessment indicates that recycle cost (including reprocessing, refabrication, and related waste disposal) would have to double or triple in order for the alternative U-235 recycle schemes to become attractive. This induces some degree of confidence in the choice of staying with the reference cycle in spite of the large degree of uncertainty over recycle and its costs
de Mouzon, J; Allavena, E; Schmitt, C; Frappé, M
The objective of the study was to make an economic evaluation of in vitro fertilization and to determine the impact of some factors on its cost, particularly the choice between recombinant follicle stimulating hormone (r-FSH) and urinary FSH (u-FSH) for ovarian stimulation. Costs were calculated in a Public Health view, by studying two phases: the stimulation cycle (including down-regulation) and the pregnancy (including the neonatal period). The calculation has included the side effects and the frozen embryos transfers. Economic data came from various sources: the French nomenclature on medical treatments (NGAP), the French drugs dictionary (Vidal) and the French Information system medical plan (PMSI). FSH costs were computed according to the currently marketed products, i.e., Fostimon (Laboratoires Genévrier, Sophia-Antipolis, France) for urinary FSH, and Gonal-F (Laboratoires Serono, Boulogne-Billancourt, France) and Puregon (Laboratoires Organon, Puteaux, France) for recombinant FSH. Two different ways of efficacy between u-FSH and r-FSH were considered for the calculations, those reported in Daya's meta-analysis (3.7% in favour of r-FSH for the clinical pregnancy rate per initiated cycle) and in the only double-blind study (Frydman et al., no difference). The annual cost of ART reaches approximately 130 million Euros in France, for the cycles only, and 170 million Euros when including the pregnancy costs. Urinary FSH is much cheaper than recombinant FSH. Whereas the number of administered FSH units was higher in u-FSH, this results in a mean lower cost of 500 Euros per cycle (2422 Euros for u-FSH and 2959 Euros for r-FSH). For one complete year, in France, the potential over cost of recombinant products reaches 24 million Euros when considering only the cycles (128.4 vs. 104.0 million Euros) and 24-31 million Euros when pregnancies and babies (neonatal period) are considered (171.4 vs 140.7 and 147.0 million Euros, respectively). The IVF per baby cost can be
Peschel, Anne; Orquin, Jacob Lund; Mueller Loose, Simone
Attention processes and decision making are accepted to be closely linked together because only information that is attended to can be incorporated in the decision process. Little is known however, to which extent bottom-up processes of attention affect stimulus selection and therefore...... the information available to form a decision. Does changing one visual cue in the stimulus set affect attention towards this cue and what does that mean for the choice outcome? To address this, we conducted a combined eye tracking and choice experiment in a consumer choice setting with visual shelf simulations...... salient. The observed effect on attention also carries over into increased choice likelihood. From these results, we conclude that even small changes in the choice capture attention based on bottom-up processes. Also for eye tracking studies in other domains (e.g. search tasks) this means that stimulus...
Caughey, Aaron B; Burchfield, David J
With increasing concerns regarding rapidly expanding healthcare costs, cost-effectiveness analysis allows assessment of whether marginal gains from new technology are worth the increased costs. Particular methodologic issues related to cost and cost-effectiveness analysis in the area of neonatal and periviable care include how costs are estimated, such as the use of charges and whether long-term costs are included; the challenges of measuring utilities; and whether to use a maternal, neonatal, or dual perspective in such analyses. A number of studies over the past three decades have examined the costs and the cost-effectiveness of neonatal and periviable care. Broadly, while neonatal care is costly, it is also cost effective as it produces both life-years and quality-adjusted life-years (QALYs). However, as the gestational age of the neonate decreases, the costs increase and the cost-effectiveness threshold is harder to achieve. In the periviable range of gestational age (22-24 weeks of gestation), whether the care is cost effective is questionable and is dependent on the perspective. Understanding the methodology and salient issues of cost-effectiveness analysis is critical for researchers, editors, and clinicians to accurately interpret results of the growing body of cost-effectiveness studies related to the care of periviable pregnancies and neonates. Copyright © 2014 Elsevier Inc. All rights reserved.
Full Text Available Intertemporal choices - involving decisions which trade off instant and delayed outcomes - are often made under stress. It remains unknown, however, whether and how stress affects intertemporal choice. We subjected 142 healthy male subjects to a laboratory stress or control protocol, and asked them to make a series of intertemporal choices either directly after stress, or 20 minutes later (resulting in four experimental groups. Based on theory and evidence from behavioral economics and cellular neuroscience, we predicted a bidirectional effect of stress on intertemporal choice, with increases in impatience or present bias immediately after stress, but decreases in present bias or impatience when subjects are tested 20 minutes later. However, our results show no effects of stress on intertemporal choice at either time point, and individual differences in stress reactivity (changes in stress hormone levels over time are not related to individual differences in intertemporal choice. Together, we did not find support for the hypothesis that psychosocial laboratory stressors affect intertemporal choice.
Primavesi, Laura; Caccavelli, Giovanna; Ciliberto, Alessandra; Pauze, Emmanuel
Promotion of healthy eating can no longer be postponed as a priority, given the alarming growth rate of chronic degenerative diseases in Western countries. We elaborated a nutrieconomic model to assess and identify the most nutritious and affordable food choices. Seventy-one food items representing the main food categories were included and their nationally representative prices monitored. Food composition was determined using CRA-NUT (Centro di Ricerca per gli Alimenti e la Nutrizione) and IEO (Istituto Europeo di Oncologia) databases. To define food nutritional quality, the mean adequacy ratio and mean excess ratio were combined. Both prices and nutritional quality were normalised for the edible food content and for the recommended serving sizes for the Italian adult population. Stores located in different provinces throughout Italy. Not applicable. Cereals and legumes presented very similar nutritional qualities and prices per serving. Seasonal fruits and vegetables presented differentiated nutritional qualities and almost equal prices. Products of animal origin showed similar nutritional qualities and varied prices: the best nutrieconomic choices were milk, oily fish and poultry for the dairy products, fish and meat groups, respectively. Analysing two balanced weekly menus, our nutrieconomic model was able to note a significant decrease in cost of approximately 30 % by varying animal-protein sources without affecting nutritional quality. Healthy eating does not necessarily imply spending large amounts of money but rather being able to make nutritionally optimal choices. The nutrieconomic model is an innovative and practical way to help consumers make correct food choices and nutritionists increase the compliance of their patients.
Gottlob, Brian J.
As a large body of high-quality research has emerged in the past few years showing that school choice benefits the students who use it, much of the debate has shifted to the "public" or "social" effects of school choice. This study examines how school choice in Missouri would raise high school graduation rates, and measures the…
Katz, David L; Doughty, Kim; Njike, Valentine; Treu, Judith A; Reynolds, Jesse; Walker, Jennifer; Smith, Erica; Katz, Catherine
The present study directly compared prices of more and less nutritious foods within given categories in US supermarkets. Foods selected from six supermarkets in Jackson County were categorized using the five criteria of the Nutrition Detectives™ (ND) programme and an item-to-item cost comparison was made using posted prices. The nutritional quality of foods was distinguished using the clues of the ND nutrition education programme for elementary-school children and validated using the Overall Nutritional Quality Index. Supermarkets in Jackson County, MO, USA. Not applicable. The average price of the item for more nutritious foods did not differ significantly from that of less nutritious foods overall ($US 2·89 (sd $US 0·74) v. $US 2·85 (sd $0·68), P = 0·76). More nutritious breads cost more than less nutritious breads ($US 3·36 (sd $ US 0·28) v. $US 2·56 (sd $US 0·80, P = 0·03), whereas more nutritious cereals ($US 2·46 (sd $US 0·69) v. $US 3·50 (sd $US 0·30), P cost less. Our findings indicate that it is possible to choose more nutritious foods within many common categories without spending more money and suggest that making small improvements in dietary choices does not invariably cost more.
Font Vivanco, David; Tukker, Arnold; Kemp, René
Improvements in resource efficiency often underperform because of rebound effects. Calculations of the size of rebound effects are subject to various types of bias, among which methodological choices have received particular attention. Modellers have primarily focused on choices related to changes in demand, however, choices related to modeling the environmental burdens from such changes have received less attention. In this study, we analyze choices in the environmental assessment methods (life cycle assessment (LCA) and hybrid LCA) and environmental input-output databases (E3IOT, Exiobase and WIOD) used as a source of bias. The analysis is done for a case study on battery electric and hydrogen cars in Europe. The results describe moderate rebound effects for both technologies in the short term. Additionally, long-run scenarios are calculated by simulating the total cost of ownership, which describe notable rebound effect sizes-from 26 to 59% and from 18 to 28%, respectively, depending on the methodological choices-with favorable economic conditions. Relevant sources of bias are found to be related to incomplete background systems, technology assumptions and sectorial aggregation. These findings highlight the importance of the method setup and of sensitivity analyses of choices related to environmental modeling in rebound effect assessments.
Kemperman, A.D.A.M.; Borgers, A.W.J.; Oppewal, H.; Timmermans, H.J.P.
Most existing mathematical models of tourist choice behavior assume that individuals' preferences for choice alternatives remain invariant over time. Although the assumption of invariant preference functions may be reasonable in some choice contexts, this study examines the hypothesis that
Kassapoglou, Christos; Rangelov, Konstantin; Rangelov, Svilen
The fabrication cost of composite aircraft structures is revisited and the effect of part size on cost is examined with emphasis on design decisions which affect the ease of (bonded) repair and the total cost of the part and subsequent repairs. The case of moderately loaded stiffened fuselage or wing panels under compression is analysed in detail and the fabrication cost of the panel made as a single piece or as an assembly of smaller identical components or modules is determined. The cost of special purpose repairs for two different damage sizes is compared to removing and replacing damaged modules. Hand layup and automated processing are compared. It is found that for certain repair sizes removing and replacing modules leads to lower overall cost as compared to applying a special purpose repair.
Full Text Available Urpo Kiiskinen,1 Stephan Matthaei,2 Matthew Reaney,3 Chantal Mathieu,4 Claes-Göran Östenson,5 Thure Krarup,6 Michael Theodorakis,7,* Jacek Kiljanski,8 Carole Salaun-Martin,9 Hélène Sapin,9 Bruno Guerci10 1Eli Lilly, Helsinki, Finland; 2Quakenbrück Diabetes Center, Quakenbrück, Germany; 3Eli Lilly, Windlesham, Surrey, UK; 4Department of Endocrinology, UZ Gasthuisberg, Leuven, Belgium; 5Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 6Department of Endocrinology, Bispebjerg Hospital, Copenhagen, Denmark; 7Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; 8Eli Lilly, Warsaw, Poland; 9Eli Lilly, Neuilly Cedex, France; 10Department of Diabetes, Metabolic Diseases, and Nutrition, Hôpital Brabois, Vandoeuvre-Lès-Nancy, France *Michael Theodorakis was affiliated with the institution shown above at the time of the study, but has since left this institution Purpose: CHOICE (CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy assessed patterns of exenatide bid and initial insulin therapy usage in clinical practice in six European countries and evaluated outcomes during the study. Methods: CHOICE was a 24-month, prospective, noninterventional observational study. Clinical and resource use data were collected at initiation of first injectable therapy (exenatide bid or insulin and at regular intervals for 24 months. Costs were evaluated from the national health care system perspective at 2009 prices. Results: A total of 2515 patients were recruited. At the 24-month analysis, significant treatment change had occurred during the study in 42.2% of 1114 eligible patients in the exenatide bid cohort and 36.0% of 1274 eligible patients in the insulin cohort. Improvements in glycemic control were observed over the course of the study in both cohorts (P < 0.001 for both, but mean weight was reduced in the exenatide bid cohort (P < 0
Gottlob, Brian J.
This study documents the public costs of high school dropouts in Indiana, and examines how school choice would provide large public benefits by increasing the graduation rate in Indiana public schools. It calculates the annual cost of high school dropouts in Indiana due to lower state income tax payments, increased reliance on Medicaid, and…
Cherchi, Elisabetta; Meloni, Italo; Ortúzar, Juan de Dios
The existence of habit (leading to inertia) in the choice process has been approached in the literature in a number of ways. In transport, inertia has been studied mainly using “long panel” data, or mixed revealed and stated preference data. In these studies inertia links the choice made in two...... approaches. We assume that inertia is revealed by past behaviour and affects also the initial condition, but we recognise that past behaviour is only an indicator of habitual behaviour, the true process behind the formation of habitual behaviour being latent. We estimate a hybrid choice model using a set...... of revealed and stated mode choice preferences collected in Cagliari (Italy). We found a significant latent inertia in the revealed preference data, indicating that inertia affects the initial conditions. The latent inertia is revealed by the frequency of past behaviour but the effect of trip frequency...
Violette, D.; Lang, C.
Utility demand and supply-side planners will face new challenges from environmental regulations. Under current proposals, every ton of pollutant will have a cost to utilities, not just the tons that put them over the allowable limit. Planners will have to account for these new costs. To do this, planners need to start tracking emissions implementation actions today, and begin strategies for future regulatory changes. Current legislative proposals include a tax on the carbon content of fuels to curb emissions of greenhouse gases and substantial reductions in sulfur dioxide and nitrogen oxide emissions. The important issue for planners is the flexible compliance requirements within these regulatory changes. The acid rain proposals, for example, include a market-based emissions trading system for emissions allowances. Whenever there is a competitive market, there are market risks, and potential winners and losers. Utilities need to be prepared to analyze and mitigate these risks. Integrated least cost planing is one way a utility will have to meet this challenge. Planning involves uncertainty and risk. The wide array of compliance choices create countless combinations of strategies for utilities to comply with the new emissions regulations. This paper discusses new compliance strategies, demand-side management (DSM) as a compliance strategy, solutions to DSM traps, and the compliance strategy game
Gluth, Sebastian; Hotaling, Jared M; Rieskamp, Jörg
Classical economic theory contends that the utility of a choice option should be independent of other options. This view is challenged by the attraction effect, in which the relative preference between two options is altered by the addition of a third, asymmetrically dominated option. Here, we leveraged the attraction effect in the context of intertemporal choices to test whether both decisions and reward prediction errors (RPE) in the absence of choice violate the independence of irrelevant alternatives principle. We first demonstrate that intertemporal decision making is prone to the attraction effect in humans. In an independent group of participants, we then investigated how this affects the neural and behavioral valuation of outcomes using a novel intertemporal lottery task and fMRI. Participants' behavioral responses (i.e., satisfaction ratings) were modulated systematically by the attraction effect and this modulation was correlated across participants with the respective change of the RPE signal in the nucleus accumbens. Furthermore, we show that, because exponential and hyperbolic discounting models are unable to account for the attraction effect, recently proposed sequential sampling models might be more appropriate to describe intertemporal choices. Our findings demonstrate for the first time that the attraction effect modulates subjective valuation even in the absence of choice. The findings also challenge the prospect of using neuroscientific methods to measure utility in a context-free manner and have important implications for theories of reinforcement learning and delay discounting. Many theories of value-based decision making assume that people first assess the attractiveness of each option independently of each other and then pick the option with the highest subjective value. The attraction effect, however, shows that adding a new option to a choice set can change the relative value of the existing options, which is a violation of the independence
Distributed energy resources (DERs), and increasingly microgrids, are becoming an integral part of modern distribution systems. Interest in microgrids--which are insular and autonomous power networks embedded within the bulk grid--stems largely from the vast array of flexibilities and benefits they can offer stakeholders. Managed well, they can improve grid reliability and resiliency, increase end-use energy efficiency by coupling electric and thermal loads, reduce transmission losses by generating power locally, and may reduce system-wide emissions, among many others. Whether these public benefits are realized, however, depends on whether private firms see a "business case", or private value, in investing. To this end, firms need models that evaluate costs, benefits, risks, and assumptions that underlie decisions to invest. The objectives of this dissertation are to assess the business case for microgrids that provide what industry analysts forecast as two primary drivers of market growth--that of providing energy services (similar to an electric utility) as well as reliability service to customers within. Prototypical first adopters are modeled--using an existing model to analyze energy services and a new model that couples that analysis with one of reliability--to explore interactions between technology choice, reliability, costs, and benefits. The new model has a bi-level hierarchy; it uses heuristic optimization to select and size DERs and analytical optimization to schedule them. It further embeds Monte Carlo simulation to evaluate reliability as well as regression models for customer damage functions to monetize reliability. It provides least-cost microgrid configurations for utility customers who seek to reduce interruption and operating costs. Lastly, the model is used to explore the impact of such adoption on system-wide greenhouse gas emissions in California. Results indicate that there are, at present, co-benefits for emissions reductions when customers
Schieber, C.; Lombard, J.; Lefaure, C.
The objective of this report is to present the principles of decision making software for radiation protection option, applying ALARA principle. The choice of optimum options is performed by applying the models of cost effectiveness and cost-benefit. Options of radiation protection are described by two indicators: a simple economic indicator: cost of radiation protection; and dosimetry indicator: collective dose related to protection. For both analyses the software enables sensitivity analysis. It would be possible to complete the software by integrating a module which would take into account combinations of two options since they are not independent
Orr, Joseph M.; Weissman, Daniel H.
Bottom-up biases are widely thought to influence task choice in the voluntary task switching paradigm. Definitive support for this hypothesis is lacking, however, because task choice and task performance are usually confounded. We therefore revisited this hypothesis using a paradigm in which task choice and task performance are temporally separated. As predicted, participants tended to choose the task that was primed by bottom-up biases. Moreover, such choices were linked to increased switch costs during subsequent task performance. These findings provide compelling evidence that bottom-up biases influence voluntary task choice. They also suggest that succumbing to such biases reflects a reduction of top-down control that persists to influence upcoming task performance. PMID:21713192
Bernstein, L M; Chapman, G B; Elstein, A S
To explore framing or editing effects and a method to debias framing in a clinical context. Clinical scenarios using multioutcome life-expectancy lotteries of equal value required choices between two supplementary drugs that either prolonged or shortened life from the 20-year beneficial effect of a baseline drug. The effects of these supplementary drugs were presented in two conditions, using a between-subjects design. In segregated editing (n = 116) the effects were presented separately from the effects of the baseline drug. In integrated editing (n = 100), effects of supplementary and baseline drugs were combined in the lottery presentation. Each subject responded to 30 problems. To explore one method of debiasing, another 100 subjects made choices after viewing both segregated and integrated editings of 20 problems (dual framing). Statistically significant preference reversals between segregated and integrated editing of pure lotteries occurred only when one framing placed outcomes in the gain domain, and the other framing placed them in the loss domain. When both editings resulted in gain-domain outcomes only, there was no framing effect. There was a related relationship of framing-effect shifts from losses to gains in mixed-lottery-choice problems. Responses to the dual framing condition did not consistently coincide with responses to either single framing. In some situations, dual framing eliminated or lessened framing effects. The results support two components of prospect theory, coding outcomes as gains or losses from a reference point, and an s-shaped utility function (concave in gain, convex in loss domains). Presenting both alternative editings of a complex situation prior to choice more fully informs the decision maker and may help to reduce framing effects. Given the extent to which preferences shift in response to alternative presentations, it is unclear which choice represents the subject's "true preferences."
Buntin, Melinda Beeuwkes; Garber, Alan M; McClellan, Mark; Newhouse, Joseph P
Objective To discuss and quantify the incentives that Medicare managed care plans have to avoid (through selective enrollment or disenrollment) people who are at risk for very high costs, focusing on Medicare beneficiaries in the last year of life—a group that accounts for more than one-quarter of Medicare's annual expenditures. Data Source Medicare administrative claims for 1994 and 1995. Study Design We calculated the payment a plan would have received under three risk-adjustment systems for each beneficiary in our 1995 sample based on his or her age, gender, county of residence, original reason for Medicare entitlement, and principal inpatient diagnoses received during any hospital stays in 1994. We compared these amounts to the actual costs incurred by those beneficiaries. We then looked for clinical categories that were predictive of costs, including costs in a beneficiary's last year of life, not accounted for by the risk adjusters. Data Extraction Methods The analyses were conducted using claims for a 5 percent random sample of Medicare beneficiaries who died in 1995 and a matched group of survivors. Principal Findings Medicare is currently implementing the Principal Inpatient Diagnostic Cost Groups (PIP-DCG) risk adjustment payment system to address the problem of risk selection in the Medicare+Choice program. We quantify the strong financial disincentives to enroll terminally ill beneficiaries that plans still have under this risk adjustment system. We also show that up to one-third of the selection observed between Medicare HMOs and the traditional fee-for-service system could be due to differential enrollment of decedents. A risk adjustment system that incorporated more of the available diagnostic information would attenuate this disincentive; however, plans could still use clinical information (not included in the risk adjustment scheme) to identify beneficiaries whose expected costs exceed expected payments. Conclusions More disaggregated prospective
Pan, X.; Rasouli, S.; Timmermans, H.J.P.
This paper introduces a model that captures the effect of social influence on individual choice behavior. The suggested model shares with previous models the idea to add a term to the deterministic utility function of the choice alternative, chosen by a social network member, to measure an
Lee, Joo-Suk; Yoo, Seung-Hoon
Korea is considering the construction of a tidal power plant (TPP) at Garolim Bay. However, as the construction of the Garolim TPP (GTPP) is expected to entail some environmental damage, it has become an increasingly important topic for public debate. Using a choice experiment (CE) approach, this study attempts to measure the economic cost that results from the environmental damage caused by the construction of GTPP. The CE is used to measure the environmental costs of individual attributes, including the reduction in the area of the tidal flat, the degradation of seawater quality, and the destruction of marine life. The results indicate that the annual willingness to pay (WTP) per household for mitigating the environmental damage that results from the worst-possible situation in relation to the present situation is about 96,042 Korean won (USD 101.1) in the seven biggest cities (off-site regions) and 18,584 Korean won (USD 19.6) in Seosan and Taean (on-site regions). This study is expected to provide policy-makers with quantitative information that will be useful to decide whether or not GTPP should be constructed.
Foster, E. Michael; Jones, Damon
Objectives To examine the cost-effectiveness of the Fast Track intervention, a multi-year, multi-component intervention designed to reduce violence among at-risk children. A previous report documented the favorable effect of intervention on the highest-risk group of ninth-graders diagnosed with conduct disorder, as well as self-reported delinquency. The current report addressed the cost-effectiveness of the intervention for these measures of program impact. Design Costs of the intervention were estimated using program budgets. Incremental cost-effectiveness ratios were computed to determine the cost per unit of improvement in the 3 outcomes measured in the 10th year of the study. Results Examination of the total sample showed that the intervention was not cost-effective at likely levels of policymakers' willingness to pay for the key outcomes. Subsequent analysis of those most at risk, however, showed that the intervention likely was cost-effective given specified willingness-to-pay criteria. Conclusions Results indicate that the intervention is cost-effective for the children at highest risk. From a policy standpoint, this finding is encouraging because such children are likely to generate higher costs for society over their lifetimes. However, substantial barriers to cost-effectiveness remain, such as the ability to effectively identify and recruit such higher-risk children in future implementations. PMID:17088509
Hanley, Nick; Wright, Robert E.; Adamowicz, Wiktor
This paper investigates whether the preference and willingness-to-pay estimates obtained from the choice experiment method of estimating non-market values are sensitive to the vector of prices used in the experimental design. We undertake this test in the context of water quality improvements under the European Union's new Water Framework Directive. Using a mixed logit model, which allows for differing scale between the two samples, we find no significant impact of changing the price vector on estimates of preferences or willingness-to-pay. (author) (Choice modelling; Non-market valuation; Design effects; Water Framework Directive)
Koivisto, Petri; Vinokur, Amiram D.; Vuori, Jukka
This randomized experimental study (N = 1,034) examines both the direct and the indirect effects of the Towards Working Life intervention on 2 components of adolescents' career preparation: preparedness for career choice and attitude toward career planning. The intervention comprised a 1-week workshop program, the proximal goals of which were to…
This paper provides a tutorial summary of some of the many effect size choices so that members of the Southwest Educational Research Association would be better able to follow the recommendations of the American Psychological Association (APA) publication manual, the APA Task Force on Statistical Inference, and the publication requirements of some…
Holleman, Thomas, Jr.
In establishing a departmental cost-effectiveness model, the traditional cost-effectiveness model was discussed and equipped with a distant and deflation equation for both benefits and costs. Next, the economics of costing was examined and program costing procedures developed. Then, the model construct was described as it was structured around the…
Zeng Wu; Tian Zhilong
With the method of duopoly game theory, the effect of firms’ innovation ability on the choice between product and process innovation is studied. The concept of cost coefficient of product innovation is introduced, and the criterion equation for the innovation type is derived. The following conclusions are made: the more the product innovation ability, the more the possibility for the firms to carry out the product innovation in both the Bertrand and the Cournot competitions. Wi...
This paper describes a cost effective approach for inspections of Computerized Nuclear Materials Control and Accounting Systems (CNMCAS). Highlighted is the capability to conduct an inspection program via portable telephone terminals from off-site locations. The program can be applied to various materials management functions including materials control, quality assurance, and materials accounting. The system is designed to facilitate inspections by both external and internal groups
For several decades researchers have focused on the entry mode decision because it is critically important for firms expanding abroad. Despite this attention we still lack clear tools to help managers make effective entry decisions. In this paper I review past research exploring transaction cost and
White, Michael T; Yeung, Shunmay; Patouillard, Edith; Cibulskis, Richard
The continued success of efforts to reduce the global malaria burden will require sustained funding for interventions specifically targeting Plasmodium vivax The optimal use of limited financial resources necessitates cost and cost-effectiveness analyses of strategies for diagnosing and treating P. vivax and vector control tools. Herein, we review the existing published evidence on the costs and cost-effectiveness of interventions for controlling P. vivax, identifying nine studies focused on diagnosis and treatment and seven studies focused on vector control. Although many of the results from the much more extensive P. falciparum literature can be applied to P. vivax, it is not always possible to extrapolate results from P. falciparum-specific cost-effectiveness analyses. Notably, there is a need for additional studies to evaluate the potential cost-effectiveness of radical cure with primaquine for the prevention of P. vivax relapses with glucose-6-phosphate dehydrogenase testing. © The American Society of Tropical Medicine and Hygiene.
In this dissertation, I study campaign effects on turnout and vote choice. I analyze different campaign messages and the way they affect voters across various situations. First, through an online survey experiment, I study the impact of campaign messages and ideological cues on voters as they make inferences on candidates. Next, through a field experiment, I test whether microtargeted messages or general messages on the economy have any effect on turnout. Lastly, using online survey data, I e...
Denninger, Thomas R; Cook, Chad E; Chapman, Cole G; McHenry, Timothy; Thigpen, Charles A
Study Design Retrospective study. Background Alternative models of care that allow patients to choose direct access to physical therapy have shown promise in terms of cost reduction for neck and back pain. However, real-world exploration within the US health care system is notably limited. Objectives To compare total claims paid and patient outcomes for patients with neck and back pain who received physical therapy intervention via direct access versus medical referral. Methods Data were accessed for patients seeking care for neck or back pain (n = 603) between 2012 and 2014, who chose to begin care either through traditional medical referral or direct access to a physical therapy- led spine management program. All patients received a standardized, pragmatic physical therapy approach, with patient-reported measures of pain and disability assessed before and after treatment. Patient demographics and outcomes data were obtained from the medical center patient registry and combined with total claims paid calculated for the year after the index claim. Linear mixed-effects modeling was used to analyze group differences in pain and disability, visits/time, and annualized costs. Results Patients who chose to enter care via the direct-access physical therapy-led spine management program displayed significantly lower total costs (mean difference, $1543; 95% confidence interval: $51, $3028; P = .04) than those who chose traditional medical referral. Patients in both groups showed clinically important improvements in pain and disability, which were similar between groups (P>.05). Conclusion The initial patient choice to begin care with a physical therapist for back or neck pain resulted in lower cost of care over the next year, while resulting in similar improvements in patient outcomes at discharge from physical therapy. These findings add to the emerging literature suggesting that patients' choice to access physical therapy through direct access may be associated with lower
Yang, Yongheng; Koutroulis, Eftichios; Sangwongwanich, Ariya
loading of the power devices. However, its feasibility is challenged by the associated energy losses. An increase of the inverter lifetime and a reduction of the energy yield can alter the cost of energy, demanding an optimization of the power limitation. Therefore, aiming at minimizing the Levelized Cost...... be flexibly performed. As an advanced control strategy, the Absolute Active Power Control (AAPC) can effectively solve the overloading issues by limiting the maximum possible PV power to a certain level (i.e., the power limitation), and also benefit the inverter reliability due to the reduction in the thermal...... performance in terms of LCOE and energy production can be obtained by enabling the AAPC strategy, compared to the conventional PV inverter operating only in the maximum power point tracking mode. In the presented case study, the minimum of the LCOE is achieved for the PV system when the power limit...
Gottlob, Brian J.
Research has documented a crisis in Texas high school graduation rates. Only 67 percent of Texas students graduate from high school, and some large urban districts have graduation rates of 50 percent or lower. This study documents the public costs of high school dropouts in Texas and examines how school choice could provide large public benefits…
Matsushima, Toshiya; Kawamori, Ai; Bem-Sojka, Tiaza
Studies on the foraging choices are reviewed, with an emphasis on the neural representations of elementary factors of food (i.e., amount, delay and consumption time) in the avian brain. Domestic chicks serve as an ideal animal model in this respect, as they quickly associate cue colors with subsequently supplied food rewards, and their choices are quantitatively linked with the rewards. When a pair of such color cues was simultaneously presented, the trained chicks reliably made choices according to the profitability of food associated with each color. Two forebrain regions are involved in distinct aspects of choices; i.e., nucleus accumbens-medial striatum (Ac-MSt) and arcopallium intermedium (AI), an association area in the lateral forebrain. Localized lesions of Ac-MSt enhanced delay aversion, and the ablated chicks made impulsive choices of immediate reward more frequently than sham controls. On the other hand, lesions of AI enhanced consumption-time aversion, and the ablated chicks shifted their choices toward easily consumable reward with their impulsiveness unchanged; delay and consumption time are thus doubly dissociated. Furthermore, chicks showed distinct patterns of risk-sensitive choices depending on the factor that varied at trials. Risk aversion occurred when food amount varied, whereas consistent risk sensitivity was not found when the delay varied; amount and delay were not interchangeable. Choices are thus deviated from those predicted as optima. Instead, factors such as amount, delay and consumption time could be separately represented and processed to yield economically sub-optimal choices.
Chhagan, Meera K; Van den Broeck, Jan; Luabeya, Kany-Kany Angelique; Mpontshane, Nontobeko; Bennish, Michael L
To describe the cost of diarrhoeal illness in children aged 6-24 months in a rural South African community and to determine the threshold prevalence of stunting at which universal Zn plus vitamin A supplementation (VAZ) would be more cost-effective than vitamin A alone (VA) in preventing diarrhoea. We conducted a cost analysis using primary and secondary data sources. Using simulations we examined incremental costs of VAZ relative to VA while varying stunting prevalence. Data on efficacy and societal costs were largely from a South African trial. Secondary data were from local and international published sources. The trial included children aged 6-24 months. The secondary data sources were a South African health economics survey and the WHO-CHOICE (CHOosing Interventions that are Cost Effective) database. In the trial, stunted children supplemented with VAZ had 2·04 episodes (95 % CI 1·37, 3·05) of diarrhoea per child-year compared with 3·92 episodes (95 % CI 3·02, 5·09) in the VA arm. Average cost of illness was $Int 7·80 per episode (10th, 90th centile: $Int 0·28, $Int 15·63), assuming a minimum standard of care (oral rehydration and 14 d of therapeutic Zn). In simulation scenarios universal VAZ had low incremental costs or became cost-saving relative to VA when the prevalence of stunting was close to 20 %. Incremental cost-effectiveness ratios were sensitive to the cost of intervention and coverage levels. This simulation suggests that universal VAZ would be cost-effective at current levels of stunting in parts of South Africa. This requires further validation under actual programmatic conditions.
Kavitt, R T; Penson, D F; Vaezi, M F
Eosinophilic esophagitis (EoE) is an increasingly recognized clinical entity. The optimal initial treatment strategy in adults with EoE remains controversial. The aim of this study was to employ a decision analysis model to determine the less costly option between the two most commonly employed treatment strategies in EoE. We constructed a model for an index case of a patient with biopsy-proven EoE who continues to be symptomatic despite proton-pump inhibitor therapy. The following treatment strategies were included: (i) swallowed fluticasone inhaler (followed by esophagogastroduodenoscopy [EGD] with dilation if ineffective); and (ii) EGD with dilation (followed by swallowed fluticasone inhaler if ineffective). The time horizon was 1 year. The model focused on cost analysis of initial treatment strategies. The perspective of the healthcare payer was used. Sensitivity analyses were performed to assess the robustness of the model. For every patient whose symptoms improved or resolved with the strategy of fluticasone first followed by EGD, if necessary, it cost an average of $1078. Similarly, it cost an average of $1171 per patient if EGD with dilation was employed first. Sensitivity analyses indicated that initial treatment with fluticasone was the less costly strategy to improve dysphagia symptoms as long as the effectiveness of fluticasone remains at or above 0.62. Swallowed fluticasone inhaler (followed by EGD with dilation if necessary) is the more economical initial strategy when compared with EGD with dilation first. © 2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.
Soegaard, Rikke; Christensen, Finn Bjarke; Christiansen, Terkel
of the Dallas Pain Questionnaire and the Low Back Pain Rating Scale at baseline and 2 years postoperatively. Regression models were used to reveal determinants for costs and effects. Costs and effects were analyzed as a net-benefit measure to reveal determinants for cost-effectiveness, and finally, adjusted...... areas. Multi-level fusion and surgical technique significantly affected the net-benefit as well. Surprisingly, no correlation was found between treatment costs and treatment effects. Incremental analysis suggested that the probability of posterior instrumentation being cost-effective was limited......Although cost-effectiveness is becoming the foremost evaluative criterion within health service management of spine surgery, scientific knowledge about cost-patterns and cost-effectiveness is limited. The aims of this study were (1) to establish an activity-based method for costing at the patient...
Lai, T.; Habicht, J.; Reinap, M.; Chisholm, D.; Baltussen, R.M.P.M.
OBJECTIVE: To assess the population-level costs, effects and cost-effectiveness of different alcohol and tobacco control strategies in Estonia. DESIGN: A WHO cost-effectiveness modelling framework was used to estimate the total costs and effects of interventions. Costs were assessed in Estonian
Rein, David B.; Wittenborn, John S.; Zhang, Xinzhi; Song, Michael; Saaddine, Jinan B.
Background To estimate the incremental cost-effectiveness of amblyopia screening at preschool and kindergarten, we compared the costs and benefits of 3 amblyopia screening scenarios to no screening and to each other: (1) acuity/stereopsis (A/S) screening at kindergarten, (2) A/S screening at preschool and kindergarten, and (3) photoscreening at preschool and A/S screening at kindergarten. Methods We programmed a probabilistic microsimulation model of amblyopia natural history and response to treatment with screening costs and outcomes estimated from 2 state programs. We calculated the probability that no screening and each of the 3 interventions were most cost-effective per incremental quality-adjusted life year (QALY) gained and case avoided. Results Assuming a minimal 0.01 utility loss from monocular vision loss, no screening was most cost-effective with a willingness to pay (WTP) of less than $16,000 per QALY gained. A/S screening at kindergarten alone was most cost-effective between a WTP of $17,000 and $21,000. A/S screening at preschool and kindergarten was most cost-effective between a WTP of $22,000 and $75,000, and photoscreening at preschool and A/S screening at kindergarten was most cost-effective at a WTP greater than $75,000. Cost-effectiveness substantially improved when assuming a greater utility loss. All scenarios were cost-effective when assuming a WTP of $10,500 per case of amblyopia cured. Conclusions All 3 screening interventions evaluated are likely to be considered cost-effective relative to many other potential public health programs. The choice of screening option depends on budgetary resources and the value placed on monocular vision loss prevention by funding agencies. PMID:21877675
Ellerby, Zack W; Tunney, Richard J
Given a repeated choice between two or more options with independent and identically distributed reward probabilities, overall pay-offs can be maximized by the exclusive selection of the option with the greatest likelihood of reward. The tendency to match response proportions to reward contingencies is suboptimal. Nevertheless, this behaviour is well documented. A number of explanatory accounts have been proposed for probability matching. These include failed pattern matching, driven by apophenia, and a heuristic-driven response that can be overruled with sufficient deliberation. We report two experiments that were designed to test the relative effects on choice behaviour of both an intuitive versus strategic approach to the task and belief that there was a predictable pattern in the reward sequence, through a combination of both direct experimental manipulation and post-experimental self-report. Mediation analysis was used to model the pathways of effects. Neither of two attempted experimental manipulations of apophenia, nor self-reported levels of apophenia, had a significant effect on proportions of maximizing choices. However, the use of strategy over intuition proved a consistent predictor of maximizing, across all experimental conditions. A parallel analysis was conducted to assess the effect of controlling for individual variance in perceptions of reward contingencies. Although this analysis suggested that apophenia did increase probability matching in the standard task preparation, this effect was found to result from an unforeseen relationship between self-reported apophenia and perceived reward probabilities. A Win-Stay Lose-Shift (WSLS ) analysis indicated no reliable relationship between WSLS and either intuition or strategy use.
Beerman, K A; Jennings, G; Crawford, S
This study assessed the effect of student residence on food choices and dietary practices of students enrolled in an undergraduate nutrition class at Washington State University. We compared food consumption patterns of students living on campus, off campus, and in Greek housing. We also identified differences between men and women in food consumption and dietary practices. The results suggested that students' residence and sex may influence food choice and dietary practices. Significant differences in food choice related to students' residence were found for 8 of the 27 variables included on a food frequency list. Differences in the consumption of fresh fruits and vegetables, beer, fish, unsweetened cereal, white bread, and cookies were identified. In addition, students who lived in Greek housing were found to skip meals less frequently than other students, and men were found to consume significantly more beer, sugar-sweetened soft drinks, meat, and white bread than women students. Men were also more accurate in their perception of their body weight.
Darmon, Nicole; Ferguson, Elaine L; Briend, André
To predict, for French women, the impact of a cost constraint on the food choices required to provide a nutritionally adequate diet. Isocaloric daily diets fulfilling both palatability and nutritional constraints were modeled in linear programming, using different cost constraint levels. For each modeled diet, total departure from an observed French population's average food group pattern ("mean observed diet") was minimized. To achieve the nutritional recommendations without a cost constraint, the modeled diet provided more energy from fish, fresh fruits and green vegetables and less energy from animal fats and cheese than the "mean observed diet." Introducing and strengthening a cost constraint decreased the energy provided by meat, fresh vegetables, fresh fruits, vegetable fat, and yogurts and increased the energy from processed meat, eggs, offal, and milk. For the lowest cost diet (ie, 3.18 euros/d), marked changes from the "mean observed diet" were required, including a marked reduction in the amount of energy from fresh fruits (-85%) and green vegetables (-70%), and an increase in the amount of energy from nuts, dried fruits, roots, legumes, and fruit juices. Nutrition education for low-income French women must emphasize these affordable food choices.
Full Text Available We investigate how different global dietary scenarios affect the constraints on, and costs of, transforming the energy system to reach a global temperature stabilization limit of 2 °C above the pre-industrial level. A global food and agriculture model, World Food Supply Model (WOFSUM, is used to create three dietary scenarios and to calculate the CH4 and N2O emissions resulting from their respective food-supply chains. The diets are: (i a reference diet based on current trends; (ii a diet with high (reference-level meat consumption, but without ruminant products (i.e., no beef, lamb, or dairy, only pork and poultry; and (iii a vegan diet. The estimated CH4 and N2O emissions from food production are fed into a coupled energy and climate-system optimization model to quantify the energy system implications of the different dietary scenarios, given a 2 °C target. The results indicate that a phase-out of ruminant products substantially increases the emission space for CO2 by about 250 GtC which reduces the necessary pace of the energy system transition and cuts the net present value energy-system mitigation costs by 25%, for staying below 2 °C. Importantly, the additional cost savings with a vegan diet––beyond those achieved with a phase-out of ruminant products––are marginal (only one additional percentage point. This means that a general reduction of meat consumption is a far less effective strategy for meeting the 2 °C target than a reduction of beef and dairy consumption.
Stenberg, Karin; Lauer, Jeremy A; Gkountouras, Georgios; Fitzpatrick, Christopher; Stanciole, Anderson
Policy makers require information on costs related to inpatient and outpatient health services to inform resource allocation decisions. Country data sets were gathered in 2008-2010 through literature reviews, website searches and a public call for cost data. Multivariate regression analysis was used to explore the determinants of variability in unit costs using data from 30 countries. Two models were designed, with the inpatient and outpatient models drawing upon 3407 and 9028 observations respectively. Cost estimates are produced at country and regional level, with 95% confidence intervals. Inpatient costs across 30 countries are significantly associated with the type of hospital, ownership, as well as bed occupancy rate, average length of stay, and total number of inpatient admissions. Changes in outpatient costs are significantly associated with location, facility ownership and the level of care, as well as to the number of outpatient visits and visits per provider per day. These updated WHO-CHOICE service delivery unit costs are statistically robust and may be used by analysts as inputs for economic analysis. The models can predict country-specific unit costs at different capacity levels and in different settings.
Chu, Lucy; Wood, Ruth I
Testosterone is essential for copulation, and contributes to sexual motivation. In addition, castrated males are fatter and less active, suggesting that androgens may play a role in non-sexual behaviors, including food-related responses. To test this hypothesis, male hamsters were trained with a cost/benefit test, which compares operant responding for more-preferred food versus ad libitum consumption of lab chow. Males were tested before and after castration. The effect of the dopamine antagonist, haloperidol, on instrumental responses in intact and castrated males was also determined. Food-deprived hamsters responded vigorously for 45 mg Bio-Serv pellets in daily 30-min tests (665 presses, 6.0+/-0.9 g). When lab chow was available, males continued to respond for pellets (3.6+/-0.6 g) over chow ad libitum (1.2+/-0.3 g). Dopamine is central to this response because haloperidol (1.0 mg/kg i.p.) reversed food intake (pellets: 0.5+/-0.1 g; chow 2.0+/-0.5 g). Castration had no effect on operant responding for pellets alone (6.6+/-0.7 g). When chow was present, castrates consumed an even greater proportion of their total food intake as pellets [6.0+/-0.4 g pellets (92%), 1.6+/-0.5 g chow (8%), vs. 75 and 25%, respectively, for intact males]. This is contrary to our original hypothesis. In addition, castration did not change the effects of haloperidol on food intake: (0.4+/-0.1 g pellets; 1.6+/-0.5 g chow). These results support previous findings in rats that dopamine affects response allocation in a cost/benefit test. However, they do not support the hypothesis that testosterone modifies the allocation of food-related responses.
Aschemann-Witzel, Jessica; Grunert, Klaus G; van Trijp, Hans
This study aims to find out whether front-of-pack nutrition label formats influence the healthfulness of consumers’ food choices and important predictors of healthful choices, depending on the size of the choice set that is made available to consumers. The predictors explored were health motivati...... the results revealed no consistent differences in the effects between the formats, they indicate that manipulating choice sets by including healthier options is an effective strategy to increase the healthfulness of food choices........ The results showed that food choices were more healthful in the extended 20-product (vs. 10-product) choice set and that this effect is stronger than a random choice would produce. The formats colour coding and texts, particularly colour coding in Germany, increased the healthfulness of product choices when...
Damask, James; Lawson, Robert
This report sets up a structure for examining the real costs of public education. It defines three approaches of gathering and reporting cost information: narrow (salaries and current expenditures, excluding capital outlays); generally accepted accounting principles (GAAP) (costs are recorded during the period in which they occur); and broad (all…
Full Text Available The competitive world today, with increasing customers satisfaction and expanding the definition of hosting and its direct connection with quality of products is essential. Thus not only the current customers stay fixed but also it increases. The purpose of this study was to investigate and ranking the crucial indicators that influence the choice of furniture by customers. Because of this, the studied indexes are classified in 6 group: quality, beauty, design, creating a suitable atmosphere for selling the goods, selling conditions and advertising. Population consisted of three major commercial areas in Tehran (Delawaran, Hassan Abad and Yaftabad. Statistical sample consisted a number of 100 people. A questionnaire was developed to gather data. Reliability of the questionnaires has been approved through Cronbach's Alpha coefficient (0.921. Investigation of effective indexes was done by chi-square method and in order to final ranking the indexes, friedman analyses have been used. The results obtained of ranking showed the chief factor in customers choice is under category of beauty due to this elegancy role in customers point of view. After elegancy, according to the classified elements studied in this research, raw material in making furniture, wood production’s price, ergonomy, customers satisfaction for his last purchase and immediate delivery, respectively, are the most important effective index in buying furniture by consumer.
Wei, Huaqiang; Alves-Foss, James; Soule, Terry; Pforsich, Hugh; Zhang, Du; Frincke, Deborah A.
System security involves decisions in at least three areas: identification of well-defined security policies, selection of cost-effective defence strategies, and implementation of real-time defence tactics. Although choices made in each of these areas affect the others, existing decision models typically handle these three decision areas in isolation. There is no comprehensive tool that can integrate them to provide a single efficient model for safeguarding a network. In addition, there is no clear way to determine which particular combinations of defence decisions result in cost-effective solutions. To address these problems, this paper introduces a Layered Decision Model (LDM) for use in deciding how to address defence decisions based on their cost-effectiveness. To validate the LDM and illustrate how it is used, we used simulation to test model rationality and applied the LDM to the design of system security for an e-commercial business case.
Sarif; Kurauchi, Shinya; Yoshii, Toshio
In the conventional travel behavior models such as logit and probit, decision makers are assumed to conduct the absolute evaluations on the attributes of the choice alternatives. On the other hand, many researchers in cognitive psychology and marketing science have been suggesting that the perceptions of attributes are characterized by the benchmark called “reference points” and the relative evaluations based on them are often employed in various choice situations. Therefore, this study developed a travel behavior model based on the mental accounting theory in which the internal reference points are explicitly considered. A questionnaire survey about the shopping trip to the CBD in Matsuyama city was conducted, and then the roles of reference points in travel mode choice contexts were investigated. The result showed that the goodness-of-fit of the developed model was higher than that of the conventional model, indicating that the internal reference points might play the major roles in the choice of travel mode. Also shown was that the respondents seem to utilize various reference points: some tend to adopt the lowest fuel price they have experienced, others employ fare price they feel in perceptions of the travel cost.
Shade, Starley B; Kevany, Sebastian; Onono, Maricianah; Ochieng, George; Steinfeld, Rachel L; Grossman, Daniel; Newmann, Sara J; Blat, Cinthia; Bukusi, Elizabeth A; Cohen, Craig R
To evaluate costs, cost-efficiency and cost-effectiveness of integration of family planning into HIV services. Integration of family planning services into HIV care and treatment clinics. A cluster-randomized trial. Twelve health facilities in Nyanza, Kenya were randomized to integrate family planning into HIV care and treatment; six health facilities were randomized to (nonintegrated) standard-of-care with separately delivered family planning and HIV services. We assessed costs, cost-efficiency (cost per additional use of more effective family planning), and cost-effectiveness (cost per pregnancy averted) associated with the first year of integration of family planning into HIV care. More effective family planning methods included oral and injectable contraceptives, subdermal implants, intrauterine device, and female and male sterilization. We collected cost data through interviews with study staff and review of financial records to determine costs of service integration. Integration of services was associated with an average marginal cost of $841 per site and $48 per female patient. Average overall and marginal costs of integration were associated with personnel costs [initial ($1003 vs. $872) and refresher ($498 vs. $330) training, mentoring ($1175 vs. $902) and supervision ($1694 vs. $1636)], with fewer resources required for other fixed ($18 vs. $0) and recurring expenses ($471 vs. $287). Integration was associated with a marginal cost of $65 for each additional use of more effective family planning and $1368 for each pregnancy averted. Integration of family planning and HIV services is feasible, inexpensive to implement, and cost-efficient in the Kenyan setting, and thus supports current Kenyan integration policy.
Cost-effectiveness has been suggested as the sole ethical basis for prioritization systems. The methods of health economics per se may be beneficial in decision making situations of various types. The structure of Finnish healthcare system and value-based choices associated with the application of cost-effectiveness make, however, utilizability more difficult than thought. Analysis of cost- effectiveness is worth using, but criteria and methods of decision making of health economics cannot be harnessed as tools for technocratic decision-making. Value-based choices should be subjected to wide public debate.
Mavranezouli, Ifigeneia [University College London, National Collaborating Centre for Mental Health, Centre for Outcomes Research and Effectiveness, Sub-department of Clinical Health Psychology, London (United Kingdom); East, James E. [St Marks Hospital, Imperial College London, Wolfson Unit for Endoscopy, London (United Kingdom); Taylor, Stuart A. [University College Hospital, Specialist X-Ray, London (United Kingdom); University College Hospital, Department of Imaging, London (United Kingdom)
CT colonography (CTC) is increasingly advocated as an effective initial screening tool for colorectal cancer. Nowadays, policy-makers are increasingly interested in cost-effectiveness issues. A number of studies assessing the cost-effectiveness of CTC have been published to date. The majority of findings indicate that CTC is probably not cost-effective when colonoscopy is available, but this conclusion is sensitive to a number of key parameters. This review discusses the findings of these studies, and considers those factors which most influence final conclusions, notably intervention costs, compliance rates, effectiveness of colonoscopy, and the assumed prevalence and natural history of diminutive advanced polyps. (orig.)
Mavranezouli, Ifigeneia; East, James E.; Taylor, Stuart A.
CT colonography (CTC) is increasingly advocated as an effective initial screening tool for colorectal cancer. Nowadays, policy-makers are increasingly interested in cost-effectiveness issues. A number of studies assessing the cost-effectiveness of CTC have been published to date. The majority of findings indicate that CTC is probably not cost-effective when colonoscopy is available, but this conclusion is sensitive to a number of key parameters. This review discusses the findings of these studies, and considers those factors which most influence final conclusions, notably intervention costs, compliance rates, effectiveness of colonoscopy, and the assumed prevalence and natural history of diminutive advanced polyps. (orig.)
Gilardi, T.; Rodriguez, G.; Gomez, A.; Leybros, J.; Borgard, J.M.; Carles, P.; Anzieu, P.
In the frame of the preliminary design of an sulfur/iodine thermochemical plant coupled with a 600 MWth Helium cooled High Temperature Reactor, CEA has pre-designed all the components of the I/S plant and has started to the cost estimation of all the key components with some industrial cost evaluation methods proposed by CHAUVEL or PETER and TIMMERHAUS. The purpose of the paper is to present the strong influence of material choice on final cost estimation of these key components by comparing price with standard material (steel) and the most appropriate material selected to support the strong corrosion involved by several chemical reactions of the I/S process. These results reinforce the fact that material selection must be done with the best accuracy and that it will be a key factor in the global economy of these plant investment. (authors)
Subramaniam, Shiva; Sharp, David; Jardim, Christopher; Batstone, Martin D
Methods of free flap monitoring have become more sophisticated and expensive. This study aims to determine the cost of free flap monitoring and examine its cost effectiveness. We examined a group of patients who had had free flaps to the head and neck over a two-year period, and combined these results with costs obtained from business managers and staff. There were 132 free flaps with a success rate of 99%. The cost of monitoring was Aus $193/flap. Clinical monitoring during this time period cost Aus$25 476 and did not lead to the salvage of any free flaps. Cost equivalence is reached between monitoring and not monitoring only at a failure rate of 15.8%. This is to our knowledge the first study to calculate the cost of clinical monitoring of free flaps, and to examine its cost-effectiveness. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. All rights reserved.
Bouffard, Jeffrey A
Previous hypothetical scenario tests of rational choice theory have presented all participants with the same set of consequences, implicitly assuming that these consequences would be relevant for each individual. Recent research demonstrates that those researcher-presented consequences do not accurately reflect those considered by study participants and that there is individual variation in the relevance of various consequences. Despite this and some theoretical propositions that such differences should exist, little empirical research has explored the possibility of predicting such variation. This study allows participants to develop their own set of relevant consequences for three hypothetical offenses and examines how several demographic and theoretical variables impact those consequences' relevance. Exploratory results suggest individual factors impact the perceived relevance of several cost and benefit types, even among a relatively homogenous sample of college students. Implications for future tests of rational choice theory, as well as policy implications are discussed.
Associated with effects of scale, scope, experience and learning there are effects of firm size on transaction costs; in the stages of contact, contract and control. These effects are due to ''threshold costs'' in setting up contacts, contracts and governance schemes, and to differences with respect
Full Text Available Steven SimoensResearch Centre for Pharmaceutical Care and Pharmaco-economics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, Leuven, BelgiumAbstract: Given that biosimilars are agents that are similar but not identical to the reference biopharmaceutical, this study aims to introduce and describe specific issues related to the economic evaluation of biosimilars by focusing on the relative costs, relative effectiveness, and cost-effectiveness of biosimilars. Economic evaluation assesses the cost-effectiveness of a medicine by comparing the costs and outcomes of a medicine with those of a relevant comparator. The assessment of cost-effectiveness of a biosimilar is complicated by the fact that evidence needed to obtain marketing authorization from a registration authority does not always correspond to the data requirements of a reimbursement authority. In particular, this relates to the availability of adequately powered equivalence or noninferiority studies, the need for comparative data about the effectiveness in a real-world setting rather than the efficacy in a structured setting, and the use of health outcome measures instead of surrogate endpoints. As a biosimilar is likely to be less expensive than the comparator (eg, the reference biopharmaceutical, the assessment of the cost-effectiveness of a biosimilar depends on the relative effectiveness. If appropriately designed and powered clinical studies demonstrate equivalent effectiveness between a biosimilar and the comparator, then a cost-minimization analysis identifies the least expensive medicine. If there are differences in the effectiveness of a biosimilar and the comparator, other techniques of economic evaluation need to be employed, such as cost-effectiveness analysis or cost-utility analysis. Given that there may be uncertainty surrounding the long-term safety (ie, risk of immunogenicity and rare adverse events and effectiveness of a biosimilar, the cost-effectiveness
Marit Kragt; Jeff Bennett
Choice experiments (CE) are increasingly used as a stated preference technique to value changes in non-market goods. Respondents to a CE survey are asked to make repeated choices between alternatives. Each alternative is described by a number of attributes – the attributes levels vary across alternatives and choice sets. A monetary attribute is typically included so that marginal values for changes in the non-market attributes presented can be estimated. The monetary attribute has central imp...
Bertram, Melanie Y; Lauer, Jeremy A; De Joncheere, Kees; Edejer, Tessa; Hutubessy, Raymond; Kieny, Marie-Paule; Hill, Suzanne R
Cost-effectiveness analysis is used to compare the costs and outcomes of alternative policy options. Each resulting cost-effectiveness ratio represents the magnitude of additional health gained per additional unit of resources spent. Cost-effectiveness thresholds allow cost-effectiveness ratios that represent good or very good value for money to be identified. In 2001, the World Health Organization's Commission on Macroeconomics in Health suggested cost-effectiveness thresholds based on multiples of a country's per-capita gross domestic product (GDP). In some contexts, in choosing which health interventions to fund and which not to fund, these thresholds have been used as decision rules. However, experience with the use of such GDP-based thresholds in decision-making processes at country level shows them to lack country specificity and this - in addition to uncertainty in the modelled cost-effectiveness ratios - can lead to the wrong decision on how to spend health-care resources. Cost-effectiveness information should be used alongside other considerations - e.g. budget impact and feasibility considerations - in a transparent decision-making process, rather than in isolation based on a single threshold value. Although cost-effectiveness ratios are undoubtedly informative in assessing value for money, countries should be encouraged to develop a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in, for example the involvement of civil society organizations and patient groups, and is transparent, consistent and fair.
Butler, Andrew C; Roediger, Henry L
Multiple-choice tests are used frequently in higher education without much consideration of the impact this form of assessment has on learning. Multiple-choice testing enhances retention of the material tested (the testing effect); however, unlike other tests, multiple-choice can also be detrimental because it exposes students to misinformation in the form of lures. The selection of lures can lead students to acquire false knowledge (Roediger & Marsh, 2005). The present research investigated whether feedback could be used to boost the positive effects and reduce the negative effects of multiple-choice testing. Subjects studied passages and then received a multiple-choice test with immediate feedback, delayed feedback, or no feedback. In comparison with the no-feedback condition, both immediate and delayed feedback increased the proportion of correct responses and reduced the proportion of intrusions (i.e., lure responses from the initial multiple-choice test) on a delayed cued recall test. Educators should provide feedback when using multiple-choice tests.
Jung, Jeah Kyoungrae; Wu, Bingxiao; Kim, Hyunjee; Polsky, Daniel
We examine consumers' use of publicized quality information in Medicare home health care markets, where consumer cost sharing and travel costs are absent. We report two findings. First, agencies with high quality scores are more likely to be preferred by consumers after the introduction of a public reporting program than before. Second, consumers' use of publicized quality information differs by patient group. Community-based patients have slightly larger responses to public reporting than hospital-discharged patients. Patients with functional limitations at the start of their care, at least among hospital-discharged patients, have a larger response to the reported functional outcome measure than those without functional limitations. In all cases of significant marginal effects, magnitudes are small. We conclude that the current public reporting approach is unlikely to have critical impacts on home health agency choice. Identifying and releasing quality information that is meaningful to consumers may help increase consumers' use of public reports. © The Author(s) 2015.
Suijkerbuijk, A W M; van Gils, P F; Greeven, P G J; de Wit, G A
A large number of interventions are available for the treatment of addiction. Professionals need to know about the effectiveness and cost-effectiveness of interventions so they can prioritise appropriate interventions for the treatment of addiction. To provide an overview of the scientific literature on the cost-effectiveness of addiction treatment for alcohol- and drug-abusers. We searched the databases Medline and Centre for Reviews and Dissemination. To be relevant for our study, articles had to focus on interventions in the health-care setting, have a Western context and have a health-related outcome measure such as quality adjusted life years (QALY). Twenty-nine studies met our inclusion criteria: 15 for alcohol and 14 for drugs. The studies on alcohol addiction related mainly to brief interventions. They proved to be cost-saving or had a favourable incremental cost-effectiveness ratio (ICER), remaining below the threshold of € 20,000 per QALY. The studies on drug addiction all involved pharmacotherapeutic interventions. In the case of 10 out of 14 interventions, the ICER was less than € 20,000 per QALY. Almost all of the interventions studied were cost-saving or cost-effective. Many studies consider only health-care costs. Additional research, for instance using a social cost-benefit analysis, could provide more details about the costs of addiction and about the impact that an intervention could have in these/the costs.
Chakravarty, A; Naware, S S
In a developing country with limited resources, it is important to utilize the total cost visibility approach over the entire life-cycle of the technology and then analyse alternative options for acquiring technology. The present study analysed cost-effectiveness of an "In-house" magnetic resonance imaging (MRI) scan facility of a large service hospital against outsourcing possibilities. Cost per unit scan was calculated by operating costing method and break-even volume was calculated. Then life-cycle cost analysis was performed to enable total cost visibility of the MRI scan in both "In-house" and "outsourcing of facility" configuration. Finally, cost-effectiveness analysis was performed to identify the more acceptable decision option. Total cost for performing unit MRI scan was found to be Rs 3,875 for scans without contrast and Rs 4,129 with contrast. On life-cycle cost analysis, net present value (NPV) of the "In-house" configuration was found to be Rs-(4,09,06,265) while that of "outsourcing of facility" configuration was Rs-(5,70,23,315). Subsequently, cost-effectiveness analysis across eight Figures of Merit showed the "In-house" facility to be the more acceptable option for the system. Every decision for acquiring high-end technology must be subjected to life-cycle cost analysis.
Md Z Sadique
Full Text Available The demand for vaccination against infectious diseases involves a choice between vaccinating and not vaccinating, in which there is a trade-off between the benefits and costs of each option. The aim of this paper is to investigate these trade-offs and to estimate how the perceived prevalence and severity of both the disease against which the vaccine is given and any vaccine associated adverse events (VAAE might affect demand. A discrete choice experiment (DCE was used to elicit stated preferences from a representative sample of 369 U.K. mothers of children below 5 years of age, for three hypothetical vaccines. Cost was included as an attribute, which enabled estimation of the willingness to pay for different vaccines having differing levels of the probability of occurrence and severity of both the infection and VAAE. The results suggest that the severity of the health effects associated with both the diseases and VAAEs exert an important influence on the demand for vaccination, whereas the probability of these events occurring was not a significant predictor. This has important implications for public health policy, which has tended to focus on the probability of these health effects as the main influence on decision making. Our results also suggest that anticipated regrets about the consequences of making the wrong decision also exert an influence on demand.
Karimi, Sara; Mesdaghinia, Azam; Farzinpour, Zahra; Hamidi, Gholamali; Haghparast, Abbas
The Lateral hypothalamus (LH) is an important component of the networks underlying the control of feeding and other motivated behaviors. Cost-benefit decision-making is mediated largely by the prefrontal cortex (PFC) which strongly innervates the LH. Therefore, in the current study, we conducted a series of experiments to elucidate the role of the perifornical area of the lateral hypothalamus (PeF-LH) in effort and/or delay-based decision-making. We trained different groups of rats in a delay-based and/or an effort-based form of cost-benefit T-maze decision- making task in which they could either choose to pay the cost to obtain a high reward in one arm or could obtain a low reward in the other arm with no cost. During test days, the rats received local injections of either vehicle or lidocaine4% (0.5 μl/side), in the PeF-LH. In an effort-based decision task, PeF-LH inactivation led to decrease in high reward choice. Similarly, in a delay-based decision task animals' preference changed to a low but immediately available reward. This was not caused by a spatial memory or motor deficit. PeF-LH inactivation modified decision behavior. The results imply that PeF-LH is important for allowing the animal to pay a cost to acquire greater rewards. Copyright © 2017 Elsevier Inc. All rights reserved.
de Wijk René A
Full Text Available Abstract Background Aromas have been associated with physiological, psychological affective and behavioral effects. We tested whether effects of low-level exposure to two ambient food-related aromas (citrus and vanilla could be measured with small numbers of subjects, low-cost physiological sensors and semi-real life settings. Tests included physiological (heart rate, physical activity and response times, psychological (emotions and mood and behavioral (food choice measures in a semi-real life environment for 22 participants. Results Exposure to ambient citrus aroma increased physical activity (P P P P P Conclusions The test battery used in this study demonstrated aroma-specific physiological, psychological and behavioral effects of aromas with similar appeal and intensities, and similar food-related origins. These effects could be measured in (semi- real life environments for freely moving subjects using relatively inexpensive commercially available physiological sensors.
Dellaert, B.G.C.; Donkers, B.; van Soest, A.H.O.
Many firms rely on choice experiment–based models to evaluate future marketing actions under various market conditions. This research investigates choice complexity (i.e., number of alternatives, number of attributes, and utility similarity between the most attractive alternatives) and individual
Christensen, Emily Fast
The purpose of this research was to test an intervention of choices in homework on the achievement and intrinsic motivation of seventh-grade science students at a middle school. The intervention was based on concepts from the cognitive evaluation theory of Edward L. Deci and Richard M. Ryan (1985). The subjects were sixteen heterogeneous classes of seventh-grade students, who were divided among four teachers. Two randomly chosen classes from each teacher received choices in their homework and the remaining two classes of each teacher received similar homework assignments without choices. Two hypotheses were developed for this study: (1) Seventh-grade science students given choices in their homework would show an increase in intrinsic motivation as measured on a motivation orientation measure, compared to students not given choices in their homework, and (2) Seventh-grade science students given choices in their homework would show an increase in achievement on an achievement measure, compared to students not given choices in their homework. Having choices in homework did not increase intrinsic motivation or achievement. However, students who did their homework did significantly better on the posttest, and students who were more intrinsically motivated did significantly better on the posttest. Just doing the homework was important for achievement, and intrinsic motivation was linked to achievement.
Preference between forced choice and free choice in concurrent-chain schedules of reinforcement was investigated in pigeons after exposure to particular combinations of terminal links. In Experiment 1, in which terminal links always ended with reinforcers, one of three pairs of terminal links was arranged as preexposure: (a) both terminal links…
Brudner, Harvey J.
Discusses the effectiveness of cost determining techniques in education. The areas discussed are: education and management; cost-effectiveness models; figures of merit determination; and the implications as they relate to the areas of audio-visual and computer educational technology. (Author/GA)
Ketel, N.; Linde, J.; Oosterbeek, H.; van der Klaauw, B.
This article reports on a field experiment testing for sunk-cost effects in an education setting. Students signing up for extra-curricular tutorial sessions randomly received a discount on the tuition fee. The sunk-cost effect predicts that students who pay more will attend more tutorial sessions,
Miller, Carla K; Branscum, Paul
To determine the effect of an economic recession on food choice behaviors. A qualitative study using semistructured, in-depth interviews followed by completion of a nutrition knowledge questionnaire and the Food Choice Questionnaire was conducted. A convenience sample from a metropolitan city in the Midwest. Women with children younger than 18 years in the household who had experienced unemployment, underemployment, or loss of a house because of foreclosure in the previous year participated (n = 25). Reported behaviors for food choices when grocery shopping and dining out and educational resources requested to inform nutrition education programs. Interviews were coded with a matrix derived from participant statements. Common behaviors were grouped and broad themes were identified. Numerous shopping strategies were recently used to save money (eg, buying only sale items, using coupons). Participants believed a healthful diet included a variety of foods with less sugar, salt, and fat. Recipes and menus that required little cost or preparation time and resources to track food expenditures were desired. Nutrition education should include money-saving shopping strategies, facilitate menu planning and cooking skills, and address food resource management to enable participants to acquire sufficient, acceptable, and nutritionally adequate food. Copyright Â© 2012 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
Morales Fusco, P.; Grau Sala, M.; Sauri Marchan, S.
Motorways of the sea operated as RoPax services are natural competitors with only-road freight haulage transportation. Cost, time and quality perceived are the determinants that make transporters and shippers use one route or another. This research considers the role that shipping companies and their ship deployment and pricing strategy have in the equation, as incentives for modal shift from road to sea. A model of the ships and transporter costs is developed considering different business models for the transporter (accompanied versus unaccompanied cargo) followed with a discrete choice model that, once calibrated, allows to test the influence that variables such as frequency, ship size and commercial speed might play into the competitiveness of a shipping line. As a result, different pricing strategies for the shipping line are developed and the characteristics of the optimal shipping line for each of them are found, to either maximize the profit of the shipping company or the modal shift. (Author)
Full Text Available Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico.A cost-effectiveness analysis was conducted using a decision analytic model of health and economic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican vital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the published literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World Health Organization price lists, supplemented with published studies from other countries as needed. The model estimated changes in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years (DALYs, and incremental cost-effectiveness ratios (ICERs for neonatal intensive care compared to no intensive care. Uncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24-26, 27-29, and 30-33 weeks gestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per infant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of neonatal intensive care at 24-26, 27-29, and 30-33 weeks were US$1,200, US$650, and US$240, per DALY averted, respectively. The findings were robust to variation in parameter values over wide ranges in sensitivity analyses
Letourneau, E.G.; Krewski, D.; Zielinski, J.M.; McGregor, R.G.
This paper examines the cost effectiveness of comprehensive strategies for reducing exposure to radon gas in indoor air in Canadian homes. The analysis is conducted within the context of a general framework for risk management programme evaluation which includes well-known evaluation techniques such as cost effectiveness and cost-benefit analyses as special cases. Based on this analysis, it is clear that any comprehensive programme to reduce exposure to environmental radon will be extremely expensive, and may not be justifiable in terms of health impact, particularly when considered in relation to other public health programmes. Testing of homes at the point of sale and installing sub-slab suction equipment to reduce exposure to indoor radon where necessary appears to be a relatively cost-effective radon mitigation strategy. In general, radon mitigation was found to be most cost effective in cities with relatively high levels of radon. (author)
Brouthers, K.D.; Nakos, G.
Although small and medium sized enterprises (SMEs) account for a significant portion of international trade, little is know about how they make international entry mode decisions. Transaction cost theory has been widely used to study entry mode selection for large firms. Here we apply the theory to
Correa-Burrows, Paulina; Burrows, Raquel A.
Objective: A recent economic approach suggests that people do not account for the long-term implications of unhealthy behaviours, preventing them from performing a fully rational trade-off between current benefits and future costs, leading to negative health outcomes. We examined whether the current allocation of time to physical activity among…
Full Text Available This paper treats the importance of the transition from valuation at historical cost to valuation at fair value of the assets within an economic entity, and the contents of the result obtained in financial reporting. The work deals with the influence that the fair value assessment can have on the level of an entity’s economic performance. Starting from a few statements such as: fair value option evaluation to influence significantly the fair value; presentation of the elements on the balance sheet at fair value leads to significant changes in the accounting of the economic entities, in data analysis was used a questionnaire based on the four questions whose results were analysed and which have led to carrying out this study. The research was supported by the information collected from individuals and companies within certain economic entities. The paper ends with the conclusions of authors related to the fair value assessment which, as if trying to address the shortcomings of historical cost, by aiming to correct cost of customer acquisition assets with market value, achieved through constant reevaluation of the balance sheet items. On the other hand, a concurrent evaluation of both historical cost and fair value, depending on the inherent characteristics of the elements of the balance sheet, resulting in getting relevant, reliable financial statements, in accordance with reality.
The marketing of religion has become a big business. Wortham examines the current religious scene and shows that Americans want religious plurality, rather than religious homogamy. Just like shopping for ice cream, Americans want 57 choices when shopping for religion
Ijeoma Chinyere Ukonu
This research seeks to investigate how the globalisation of fast food has affected students' food choice. A mixed method approach was used in this research; basically involving quantitative and qualitative methods. The quantitative method uses a self-completion questionnaire to randomly sample one hundred and four students; while the qualitative method uses a semi structured interview technique to survey four students on their knowledge and choice to consume fast food. A cross tabulation of v...
ILIE RĂSCOLEAN; ILEANA-SORINA RAKOS
This paper treats the importance of the transition from valuation at historical cost to valuation at fair value of the assets within an economic entity, and the contents of the result obtained in financial reporting. The work deals with the influence that the fair value assessment can have on the level of an entity’s economic performance. Starting from a few statements such as: fair value option evaluation to influence significantly the fair value; presentation of the elements on the ba...
Carmona Benitez, R.B.; Lodewijks, G.
This paper examines the effects that low-cost carriers (LCC’s) produce when entering new routes operated only by full-service carriers (FSC’s) and routes operated by low-cost carriers in competition with full-service carriers. A mathematical model has been developed to determine what routes should
Marcum, Christopher Steven; Goldring, Megan R; McBride, Colleen M; Persky, Susan
Meal construction is largely governed by nonconscious and habit-based processes that can be represented as a collection of in dividual, micro-level food choices that eventually give rise to a final plate. Despite this, dietary behavior intervention research rarely captures these micro-level food choice processes, instead measuring outcomes at aggregated levels. This is due in part to a dearth of analytic techniques to model these dynamic time-series events. The current article addresses this limitation by applying a generalization of the relational event framework to model micro-level food choice behavior following an educational intervention. Relational event modeling was used to model the food choices that 221 mothers made for their child following receipt of an information-based intervention. Participants were randomized to receive either (a) control information; (b) childhood obesity risk information; (c) childhood obesity risk information plus a personalized family history-based risk estimate for their child. Participants then made food choices for their child in a virtual reality-based food buffet simulation. Micro-level aspects of the built environment, such as the ordering of each food in the buffet, were influential. Other dynamic processes such as choice inertia also influenced food selection. Among participants receiving the strongest intervention condition, choice inertia decreased and the overall rate of food selection increased. Modeling food selection processes can elucidate the points at which interventions exert their influence. Researchers can leverage these findings to gain insight into nonconscious and uncontrollable aspects of food selection that influence dietary outcomes, which can ultimately improve the design of dietary interventions.
Good packaging and quality product that matches the price often calls for repeated patronage from consumers which enable the firm to stay in business. Good and attractive packaging of products creates readily available market for the firm and may help to cut down on advertising cost. The study examines the effect of good packaging of products on consumers’ buying choice as well as on impulse buying. Data were obtained from the administration of 400 copies of a structured questionnaire to cons...
Full Text Available Malaria remains a leading cause of mortality and morbidity among the children under five and pregnant women in sub-Saharan Africa, but it is preventable and controllable provided current recommended interventions are properly implemented. Better utilization of malaria intervention strategies will ensure the gain for the value for money and producing health improvements in the most cost effective way. The purpose of the value for money drive is to develop a better understanding (and better articulation of costs and results so that more informed, evidence-based choices could be made. Cost effectiveness analysis is carried out to inform decision makers on how to determine where to allocate resources for malaria interventions. This study carries out cost effective analysis of one or all possible combinations of the optimal malaria control strategies (Insecticide Treated Bednets—ITNs, Treatment, Indoor Residual Spray—IRS and Intermittent Preventive Treatment for Pregnant Women—IPTp for the four different transmission settings in order to assess the extent to which the intervention strategies are beneficial and cost effective. For the four different transmission settings in Kenya the optimal solution for the 15 strategies and their associated effectiveness are computed. Cost-effective analysis using Incremental Cost Effectiveness Ratio (ICER was done after ranking the strategies in order of the increasing effectiveness (total infections averted. The findings shows that for the endemic regions the combination of ITNs, IRS, and IPTp was the most cost-effective of all the combined strategies developed in this study for malaria disease control and prevention; for the epidemic prone areas is the combination of the treatment and IRS; for seasonal areas is the use of ITNs plus treatment; and for the low risk areas is the use of treatment only. Malaria transmission in Kenya can be minimized through tailor-made intervention strategies for malaria control
Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Parcel scale green infrastructure siting and cost effectiveness analysis. You can find more details at the project's website.
Full Text Available [english] Introduction: Multiple-choice-examinations are still fundamental for assessment in medical degree programs. In addition to content related research, the optimization of the technical procedure is an important question. Medical examiners face three options: paper-based examinations with or without computer support or completely electronic examinations. Critical aspects are the effort for formatting, the logistic effort during the actual examination, quality, promptness and effort of the correction, the time for making the documents available for inspection by the students, and the statistical analysis of the examination results.Methods: Since three semesters a computer program for input and formatting of MC-questions in medical and other paper-based examinations is used and continuously improved at Wuerzburg University. In the winter semester (WS 2009/10 eleven, in the summer semester (SS 2010 twelve and in WS 2010/11 thirteen medical examinations were accomplished with the program and automatically evaluated. For the last two semesters the remaining manual workload was recorded. Results: The cost of the formatting and the subsequent analysis including adjustments of the analysis of an average examination with about 140 participants and about 35 questions was 5-7 hours for exams without complications in the winter semester 2009/2010, about 2 hours in SS 2010 and about 1.5 hours in the winter semester 2010/11. Including exams with complications, the average time was about 3 hours per exam in SS 2010 and 2.67 hours for the WS 10/11. Discussion: For conventional multiple-choice exams the computer-based formatting and evaluation of paper-based exams offers a significant time reduction for lecturers in comparison with the manual correction of paper-based exams and compared to purely electronically conducted exams it needs a much simpler technological infrastructure and fewer staff during the exam.[german] Einleitung: Multiple-Choice
Pagel, N; Dick, H B; Krummenauer, F
Supplementation of cataract patients with multifocal intraocular lenses involves an additional financial investment when compared to the corresponding monofocal supplementation, which usually is not funded by German health care insurers. In the context of recent resource allocation discussions, however, the cost effectiveness of multifocal cataract surgery could become an important rationale. Therefore an evidence-based estimation of its cost effectiveness was carried out. Three independent meta-analyses were implemented to estimate the gain in uncorrected near visual acuity and best corrected visual acuity (vision lines) as well as the predictability (fraction of patients without need for reading aids) of multifocal supplementation. Study reports published between 1995 and 2004 (English or German language) were screened for appropriate key words. Meta effects in visual gain and predictability were estimated by means and standard deviations of the reported effect measures. Cost data were estimated by German DRG rates and individual lens costs; the cost effectiveness of multifocal cataract surgery was then computed in terms of its marginal cost effectiveness ratio (MCER) for each clinical benefit endpoint; the incremental costs of multifocal versus monofocal cataract surgery were further estimated by means of their respective incremental cost effectiveness ratio (ICER). An independent meta-analysis estimated the complication profiles to be expected after monofocal and multifocal cataract surgery in order to evaluate expectable complication-associated additional costs of both procedures; the marginal and incremental cost effectiveness estimates were adjusted accordingly. A sensitivity analysis comprised cost variations of +/- 10 % and utility variations alongside the meta effect estimate's 95 % confidence intervals. Total direct costs from the health care insurer's perspective were estimated 3363 euro, associated with a visual meta benefit in best corrected visual
Soyer, Meral Turk; Ergin, Isil; Gursoy, Safak Taner
To present data that contributes to understanding factors that influence food choice and skipping meals in adolescents. A cross sectional study is carried in selected high schools in Bornova. Study sample compromises of 527 students chosen randomly by class from a population of 2410 first year in high school students. Self-administered questionnaires containing sociodemographic determinants, self reported weight and height, food choices and meal patterns were used. A psychosocial factor that affects almost all of the students is the "taste and sensory perception of food". The second noticable factor is the "health and nutritious value of food". The time conserved and the convenience in the preparation of food is one of the lifestyle factors that affect more than half of the students. The cost of the food was also found to have an effect. Among the third group of factors categorized as "media", the leading factor is advertisement, effective in one third of the students. Among boys and girls, there was no statistical difference in the type of meal skipped. Living in Izmir for more than 10 years compared to less than ten years, being in a nuclear family to extended family, and belonging to the "owner" social class to "wage laborer" class also do not statistically differ with regard to skipping meals. However, the mother's and father's education level and having a working mother are associated with skipping meals. These results provide important evidence to support opportunities to positively influence the adoption of healthful eating.
Erath, A.; Axhausen, K. W.
This comprehensive final report for the Swiss Federal Office of Energy (SFOE) examines the long-term effects of fuel price elasticity. The study analyses how mobility tool usage and ownership as well as residence location choice are affected by rising fuel costs. Based on econometric models, long-term fuel price elasticity is derived. The authors quote that the demand reactions to higher fuel prices mainly observed are the reduction of mileage and the consideration of smaller-engined and diesel-driven cars. As cars with natural gas powered engines and electric drives were hardly considered in the survey, the results of the natural gas model can, according to the authors, only serve as a trend. No stable model could be estimated for the demand and usage of electric cars. A literature overview is presented and the design of the survey is discussed, whereby socio-demographical variables and the effects of price and residence changes are discussed. Modelling of mobility tool factors and results obtained are looked at. Finally, residence choice factors are modelled and discussed. Several appendices complete the report.
Nord, Mark; Hopwood, Heather
The cost of “enough food,” estimated from the amount that low- and medium-income households in a geographic area report needing to spend to just meet their food needs, differs substantially across States and among metropolitan areas. In areas with high food costs, many food-stamp recipients are likely to have inadequate food resources to support healthy food choices.
Arias, M; Díez, F J
Cost-effectiveness analysis (CEA) is used increasingly in medicine to determine whether the health benefit of an intervention is worth the economic cost. Decision trees, the standard decision modeling technique for non-temporal domains, can only perform CEA for very small problems. To develop a method for CEA in problems involving several dozen variables. We explain how to build influence diagrams (IDs) that explicitly represent cost and effectiveness. We propose an algorithm for evaluating cost-effectiveness IDs directly, i.e., without expanding an equivalent decision tree. The evaluation of an ID returns a set of intervals for the willingness to pay - separated by cost-effectiveness thresholds - and, for each interval, the cost, the effectiveness, and the optimal intervention. The algorithm that evaluates the ID directly is in general much more efficient than the brute-force method, which is in turn more efficient than the expansion of an equivalent decision tree. Using OpenMarkov, an open-source software tool that implements this algorithm, we have been able to perform CEAs on several IDs whose equivalent decision trees contain millions of branches. IDs can perform CEA on large problems that cannot be analyzed with decision trees.
Baker, E.G.; Freeman, H.D.; Hartley, J.N.; Gee, G.W.
Earthen, asphalt, and multilayer radon barrier systems can all provide reduction in the amount of radon gas released from uranium mill tailings. Pacific Northwest Laboratory field tested all three types of covers at Grand Junction, Colorado during the summer of 1981. All nine individual radon barrier systems tested currently meet the EPA standard for radon flux of 20 pCi m - 2 s - 1 . The cost of the asphalt and 3m earthen covers were about the same at the field test. Multilayer covers were significantly more costly. Cost estimates for three high priority western sites indicate 3m of earthen cover is the least costly radon barrier when earthen material is available at or near the disposal site. If earthen material must be imported more than 8 to 10 km asphalt and possibly multilayer radon barriers can be cost effective
Allen, Kelly N.; Taylor, Julie Smith; Kuiper, RuthAnne
Adolescent obesity has become a major health concern in the United States. An increased frequency of fast food restaurant dining is associated with higher intake of calories and calories from fat. The purpose of this study was to gain insight as to how food choices in a "simulated" fast food environment might be influenced by nutrition…
K. Hytönen (Kaisa)
textabstractIt is well known that our choices and judgments depend on the context. For instance, prior experiences can influence subsequent decisions. People tend to make riskier decisions if they have a chance to win back a previous loss or if they can gamble with previously won money. Another
Constantinides, Efthymios; Lorenzo Romero, Carlota; Gomez, Miguel A.
Purpose – This paper seeks to analyze the buying behavior of internet users in two European countries with different cultural backgrounds, Spain and The Netherlands, assessing the influence of online experience factors on the choice of an internet vendor. It also aims to identify and compare the
Amabile, Teresa M.
In a test of intrinsic motivation hypothesis of creativity, 60 undergraduate women did an artistic creativity task with either the expectation of receiving a reward or no expectation of reward. Reward was crossed with choice in task engagement, such that half of the reward Ss contracted to do the task in order to receive reward, and half simply…
Full Text Available The marketing of religion has become a big business. Wortham examines the current religious scene and shows that Americans want religious plurality, rather than religious homogamy. Just like shopping for ice cream, Americans want 57 choices when shopping for religion
The purpose of this qualitative study is to analyze how advertising affects a student's search and community college choice among the plethora of community colleges, career/technical schools, universities, and other influencers. The results of the research indicate that parents, friends, high school counselors, economics (i.e., money), and…
Tonjes, David J., E-mail: firstname.lastname@example.org [Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY 11794-3560 (United States); Waste Reduction and Management Institute, School of Marine and Atmospheric Sciences, Stony Brook University, Stony Brook, NY 11794-5000 (United States); Center for Bioenergy Research and Development, Advanced Energy Research and Technology Center, Stony Brook University, 1000 Innovation Rd., Stony Brook, NY 11794-6044 (United States); Mallikarjun, Sreekanth, E-mail: email@example.com [Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY 11794-3560 (United States)
Highlights: • Curbside collection of recyclables reduces overall system costs over a range of conditions. • When avoided costs for recyclables are large, even high collection costs are supported. • When avoided costs for recyclables are not great, there are reduced opportunities for savings. • For common waste compositions, maximizing curbside recyclables collection always saves money. - Abstract: Financial analytical models of waste management systems have often found that recycling costs exceed direct benefits, and in order to economically justify recycling activities, externalities such as household expenses or environmental impacts must be invoked. Certain more empirically based studies have also found that recycling is more expensive than disposal. Other work, both through models and surveys, have found differently. Here we present an empirical systems model, largely drawn from a suburban Long Island municipality. The model accounts for changes in distribution of effort as recycling tonnages displace disposal tonnages, and the seven different cases examined all show that curbside collection programs that manage up to between 31% and 37% of the waste stream should result in overall system savings. These savings accrue partially because of assumed cost differences in tip fees for recyclables and disposed wastes, and also because recycling can result in a more efficient, cost-effective collection program. These results imply that increases in recycling are justifiable due to cost-savings alone, not on more difficult to measure factors that may not impact program budgets.
Joseph Farrell; Paul Klemperer
Switching costs and network effects bind customers to vendors if products are incompatible, locking customers or even markets in to early choices. Lock-in hinders customers from changing suppliers in response to (predictable or unpredictable) changes in effciency, and gives vendors lucrative ex post market power-over the same buyer in the case of switching costs (or brand loyalty), or over others with network effects. Firms compete ex ante for this ex post power, using penetration pricing, in...
Farrell, Joseph; Klemperer, Paul
Switching costs and network effects bind customers to vendors if products are incompatible, locking customers or even markets in to early choices. Lock-in hinders customers from changing suppliers in response to (predictable or unpredictable) changes in efficiency, and gives vendors lucrative ex post market power—over the same buyer in the case of switching costs (or brand loyalty), or over others with network effects. Firms compete ex ante for this ex post power, using penetration ...
Richard P. Coe; Patricia A. Lake
Training is crucial to the success of any organization. It is also expensive, with some estimates exceeding $50 billion annually spent on training by U.S. corporations. Nuclear training, like that of many other highly technical organizations, is both crucial and costly. It is unlikely that the amount of training can be significantly reduced. If anything, current trends indicate that training needs will probably increase as the industry and workforce ages and changes. With the advent of energy deregulation in the United States, greater pressures will surface to make the costs of energy more cost-competitive. This in turn will drive businesses to more closely examine existing costs and find ways to do things in a more cost-effective way. The commercial nuclear industry will be no exception, and nuclear training will be equally affected. It is time for nuclear training and indeed the entire nuclear industry to begin using more aggressive techniques to reduce costs. This includes the need for nuclear training to find alternatives to traditional methods for the delivery of cost-effective high-quality training that meets regulatory requirements and produces well-qualified personnel capable of working in an efficient and safe manner. Computer-based and/or Web-based training are leading emerging technologies
Full Text Available Empirical evidence suggests the incentive value of an option is affected by other options available during choice and by options presented in the past. These contextual effects are hard to reconcile with classical theories and have inspired accounts where contextual influences play a crucial role. However, each account only addresses one or the other of the empirical findings and a unifying perspective has been elusive. Here, we offer a unifying theory of context effects on incentive value attribution and choice based on normative Bayesian principles. This formulation assumes that incentive value corresponds to a precision-weighted prediction error, where predictions are based upon expectations about reward. We show that this scheme explains a wide range of contextual effects, such as those elicited by other options available during choice (or within-choice context effects. These include both conditions in which choice requires an integration of multiple attributes and conditions where a multi-attribute integration is not necessary. Moreover, the same scheme explains context effects elicited by options presented in the past or between-choice context effects. Our formulation encompasses a wide range of contextual influences (comprising both within- and between-choice effects by calling on Bayesian principles, without invoking ad-hoc assumptions. This helps clarify the contextual nature of incentive value and choice behaviour and may offer insights into psychopathologies characterized by dysfunctional decision-making, such as addiction and pathological gambling.
This paper analyses the effects of activity choices on farm household income and consumption in a war-affected developing country. The study uses household survey data from Mozambique and controls for the endogeneity of activity choices with instrumental variables. War-time activity choices (such as subsistence farming) are shown to enhance welfare in the post-war period. Market and social exchange induce only limited welfare gains. Cotton adoption reduces household welfare, which contradicts...
Full Text Available ABSTRACT The study investigates the effect of generic strategic choices and management control systems (MCS on the organizational performance of large and medium-sized companies located in Espírito Santo, using Contingency Theory as the theoretical framework. It is a quantitative study, using a survey as the data collection technique. 73 questionnaires were validated, after being completed by those responsible for the controlling or related area of these enterprises over the period between February and April of 2014. The data analysis was performed using the structural equations modeling technique. The main results indicate that: (i competitive forces shape the strategy adopted by the organizations surveyed, however, contrary to what the literature predicts, those companies that operate in more competitive environments choose a strategy of cost leadership instead of differentiation; (ii the design and use of the MCS is influenced by the strategy chosen, and the use of contemporary management practices is associated with a differentiation strategy; (iii strategic choices and the MCS have a positive impact on organizational performance. In addition, those companies that combine differentiation strategy with contemporary management practices perform better than the other companies analyzed.
Bos, C.; Lans, van der I.A.; Rijnsoever, F.J.; Trijp, van J.C.M.
The present study investigates acceptance of intervention strategies for low-calorie snack choices that vary regarding the effect they have on consumers’ freedom of choice (providing information, guiding choice through (dis)incentives, and restricting choice). We examine the mediating effects of
Full Text Available Abstract Background Proposals to expand Medicare coverage tend to be expensive, but the value of services purchased is not known. This study evaluates the efficiency of the average private supplemental insurance plan for Medicare recipients. Methods Data from the National Health Interview Survey, the National Death Index, and the Medical Expenditure Panel Survey were analyzed to estimate the costs, changes in life expectancy, and health-related quality of life gains associated with providing private supplemental insurance coverage for Medicare beneficiaries. Model inputs included socio-demographic, health, and health behavior characteristics. Parameter estimates from regression models were used to predict quality-adjusted life years (QALYs and costs associated with private supplemental insurance relative to Medicare only. Markov decision analysis modeling was then employed to calculate incremental cost-effectiveness ratios. Results Medicare supplemental insurance is associated with increased health care utilization, but the additional costs associated with this utilization are offset by gains in quality-adjusted life expectancy. The incremental cost-effectiveness of private supplemental insurance is approximately $24,000 per QALY gained relative to Medicare alone. Conclusion Supplemental insurance for Medicare beneficiaries is a good value, with an incremental cost-effectiveness ratio comparable to medical interventions commonly deemed worthwhile.
Graziose, Matthew M; Koch, Pamela A; Wang, Y Claire; Lee Gray, Heewon; Contento, Isobel R
To estimate the long-term cost-effectiveness of an obesity prevention nutrition education curriculum (Food, Health, & Choices) as delivered to all New York City fifth-grade public school students over 1 year. This study is a standard cost-effectiveness analysis from a societal perspective, with a 3% discount rate and a no-intervention comparator, as recommended by the US Panel on Cost-effectiveness in Health and Medicine. Costs of implementation, administration, and future obesity-related medical costs were included. Effectiveness was based on a cluster-randomized, controlled trial in 20 public schools during the 2012-2013 school year and linked to published estimates of childhood-to-adulthood body mass index trajectories using a decision analytic model. The Food, Health, & Choices intervention was estimated to cost $8,537,900 and result in 289 fewer males and 350 fewer females becoming obese (0.8% of New York City fifth-grade public school students), saving 1,599 quality-adjusted life-years (QALYs) and $8,098,600 in direct medical costs. Food, Health, & Choices is predicted to be cost-effective at $275/QALY (95% confidence interval, -$2,576/QALY to $2,084/QALY) with estimates up to $6,029/QALY in sensitivity analyses. This cost-effectiveness model suggests that a nutrition education curriculum in public schools is effective and cost-effective in reducing childhood obesity, consistent with the authors' hypothesis and previous literature. Future research should assess the feasibility and sustainability of scale-up. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
Full Text Available Universal inferences like (i have been taken as evidence for a local/syntactic treatment of scalar implicatures (i.e. theories where the enrichment of "some" into "some but not all" can happen sub-sententially: (i Everybody read some of the books --> Everybody read [some but not all the books]. In this paper, I provide experimental evidence which casts doubt on this argument. The counter-argument relies on a new set of data involving free choice inferences (a sub-species of scalar implicatures and negative counterparts of (i, namely sentences with the quantifier "no" instead of "every". The results show that the globalist account of scalar implicatures is incomplete (mainly because of free choice inferences but that the distribution of universal inferences made available by the localist move remains incomplete as well (mainly because of the negative cases. doi:10.3765/sp.2.2 BibTeX info
Aschemann-Witzel, Jessica; Grunert, Klaus G; van Trijp, Hans C M; Bialkova, Svetlana; Raats, Monique M; Hodgkins, Charo; Wasowicz-Kirylo, Grazyna; Koenigstorfer, Joerg
This study aims to find out whether front-of-pack nutrition label formats influence the healthfulness of consumers' food choices and important predictors of healthful choices, depending on the size of the choice set that is made available to consumers. The predictors explored were health motivation and perceived capability of making healthful choices. One thousand German and Polish consumers participated in the study that manipulated the format of nutrition labels. All labels referred to the content of calories and four negative nutrients and were presented on savoury and sweet snacks. The different formats included the percentage of guideline daily amount, colour coding schemes, and text describing low, medium and high content of each nutrient. Participants first chose from a set of 10 products and then from a set of 20 products, which was, on average, more healthful than the first choice set. The results showed that food choices were more healthful in the extended 20-product (vs. 10-product) choice set and that this effect is stronger than a random choice would produce. The formats colour coding and texts, particularly colour coding in Germany, increased the healthfulness of product choices when consumers were asked to choose a healthful product, but not when they were asked to choose according to their preferences. The formats did not influence consumers' motivation to choose healthful foods. Colour coding, however, increased consumers' perceived capability of making healthful choices. While the results revealed no consistent differences in the effects between the formats, they indicate that manipulating choice sets by including healthier options is an effective strategy to increase the healthfulness of food choices. Copyright © 2013 Elsevier Ltd. All rights reserved.
I. Lansdorp-Vogelaar (Iris); A.B. Knudsen (Amy); H. Brenner (Hermann)
textabstractColorectal cancer is an important public health problem. Several screening methods have been shown to be effective in reducing colorectal cancer mortality. The objective of this review was to assess the cost-effectiveness of the different colorectal cancer screening methods and to
Marshall, Andrew T.; Kirkpatrick, Kimberly
This study examined the effects of previous outcomes on subsequent choices in a probabilistic-choice task. Twenty-four rats were trained to choose between a certain outcome (1 or 3 pellets) versus an uncertain outcome (3 or 9 pellets), delivered with a probability of .1, .33, .67, and .9 in different phases. Uncertain outcome choices increased with the probability of uncertain food. Additionally, uncertain choices increased with the probability of uncertain food following both certain-choice outcomes and unrewarded uncertain choices. However, following uncertain-choice food outcomes, there was a tendency to choose the uncertain outcome in all cases, indicating that the rats continued to “gamble” after successful uncertain choices, regardless of the overall probability or magnitude of food. A subsequent manipulation, in which the probability of uncertain food varied within each session as a function of the previous uncertain outcome, examined how the previous outcome and probability of uncertain food affected choice in a dynamic environment. Uncertain-choice behavior increased with the probability of uncertain food. The rats exhibited increased sensitivity to probability changes and a greater degree of win–stay/lose–shift behavior than in the static phase. Simulations of two sequential choice models were performed to explore the possible mechanisms of reward value computations. The simulation results supported an exponentially decaying value function that updated as a function of trial (rather than time). These results emphasize the importance of analyzing global and local factors in choice behavior and suggest avenues for the future development of sequential-choice models. PMID:23205915
Thorhauge, Mikkel; Cherchi, Elisabetta; Rich, Jeppe
is likely to affect the choice of departure time. However departure time choice is also related to the full daily activity pattern, such as a restriction or a preference in one activity may form restrictions in the flexibility of other activities and thereby affect the preference for the related departure...... time. In this paper we investigate how the latent effect of the perceived mobility necessities affects the choice of departure time. A stated choice experiment collected among workers who commute to Copenhagen center is used to estimate 9 hybrid choice models where the discrete choice of departing...... before or later than the current trip depends on the latent construct of the perceived mobility necessities. Results show that individuals who perceive they have high mobility necessity tend to prefer the current departure time, and in particular dislike departing later. However the latent variables...
Sanders, Gabriel J; Juvancic-Heltzel, Judith; Williamson, Megan L; Roemmich, James N; Feda, Denise M; Barkley, Jacob E
Increasing autonomy by manipulating the choice of available physical activity options in a laboratory setting can increase physical activity in older children and adults. However, the effect of manipulating the number of physically active choices has yet to be examined in young children in a gymnasium environment. Twenty children (n = 10 girls, 6.1 ± 1.4 years old) individually participated in 2 [low choice (LC), high choice (HC)] free-choice activity conditions for 30 minutes in a 4360 square foot gymnasium. Children had access to 2 or 8 physical activity options in the LC and HC conditions, respectively. Physical activity behavior was measured via accelerometry. Children's 30-minute accelerometer counts increased (P autonomy through choice of a greater number of physically active options increased young children's physical activity participation by 20.5%.
Kreitler, J.; Thompson, M.; Vaillant, N.
The cost of fighting large wildland fires in the western United States has grown dramatically over the past decade. This trend will likely continue with growth of the WUI into fire prone ecosystems, dangerous fuel conditions from decades of fire suppression, and a potentially increasing effect from prolonged drought and climate change. Fuel treatments are often considered the primary pre-fire mechanism to reduce the exposure of values at risk to wildland fire, and a growing suite of fire models and tools are employed to prioritize where treatments could mitigate wildland fire damages. Assessments using the likelihood and consequence of fire are critical because funds are insufficient to reduce risk on all lands needing treatment, therefore prioritization is required to maximize the effectiveness of fuel treatment budgets. Cost-effectiveness, doing the most good per dollar, would seem to be an important fuel treatment metric, yet studies or plans that prioritize fuel treatments using costs or cost-effectiveness measures are absent from the literature. Therefore, to explore the effect of using costs in fuel treatment planning we test four prioritization algorithms designed to reduce risk in a case study examining fuel treatments on the Sisters Ranger District of central Oregon. For benefits we model sediment retention and standing biomass, and measure the effectiveness of each algorithm by comparing the differences among treatment and no treat alternative scenarios. Our objective is to maximize the averted loss of net benefits subject to a representative fuel treatment budget. We model costs across the study landscape using the My Fuel Treatment Planner software, tree list data, local mill prices, and GIS-measured site characteristics. We use fire simulations to generate burn probabilities, and estimate fire intensity as conditional flame length at each pixel. Two prioritization algorithms target treatments based on cost-effectiveness and show improvements over those
Machado, Flávia Mori Sarti; Simões, Arlete Naresse
To test the use of cost-effectiveness analysis as a decision making tool in the production of meals for the inclusion of the recommendations published in the World Health Organization's Global Strategy. Five alternative options for breakfast menu were assessed previously to their adoption in a food service at a university in the state of Sao Paulo, Southeastern Brazil, in 2006. Costs of the different options were based on market prices of food items (direct cost). Health benefits were estimated based on adaptation of the Diet Quality Index (DQI). Cost-effectiveness ratios were estimated by dividing benefits by costs and incremental cost-effectiveness ratios were estimated as cost differential per unit of additional benefit. The meal choice was based on health benefit units associated to direct production cost as well as incremental effectiveness per unit of differential cost. The analysis showed the most simple option with the addition of a fruit (DQI = 64 / cost = R$ 1.58) as the best alternative. Higher effectiveness was seen in the options with a fruit portion (DQI1=64 / DQI3=58 / DQI5=72) compared to the others (DQI2=48 / DQI4=58). The estimate of cost-effectiveness ratio allowed to identifying the best breakfast option based on cost-effectiveness analysis and Diet Quality Index. These instruments allow easy application easiness and objective evaluation which are key to the process of inclusion of public or private institutions under the Global Strategy directives.
Aud, Susan L.
School choice programs, which allow students to attend the public or private school of their choice using public funds, have taken root in the U.S. and are growing rapidly both in number and size. Their fiscal impact has become an important political issue. Proponents say school choice saves money because private schooling is more efficient,…
Increasing autonomy by manipulating the choice of available physical activity options in a laboratory setting can increase physical activity in older children and adults. However, the effect of manipulating the number of physically active choices has yet to be examined in young children in a gymnas...
Miller, Carla K.; Branscum, Paul
Objective: To determine the effect of an economic recession on food choice behaviors. Design: A qualitative study using semistructured, in-depth interviews followed by completion of a nutrition knowledge questionnaire and the Food Choice Questionnaire was conducted. Setting and Participants: A convenience sample from a metropolitan city in the…
Sensenig, Amanda E.
Taking a test often leads to enhanced later memory for the tested information, a phenomenon known as the "testing effect". This memory advantage has been reliably demonstrated with recall tests but not multiple choice tests. One potential explanation for this finding is that multiple choice tests do not rely on retrieval processes to the same…
Berends, Mark; Waddington, R. Joseph
School choice researchers are often limited to comparing one type of choice with another (e.g., charter schools vs. traditional public schools). One area researchers have not examined is the effects of different school types within the same urban region. We fill this gap by analyzing longitudinal data for students (grades 3-8) in Indianapolis,…
Kleef, van Ellen; Seijdell, Karen; Vingerhoeds, Monique H.; Wijk, de René A.; Trijp, van Hans C.M.
Consumer choices are often influenced by the default option presented. This study examines the effect of whole wheat bread as a default option in a sandwich choice situation. Whole wheat bread consists of 100% whole grain and is healthier than other bread types that are commonly consumed, such as
Geske, Terry G.
The general nature of cost-effectiveness analysis is discussed, analytical frameworks for conducting cost-effectiveness studies are described, and some of the problems inherent in measuring educational costs and in assessing program effectiveness are addressed. (Author/IRT)
Tom Holmes; Armando Gonzalez-Caban; John Loomis; Jose Sanchez
In this paper, we investigate homeowner preferences and willingness to pay for wildfire protection programs using a choice experiment with three attributes: risk, loss and cost. Preference heterogeneity among survey respondents was examined using three econometric models and risk preferences were evaluated by comparing willingness to pay for wildfire protection...
Verhoeve, H R; Moolenaar, L M; Hompes, P; van der Veen, F; Mol, B W J
Guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing; therefore, we evaluated the cost-effectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment. Cost-effectiveness analysis. Decision analytic framework. Computer-simulated cohort of subfertile women. We evaluated six scenarios: (1) no tests and no treatment; (2) immediate treatment without tubal testing; (3) delayed treatment without tubal testing; (4) hysterosalpingogram (HSG), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); (5) HSG and a diagnostic laparoscopy (DL) in case HSG does not prove tubal patency, followed by tailored treatment; and (6) DL followed by tailored treatment. Expected cumulative live births after 3 years. Secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. For a 30-year-old woman with otherwise unexplained subfertility for 12 months, 3-year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4%, and costs per couple were €0, €6968, €5063, €5410, €5405 and €6163 for scenarios 1, 2, 3, 4, 5 and 6, respectively. The incremental cost-effectiveness ratios compared with scenario 1 (reference strategy), were €26,541, €19,046, €20,372, €20,150 and €23,184 for scenarios 2, 3, 4, 5 and 6, respectively. Sensitivity analysis showed the model to be robust over a wide range of values for the variables. The most cost-effective scenario is to perform no diagnostic tubal tests and to delay in vitro fertilisation (IVF) treatment for at least 12 months for women younger than 38 years old, and to perform no tubal tests and start immediate IVF treatment from the age of 39 years. If an invasive diagnostic test is planned, HSG followed by tailored treatment, or a DL if HSG shows no tubal patency, is more cost-effective than DL. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013
Jena, Anupam B; Philipson, Tomas J
While cost-effectiveness (CE) analysis has provided a guide to allocating often scarce resources spent on medical technologies, less emphasis has been placed on the effect of such criteria on the behavior of innovators who make health care technologies available in the first place. A better understanding of the link between innovation and cost-effectiveness analysis is particularly important given the large role of technological change in the growth in health care spending and the growing interest of explicit use of CE thresholds in leading technology adoption in several Westernized countries. We analyze CE analysis in a standard market context, and stress that a technology's cost-effectiveness is closely related to the consumer surplus it generates. Improved CE therefore often clashes with interventions to stimulate producer surplus, such as patents. We derive the inconsistency between technology adoption based on CE analysis and economic efficiency. Indeed, static efficiency, dynamic efficiency, and improved patient health may all be induced by the cost-effectiveness of the technology being at its worst level. As producer appropriation of the social surplus of an innovation is central to the dynamic efficiency that should guide CE adoption criteria, we exemplify how appropriation can be inferred from existing CE estimates. For an illustrative sample of technologies considered, we find that the median technology has an appropriation of about 15%. To the extent that such incentives are deemed either too low or too high compared to dynamically efficient levels, CE thresholds may be appropriately raised or lowered to improve dynamic efficiency.
Hogendoorn, Wouter; Lavida, Anthi; Hunink, M. G Myriam; Moll, Frans L.; Geroulakos, George; Muhs, Bart E.; Sumpio, Bauer E.
Objective Open repair (OPEN) and conservative management (CONS) have been the treatments of choice for splenic artery aneurysms (SAAs) for many years. Endovascular repair (EV) has been increasingly used with good short-term results. In this study, we evaluated the cost-effectiveness of OPEN, EV, and
Toyota, Hiroshi; Konishi, Tomoko
The present study investigated age differences in the effects of a self-choice elaboration and an experimenter-provided elaboration on incidental memory. Adults, sixth grade, and second grade subjects chose which of two sentence frames the target fit better in a self-choice elaboration condition. They then judged whether each target made sense in its sentence frame in the experimenter-provided elaboration, then did free recall tests. Only adults recalled better the targets with an image sentence with self-choice elaboration, rather than experimenter-provided elaboration. However, self-choice elaboration was far superior for the recall of targets with nonimage sentences only for second graders. Thus, the effects of self-choice elaboration were determined both by age and by type of sentence frame.
... 10 Energy 3 2010-01-01 2010-01-01 false Measuring cost-effectiveness. 436.18 Section 436.18 Energy... Procedures for Life Cycle Cost Analyses § 436.18 Measuring cost-effectiveness. (a) In accordance with this section, each Federal agency shall measure cost-effectiveness by combining cost data established under...
... 42 Public Health 4 2010-10-01 2010-10-01 false Cost-effectiveness. 457.1015 Section 457.1015... Waivers: General Provisions § 457.1015 Cost-effectiveness. (a) Definition. For purposes of this subpart... may demonstrate cost-effectiveness by comparing the cost of coverage for the family to the cost of...
Steffansson, Marina; Pulliainen, Marjo; Kettunen, Aija; Linnosmaa, Ismo; Halonen, Miikka
The aim of this paper is to study home care clients' freedom to choose their services, as well the association between the effectiveness of home care services and freedom of choice, among other factors. A structured postal survey was conducted among regular home care clients (n = 2096) aged 65 or older in three towns in Finland. Freedom of choice was studied based on clients' subjective experiences. The effectiveness of the services was evaluated by means of changes in the social-care-related quality of life. Regression analyses were used to test associations. As much as 62% of home care recipients reported having some choice regarding their services. Choosing meals and visiting times for the care worker were associated with better effectiveness. The basic model, which included needs and other factors expected to have an impact on quality of life, explained 15.4% of the changes in quality of life, while the extended model, which included the freedom-of-choice variables, explained 17.4%. The inclusion of freedom-of-choice variables increased the adjusted coefficient of determination by 2%. There was a significant positive association between freedom of choice and the effectiveness of public home care services. Freedom of choice does not exist for all clients of home care who desire it. By changing social welfare activities and structures, it is possible to show respect for clients' opinions and to thereby improve the effectiveness of home care services.
Dixon, S; Faghih Nasiri, F; Ledger, W L; Lenton, E A; Duenas, A; Sutcliffe, P; Chilcott, J B
The objective of this study was to assess the cost-effectiveness of different embryo transfer strategies for a single cycle when two embryos are available, and taking the NHS cost perspective. Cost-effectiveness model. Five in vitro fertilisation (IVF) centres in England between 2003/04 and 2004/05. Women with two embryos available for transfer in three age groups (Costs and adverse outcomes are estimated up to 5 years after the birth. Incremental cost per live birth was calculated for different embryo transfer strategies and for three separate age groups: less than 30, 30-35 and 36-39 years. Premature birth, neonatal intensive care unit admissions and days, cerebral palsy and incremental cost-effectiveness ratios. Single fresh embryo transfer (SET) plus frozen single embryo transfer (fzSET) is the more costly in terms of IVF costs, but the lower rates of multiple births mean that in terms of total costs, it is less costly than double embryo transfer (DET). Adverse events increase when moving from SET to SET+fzSET to DET. The probability of SET+fzSET being cost-effective decreases with age. When SET is included in the analysis, SET+fzSET no longer becomes a cost-effective option at any threshold value for all age groups studied. The analyses show that the choice of embryo transfer strategy is a function of four factors: the age of the mother, the relevance of the SET option, the value placed on a live birth and the relative importance placed on adverse outcomes. For each patient group, the choice of strategy is a trade-off between the value placed on a live birth and cost.
Lewandowsky, S.; Cook, J.; Ecker, U. K.
The widespread prevalence and persistence of misinformation about many important scientific issues, from climate change to vaccinations or the link between HIV and AIDS, must give rise to concern. We first review the mechanisms by which such misinformation is disseminated in society, both inadvertently and purposely. We then survey and explain the cognitive factors that often render misinformation resistant to correction. We answer the question why retractions of misinformation can be so ineffective and why they can even backfire and ironically increase misbelief. We discuss the overriding role of ideology and personal worldviews in the resistance of misinformation to correction and show how their role can be attenuated. We discuss the risks associated with repeating misinformation while seeking to correct it and we point to the design of "choice architectures" as an alternative to the attempt to retract misinformation.
, a scenario-part and a cost-benefit part. Air and sea modes are not analyzed. The model adopts a bottom-up approach to allow a detailed assessment of transport policy measures. Four generic areas of intervention were identified and the likely effect on CO2 emissions, socioeconomic efficiency and other...... are evaluated according to CO2 reduction potential and according to the ‘shadow price’ on a reduction of one ton CO2. The shadow price reflects the costs (and benefits) of the different measures. Comparing the measures it is possible to identify cost effective measures, but these measures are not necessarily...... by the Ministry of Transport, with the Technical University of Denmark as one of the main contributors. The CO2-strategy was to be based on the principle of cost-effectiveness. A model was set up to assist in the assessment. The model consists of a projection of CO2-emissions from road and rail modes from 2020...
De Jager, D.; Faaij, A.P.C.; Troelstra, W.P.
The aim of the study on the title subject was to investigate whether stimulation of the production and use of biofuels for transportation is worthwhile compared to the production of electricity from biomass. Several options are compared to each other and with reference technologies on the basis of the consumption or the avoided input of fossil fuels, emissions of greenhouse gases, specific costs and cost effectiveness. For each phase in the biomass conversion process (cultivation, pretreatment, transportation, conversion, distribution and final consumption) indicators were collected from the literature. Next to costs of the bioconversion routes attention is paid to other relevant aspects that are important for the introduction of the technological options in the Netherlands. 41 refs
Thorhauge, Mikkel; Cherchi, Elisabetta; Walker, Joan L.
of them consider the effect of intention and its role as mediator between those psychological effects and the choice, as implied in the Theory of Planned Behavior. In this paper we contribute to the literature in this field by specifically studying the direct effect of the intention on the actual behavior......, while attitude, social norms, and perceived behavioral control affect the intention to behave in a given way. We apply a hybrid choice model to study the departure time choice. For this, we use data from Danish commuters in the morning rush hours in the Greater Copenhagen area. We find a significant...
Walton Surrey M
Full Text Available Abstract Background Cost utility analysis (CUA using SF-36/SF-12 data has been facilitated by the development of several preference-based algorithms. The purpose of this study was to illustrate how decision-making could be affected by the choice of preference-based algorithms for the SF-36 and SF-12, and provide some guidance on selecting an appropriate algorithm. Methods Two sets of data were used: (1 a clinical trial of adult asthma patients; and (2 a longitudinal study of post-stroke patients. Incremental costs were assumed to be $2000 per year over standard treatment, and QALY gains realized over a 1-year period. Ten published algorithms were identified, denoted by first author: Brazier (SF-36, Brazier (SF-12, Shmueli, Fryback, Lundberg, Nichol, Franks (3 algorithms, and Lawrence. Incremental cost-utility ratios (ICURs for each algorithm, stated in dollars per quality-adjusted life year ($/QALY, were ranked and compared between datasets. Results In the asthma patients, estimated ICURs ranged from Lawrence's SF-12 algorithm at $30,769/QALY (95% CI: 26,316 to 36,697 to Brazier's SF-36 algorithm at $63,492/QALY (95% CI: 48,780 to 83,333. ICURs for the stroke cohort varied slightly more dramatically. The MEPS-based algorithm by Franks et al. provided the lowest ICUR at $27,972/QALY (95% CI: 20,942 to 41,667. The Fryback and Shmueli algorithms provided ICURs that were greater than $50,000/QALY and did not have confidence intervals that overlapped with most of the other algorithms. The ICUR-based ranking of algorithms was strongly correlated between the asthma and stroke datasets (r = 0.60. Conclusion SF-36/SF-12 preference-based algorithms produced a wide range of ICURs that could potentially lead to different reimbursement decisions. Brazier's SF-36 and SF-12 algorithms have a strong methodological and theoretical basis and tended to generate relatively higher ICUR estimates, considerations that support a preference for these algorithms over the
Hoehn, John P.; Lupi, Frank; Kaplowitz, Michael D.
Stated choice experiments about ecosystem changes involve complex information. This study examines whether the format in which ecosystem information is presented to respondents affects stated choice outcomes. Our analysis develops a utility-maximizing model to describe respondent behavior. The model shows how alternative questionnaire formats alter respondentsâ€™ use of filtering heuristics and result in differences in preference estimates. Empirical results from a large-scale stated choice e...
To prevent HIV transmission through breastfeeding, African health services in 1998 implemented the World Health Organization's approach of 'informed choice' when recommending infant feeding options to HIV-positive mothers. In 2010, 'informed choice' was withdrawn in favour of antiretroviral prophylaxis with breastfeeding. A 2010-11 ethnographic study conducted in Senegal among HIV-positive mothers revealed three broad responses to the withdrawal of choice and formula provision: 'resistance' from association members claiming the health system was responsible for providing formula to ensure efficient prevention; 'compliance' among mothers adopting 'protected breastfeeding' without complaints; and 'self-reliance' among women trying to obtain formula through other means without mentioning choice. These three responses shed light on the meanings attributed to choice and on the social impact of formula provision during the 'informed choice era.' The analysis shows that the top-down introduction of 'informed choice' as an ethical and management imperative was appropriated and re-signified locally, making space for new forms of sociality within medical and associative social spaces. These social forms could not easily be maintained after the withdrawal of formula provision; women who continue to exert choice do so silently. By focusing on the upheaval of social care arrangements after the introduction of prophylaxis by pharmaceuticals, this paper sheds light on the understudied local consequences of changes in public health policies and the social framing of 'choice' in low-income countries' health systems.
Inoue, Takehiro; Inoue, Toshihiko
We carried out two Phase III clinical trials using high dose rate (HDR) remote afterloading brachytherapy unit. We evaluated the clinical results based not only on the medical but also the economical standpoint. The first trial is the Phase III trial for cervical cancer treated with HDR or medium dose rate (MDR) intracavitary radiotherapy. The second one is the Phase III trial for tongue cancer treated with HDR or low dose rate (LDR) interstitial radiation. For cervical cancer, the survival rate of patients treated with HDR brachytherapy is the some as for LDR brachytherapy. The average total cost of treatment for the HDR group was 1.47 million yen, while that for the MDR group was 1.58 million yen. The average total admission days was 63. For tongue cancer, the local control rate of the HDR group is almost the same as that of the LDR groups. The average total cost for the HDR group was 780 thousand yen, and that for the LDR group was 830 thousand yen. The average total admission days was 34. According to the cost-effectiveness, HDR brachytherapy for cervical cancer has the same result as MDR, and HDR brachytherapy for tongue cancer has the same result as LDR. However, HDR can be treated without admission for patients who live near the hospital. HDR can be applied for these patients with less expense. We must be aware of not only the medical results but also the cost-effectiveness. (author)
Thomsen, Morgane; Barrett, Andrew C; Negus, S Stevens; Caine, S Barak
We have adapted a nonhuman primate model of cocaine versus food choice to the rat species. To evaluate the procedure, we tested cocaine versus food choice under a variety of environmental manipulations as well as pharmacological pretreatments. Complete cocaine-choice dose-effect curves (0-1.0 mg/kg/infusion) were obtained for each condition under concurrent fixed ratio schedules of reinforcement. Percentage of responding emitted on the cocaine-reinforced lever was not affected significantly by removal of cocaine-associated visual or auditory cues, but it was decreased after removal of response-contingent or response-independent cocaine infusions. Cocaine choice was sensitive to the magnitude and fixed ratio requirement of both the cocaine and food reinforcers. We also tested the effects of acute (0.32, 0.56, 1.0, 1.8 mg/kg) and chronic (0.1, 0.32 mg/kg/hr) d-amphetamine treatment on cocaine choice. Acute and chronic d-amphetamine had opposite effects, with acute increasing and chronic decreasing cocaine choice, similar to observations in humans and in nonhuman primates. The results suggest feasibility and utility of the choice procedure in rats and support its comparability to similar procedures used in humans and monkeys. © Society for the Experimental Analysis of Behavior.
Thomsen, Morgane; Barrett, Andrew C.; Negus, S. Stevens; Caine, S. Barak
We have adapted a nonhuman primate model of cocaine versus food choice to the rat species. To evaluate the procedure, we tested cocaine versus food choice under a variety of environmental manipulations as well as pharmacological pretreatments. Complete cocaine-choice dose-effect curves (0–1.0 mg/kg/infusion) were obtained for each condition under concurrent fixed ratio schedules of reinforcement. Percentage of responding emitted on the cocaine-reinforced lever was not affected significantly by removal of cocaine-associated visual or auditory cues, but it was decreased after removal of response-contingent or response-independent cocaine infusions. Cocaine choice was sensitive to the magnitude and fixed ratio requirement of both the cocaine and food reinforcers. We also tested the effects of acute (0.32, 0.56, 1.0, 1.8 mg/kg) and chronic (0.1, 0.32 mg/kg/hr) d-amphetamine treatment on cocaine choice. Acute and chronic d-amphetamine had opposite effects, with acute increasing and chronic decreasing cocaine choice, similar to observations in humans and in nonhuman primates. The results suggest feasibility and utility of the choice procedure in rats and support its comparability to similar procedures used in humans and monkeys. PMID:23319458
Fiddelers, Audrey A A; Dirksen, Carmen D; Dumoulin, John C M; van Montfoort, Aafke P A; Land, Jolande A; Janssen, J Marij; Evers, Johannes L H; Severens, Johan L
A selective switch to elective single embryo transfer (eSET) in IVF has been suggested to prevent complications of fertility treatment for both mother and infants. We compared seven IVF strategies concerning their cost-effectiveness using a Markov model. The model was based on a three IVF-attempts time horizon and a societal perspective using real world strategies and data, comparing seven IVF strategies, concerning costs, live births and incremental cost-effectiveness ratios (ICERs). In order to increase pregnancy probability, one cycle of eSET + one cycle of standard treatment policy [STP, i.e. eSET in patients IVF treatment, combining several transfer policies was not cost-effective. A choice has to be made between three cycles of eSET, STP or DET. It depends, however, on society's willingness to pay which strategy is to be preferred from a cost-effectiveness point of view.
Omidvari, Amir-Houshang; Meester, Reinier G S; Lansdorp-Vogelaar, Iris
Gastrointestinal (GI) diseases are among the leading causes of death in the world. To reduce the burden of GI diseases, surveillance is recommended for some diseases, including for patients with inflammatory bowel diseases, Barrett's oesophagus, precancerous gastric lesions, colorectal adenoma, and pancreatic neoplasms. This review aims to provide an overview of the evidence on cost-effectiveness of surveillance of individuals with GI conditions predisposing them to cancer, specifically focussing on the aforementioned conditions. We searched the literature and reviewed 21 studies. Despite heterogeneity of studies in terms of settings, study populations, surveillance strategies and outcomes, most reviewed studies suggested at least some surveillance of patients with these GI conditions to be cost-effective. For some high-risk conditions frequent surveillance with 3-month intervals was warranted, while for other conditions, surveillance may only be cost-effective every 10 years. Further studies based on more robust effectiveness evidence are needed to inform and optimise surveillance programmes for GI cancers. Copyright © 2016 Elsevier Ltd. All rights reserved.
Yu, Siyu; Xie, Yu
Observed friendship choices are constrained by social structures and thus problematic indicators for underlying personal preferences. In this paper, we report on a study demonstrating the causal effects of preference in friendship choice based on an online field experiment. Specifically, we tested two important forces that govern friendship choices: preference for shared group identity (operationalized as the desire to befriend others sharing the same place-of-origin identity) and preference for high status (operationalized as the desire to befriend others from high-status institutions). Using an online field experiment in one of the largest social network service websites in China, we investigated the causal preference effects of these two forces free from structural constraints. The results of our study confirm the preference effects on friendship choice in both of the two dimensions we tested. Copyright © 2017. Published by Elsevier Inc.
Eichholz, G G; Lando, A V [Georgia Inst. of Tech., Atlanta (USA). School of Nuclear Engineering
The grass-cow-milk pathway for /sup 131/I is one of the main contributers to estimated population dose from BWR's and PWR's. Such estimates assume a cow at the fenceline grazing for 12 months of the year. Reductions in the population dose would require a trade-off, based on cost-effectiveness criteria, between additions to the effluent treatment system, expanding the exclusion area, or raising the stack height. It is suggested that a more practical and more cost-effective means may be provided by redistribution of nearby dairy cattle (or goats), and that the plant operator buy these animals and/or contract with the land owner(s) to use the land for alternative crops. Even a subsidy to compensate the farmer for any financial losses entailed in these changes might be less expensive than alternative technical installations to lower iodine effluent levels. Figures are provided to illustrate these points.
Hemsworth, Paul H; Smith, Kenneth; Karlen, Marcus G; Arnold, Naomi A; Moeller, Steven J; Barnett, John L
We examined effects of deprivation of feed, social contact and bedding on the choice behaviour in Y maze tests. Eighty pigs were used to study two main effects: feed (estimated voluntary feed intake (VFI) vs. 70% VFI) and bedding (presence vs. absence), experiment 1; social contact (full vs. restricted) and bedding (presence vs. absence), experiment 2; and feed (as in experiment 1) and social contact (as in experiment 2), experiment 3. Overall pigs consistently chose feed and social contact over bedding. While social contact was more preferred than feed in experiment 3, there was substantial variation between pigs in their choice behaviour. The overall choice behaviour in experiment 3 contradicts previous research, but differences such as the preference methodology as well as the level of deprivation, level of reward and cost involved in accessing reward, may be responsible. Average daily weight gain (ADG) was affected in experiment 3: both feed and social restriction reduced ADG. While the feed effect is expected, one interpretation of the social effect is that social deprivation, through stress, may have reduced ADG. These results provide limited support for the notion that deprivation of a highly preferred resource may disrupt biological function. Copyright © 2011 Elsevier B.V. All rights reserved.
Olander, Ellinor K; Eves, Frank F
The current study compared two interventions for promotion of stair climbing in the workplace, an information-based intervention at a health information day and an environmental intervention (point-of-choice prompts), for their effectiveness in changing stair climbing and cost per employee. Interrupted time-series design. Four buildings on a university campus. Employees at a university in the United Kingdom. Two stair-climbing interventions were compared: (1) a stand providing information on stair climbing at a health information day and (2) point-of-choice prompts (posters). Observers recorded employees' gender and method of ascent (n = 4279). The cost of the two interventions was calculated. Logistic regression. There was no significant difference between baseline (47.9% stair climbing) and the Workplace Wellbeing Day (48.8% stair climbing), whereas the prompts increased stair climbing (52.6% stair climbing). The health information day and point-of-choice prompts cost $773.96 and $31.38, respectively. The stand at the health information day was more expensive than the point-of-choice prompts and was inferior in promoting stair climbing. It is likely that the stand was unable to encourage stair climbing because only 3.2% of targeted employees visited the stand. In contrast, the point-of-choice prompts were potentially visible to all employees using the buildings and hence better for disseminating the stair climbing message to the target audience.
Bialkova, Svetlana; Bialkova, Svetlana; Grunert, Klaus G.; Juhl, Hans Jørn; Wasowicz-Kirylo, Grazyna; Stysko-Kunkowska, Malgorzata; van Trijp, Hans C.M.
In two eye-tracking studies, we explored whether and how attention to nutrition information mediates consumers’ choice. Consumers had to select either the healthiest option or a product of their preference within an assortment. On each product a particular label (Choices logo, monochrome GDA label,
Bialkova, S.; Grunert, K.G.; Juhl, H.J.; Wasowicz-Kirylo, G.; Stysko-Kunkowska, M.; Trijp, van J.C.M.
In two eye-tracking studies, we explored whether and how attention to nutrition information mediates consumers' choice. Consumers had to select either the healthiest option or a product of their preference within an assortment. On each product a particular label (Choices logo, monochrome GDA label,
Wasterlain, Amy S; Melamed, Eitan; Bello, Ricardo; Karia, Raj; Capo, John T
Surgical costs are under scrutiny and surgeons are being held increasingly responsible for cost containment. In some instances, implants are the largest component of total procedure cost, yet previous studies reveal that surgeons' knowledge of implant prices is poor. Our study aims to (1) understand drivers behind implant selection and (2) assess whether educating surgeons about implant costs affects implant selection. We surveyed 226 orthopedic surgeons across 6 continents. The survey presented 8 clinical cases of upper extremity fractures with history, radiographs, and implant options. Surgeons were randomized to receive either a version with each implant's average selling price ("price-aware" group), or a version without prices ("price-naïve" group). Surgeons selected a surgical implant and ranked factors affecting implant choice. Descriptive statistics and univariate, multivariable, and subgroup analyses were performed. For cases offering implants within the same class (eg, volar locking plates), price-awareness reduced implant cost by 9% to 11%. When offered different models of distal radius volar locking plates, 25% of price-naïve surgeons selected the most expensive plate compared with only 7% of price-aware surgeons. For cases offering different classes of implants (eg, plate vs external fixator), there was no difference in implant choice between price-aware and price-naïve surgeons. Familiarity with the implant was the most common reason for choosing an implant in both groups (35% vs 46%). Price-aware surgeons were more likely to rank cost as a factor (29% vs 21%). Price awareness significantly influences surgeons' choice of a specific model within the same implant class. Merely including prices with a list of implants leads surgeons to select less expensive implants. This implies that an untapped opportunity exists to reduce surgical expenditures simply by enhancing surgeons' cost awareness. Economic/Decision Analyses I. Copyright © 2017 American
Azevedo, Helda; Mateus, Céu
The Portuguese hospital sector has been restructured by wide-ranging hospital mergers, following a conviction among policy makers that bigger hospitals lead to lower average costs. Since the effects of mergers have not been systematically evaluated, the purpose of this article is to contribute to this area of knowledge by assessing potential economies of scale to explore and compare these results with realized cost savings after mergers. Considering the period 2003-2009, we estimate the translog cost function to examine economies of scale in the years preceding restructuring. Additionally, we use the difference-in-differences approach to evaluate hospital centres (HC) that occurred between 2004 and 2007, comparing the years after and before mergers. Our findings suggest that economies of scale are present in the pre-merger configuration with an optimum hospital size of around 230 beds. However, the mergers between two or more hospitals led to statistically significant post-merger cost increases, of about 8 %. This result indicates that some HC become too large to explore economies of scale and suggests the difficulty of achieving efficiencies through combining operations and service specialization.
Sun, Yan; Li, Shu
Previous studies using Western samples have found that introducing uncertainty to an intertemporal choice decreases the degree of discounting future rewards. The authors of this article examined the effect of risk on intertemporal choice using Chinese participants and found that respondents preferred the smaller but sooner (SS) outcome to the larger but later (LL) one in the presence of risk, which indicates that risk increases rather than decreases the degree of discounting future rewards. Thus, variations in response patterns between different cultural groups suggest that culture may play an important role in intertemporal choice and researchers should delve into this topic from an emic rather than an etic perspective.
Fortes, Inês; Pinto, Carlos; Machado, Armando; Vasconcelos, Marco
When offered a choice between 2 alternatives, animals sometimes prefer the option yielding less food. For instance, pigeons and starlings prefer an option that on 20% of the trials presents a stimulus always followed by food, and on the remaining 80% of the trials presents a stimulus never followed by food (the Informative Option), over an option that provides food on 50% of the trials regardless of the stimulus presented (the Noninformative Option). To explain this suboptimal behavior, it has been hypothesized that animals ignore (or do not engage with) the stimulus that is never followed by food in the Informative Option. To assess when pigeons attend to the stimulus usually not followed by food, we increased the probability of reinforcement, p, in the presence of that stimulus. Across 2 experiments, we found that the value of the Informative Option decreased with p. To account for the results, we added to the Reinforcement Rate Model (and also to the Hyperbolic Discounting Model) an engagement function, f(p), that specified the likelihood the animal attends to a stimulus followed by reward with probability p, and then derived the model predictions for 2 forms of f(p), a linear function, and an all-or-none threshold function. Both models predicted the observed findings with a linear engagement function: The higher the probability of reinforcement after a stimulus, the higher the probability of engaging the stimulus, and, surprisingly, the less the value of the option comprising the stimulus. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Stille, Lotta; Norin, Emelie; Sikström, Sverker
Choice blindness is the failure to detect a discrepancy between a choice and its outcome. The misinformation effect occurs when the recollection of an event changes because new, misleading information about the event is received. The purpose of this study was to merge the choice blindness and misinformation effect paradigms, and thus examine whether choice blindness can be created for individuals' recollections of a witnessed event, and whether this will affect their later recollections of the event. Thus, as a way of delivering misinformation the participants ostensibly became their own source of the misleading information. The participants watched a short film and filled out a questionnaire about events shown in the film. Some of their answers were then manipulated using reattachable stickers, which allowed alteration of their original answers. The participants gave justifications for their manipulated choices, and later their recollection of the original event was tested through another questionnaire. Choice blindness was created for a majority of the participants. A majority of the choice blind participants later changed their reported recollection of the event in line with the manipulations, whereas only a small minority of the participants in the control condition changed their recollection. This study provides new information about the misinformation effect, suggesting that this effect also can occur when misinformation is given immediately following presentation of the original stimuli, and about choice blindness and its effects on the recollections of events. The results suggest that memory blindness can be created when people inadvertently supply themselves with misleading information about an event, causing a change in their recollection.
Full Text Available Choice blindness is the failure to detect a discrepancy between a choice and its outcome. The misinformation effect occurs when the recollection of an event changes because new, misleading information about the event is received. The purpose of this study was to merge the choice blindness and misinformation effect paradigms, and thus examine whether choice blindness can be created for individuals' recollections of a witnessed event, and whether this will affect their later recollections of the event. Thus, as a way of delivering misinformation the participants ostensibly became their own source of the misleading information. The participants watched a short film and filled out a questionnaire about events shown in the film. Some of their answers were then manipulated using reattachable stickers, which allowed alteration of their original answers. The participants gave justifications for their manipulated choices, and later their recollection of the original event was tested through another questionnaire. Choice blindness was created for a majority of the participants. A majority of the choice blind participants later changed their reported recollection of the event in line with the manipulations, whereas only a small minority of the participants in the control condition changed their recollection. This study provides new information about the misinformation effect, suggesting that this effect also can occur when misinformation is given immediately following presentation of the original stimuli, and about choice blindness and its effects on the recollections of events. The results suggest that memory blindness can be created when people inadvertently supply themselves with misleading information about an event, causing a change in their recollection.
Chen, Yi-Fen; Wang, Ya-Ju
Previous works have shown that consumers are influenced by others in decision making. Herd behavior is common in situations in which consumers infer product quality from other consumer choices and incorporate that information into their own decision making. This research presents two studies examining herd effect and the moderating role of product involvement on bidder choices in online auctions. The two studies addressed the influence on bidder online choices of herd cues frequently found in online auctions, including feedback ratings and number of questions and answers. The experimental results demonstrated that bidders use online herd cues when making decisions in online auctions. Additionally, the effects of herd cues on bidder online choices were stronger in high-involvement than low-involvement participants. Results and implications are discussed.
Setlow, Barry; Mendez, Ian A; Mitchell, Marci R; Simon, Nicholas W
Drug-addicted individuals show high levels of impulsive choice, characterized by preference for small immediate over larger but delayed rewards. Although the causal relationship between chronic drug use and elevated impulsive choice in humans has been unclear, a small but growing body of literature over the past decade has shown that chronic drug administration in animal models can cause increases in impulsive choice, suggesting that a similar causal relationship may exist in human drug users. This article reviews this literature, with a particular focus on the effects of chronic cocaine administration, which have been most thoroughly characterized. The potential mechanisms of these effects are described in terms of drug-induced neural alterations in ventral striatal and prefrontal cortical brain systems. Some implications of this research for pharmacological treatment of drug-induced increases in impulsive choice are discussed, along with suggestions for future research in this area.
Foreback, Laura Elizabeth
The purpose of this study was to determine the effects of increasing individual student choice in assignments on student engagement and understanding of content. It was predicted that if students are empowered to choose learning activities based on individual readiness, learning style, and interests, they would be more engaged in the curriculum and consequently would develop deeper understanding of the material. During the 2009--2010 school year, I implemented differentiated instructional strategies that allowed for an increased degree of student choice in five sections of eighth grade science at DeWitt Junior High School. These strategies, including tiered lessons and student-led, project-based learning, were incorporated into the "Earth History and Geologic Time Scale" unit of instruction. The results of this study show that while offering students choices can be used as an effective motivational strategy, their academic performance was not increased compared to their performance during an instructional unit that did not offer choice.
Full Text Available Abstract Background The World Health Organization recommends that national malaria programmes universally distribute long-lasting insecticide-treated bed nets (LLINs. LLINs provide effective insecticide protection for at least three years while conventional nets must be retreated every 6-12 months. LLINs may also promise longer physical durability (lifespan, but at a higher unit price. No prospective data currently available is sufficient to calculate the comparative cost effectiveness of different net types. We thus constructed a model to explore the cost effectiveness of LLINs, asking how a longer lifespan affects the relative cost effectiveness of nets, and if, when and why LLINs might be preferred to conventional insecticide-treated nets. An innovation of our model is that we also considered the replenishment need i.e. loss of nets over time. Methods We modelled the choice of net over a 10-year period to facilitate the comparison of nets with different lifespan (and/or price and replenishment need over time. Our base case represents a large-scale programme which achieves high coverage and usage throughout the population by distributing either LLINs or conventional nets through existing health services, and retreats a large proportion of conventional nets regularly at low cost. We identified the determinants of bed net programme cost effectiveness and parameter values for usage rate, delivery and retreatment cost from the literature. One-way sensitivity analysis was conducted to explicitly compare the differential effect of changing parameters such as price, lifespan, usage and replenishment need. Results If conventional and long-lasting bed nets have the same physical lifespan (3 years, LLINs are more cost effective unless they are priced at more than USD 1.5 above the price of conventional nets. Because a longer lifespan brings delivery cost savings, each one year increase in lifespan can be accompanied by a USD 1 or more increase in price
How to efficiently design a communication network is a paramount task for network designing and engineering. It is, however, not a single objective optimization process as perceived by most previous researches, i.e., to maximize its transmission capacity, but a multi-objective optimization process, with lowering its cost to be another important objective. These two objectives are often contradictive in that optimizing one objective may deteriorate the other. After a deep investigation of the impact that network topology, node capability scheme and routing algorithm as well as their interplays have on the two objectives, this letter presents a systematic approach to achieve a cost-effective design by carefully choosing the three designing aspects. Only when routing algorithm and node capability scheme are elegantly chosen can BA-like scale-free networks have the potential of achieving good tradeoff between the two objectives. Random networks, on the other hand, have the built-in character for a cost-effective design, especially when other aspects cannot be determined beforehand.
Full Text Available This study based on literature review aims to evaluate and emphasize the affect of the strategic facility management (SFM on choice of medical tourism destination. Medical Tourism, which ranges from the health care services involving a cure to the wellness services involving no specific health trouble to pleasure and amusement services, is one of the most growing sectors in the world. Cost and quality of medical services are among the main reasons for the choice of destination. Strategic facility management has a positive correlation on the levels of quality, cost and customer satisfaction. Thus medical tourism and destination managers should take into account of the potential advantages of value creation offered through SFM in order to be chosen by customers (stakeholders.
... 49 Transportation 7 2010-10-01 2010-10-01 false Determination of cost-effectiveness. 639.21... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CAPITAL LEASES Cost-Effectiveness § 639.21 Determination of cost...-effectiveness comparison as described in this subpart, it may ask FTA to approve an alternate form of cost...
Friedman, S. N.
The possibility to combine various technologies, such as Bi-Polar linear and CMOS/Digital makes it feasible to create systems with a tailored performance not available on a single monolithic circuit. The custom LSI 'BLOCK', especially if it is universal in nature, is proving to be a cost effective way for the developer to improve his product. The custom LSI represents a low price part in contrast to the discrete components it will replace. In addition, the hybrid assembly can realize a savings in labor as a result of the reduced parts handling and associated wire bonds. The possibility of the use of automated system manufacturing techniques leads to greater reliability as the human factor is partly eliminated. Attention is given to reliability predictions, cost considerations, and a product comparison study.
.... However, there is still confusion over which factors influence media choice. This study examined the effectiveness of five media under different conditions in an effort to better understand which factors impact media choice...
Mendez, I A; Damborsky, J C; Winzer-Serhan, U H; Bizon, J L; Setlow, B
Nicotinic receptors have been linked to a wide range of cognitive and behavioral functions, but surprisingly little is known about their involvement in cost benefit decision making. The goal of these experiments was to determine how nicotinic acetylcholine receptor (nAChR) expression is related to two forms of cost benefit decision making. Male Long Evans rats were tested in probability- and delay-discounting tasks, which required discrete trial choices between a small reward and a large reward associated with varying probabilities of omission and varying delays to reward delivery, respectively. Following testing, radioligand binding to α4β2 and α7 nAChR subtypes in brain regions implicated in cost benefit decision making was examined. Significant linear relationships were observed between choice of the large delayed reward in the delay discounting task and α4β2 receptor binding in both the dorsal and ventral hippocampus. Additionally, trends were found suggesting that choice of the large costly reward in both discounting tasks was inversely related to α4β2 receptor binding in the medial prefrontal cortex and nucleus accumbens shell. Similar trends suggested that choice of the large delayed reward in the delay discounting task was inversely related to α4β2 receptor binding in the orbitofrontal cortex, nucleus accumbens core, and basolateral amygdala, as well as to α7 receptor binding in the basolateral amygdala. These data suggest that nAChRs (particularly α4β2) play both unique and common roles in decisions that require consideration of different types of reward costs. Copyright © 2012 IBRO. Published by Elsevier Ltd. All rights reserved.
Kim, Sung Ki; Lee, Min Soo; Lee, Jong Youl; Choi, Heui Joo; Choi, Jong Won
This paper provides the cost effect results of Cu powder and bentonite on the disposal cost for an HLW repository in Korea. In the cost analysis for both of these cost drivers, the price of Cu powder and the bentonite can affect the canister cost and the bentonite cost of the disposal holes as well as backfilling cost of the tunnels, respectively. Finally, we found that the unit cost of Cu and bentonite was the dominant cost drivers for the surface and underground facilities of an HLW repository. Therefore, an optimization of a canister and the layout of a disposal hole and disposal tunnels are essential to decrease the direct disposal cost of spent fuels. The disposal costs can be largely divided into two parts such as a surface facilities' cost and an underground facilities' cost. According to the KRS' cost analysis, the encapsulation material as well as the buffering and backfilling cost were the significant costs. Especially, a canister's cost was approximately estimated to be more than one fourth of the overall disposal costs. So it can be estimated that the unit cost of Cu powder is an important cost diver. Because the outer shell of the canister was made of Cu powder by a cold spray coating method. In addition, the unit cost of bentonite can also affect the buffering and the backfilling costs of the disposal holes and the disposal tunnels. But, these material costs will be highly expensive and unstable due to the modernization of the developing countries. So the studies for a material cost should be continued to identify the actual cost of an HLW repository
Francis, Tittu; Washington, Travis; Srivastava, Karan; Moutzouros, Vasilios; Makhni, Eric C; Hakeos, William
Tension band wiring (TBW) and locked plating are common treatment options for Mayo IIA olecranon fractures. Clinical trials have shown excellent functional outcomes with both techniques. Although TBW implants are significantly less expensive than a locked olecranon plate, TBW often requires an additional operation for implant removal. To choose the most cost-effective treatment strategy, surgeons must understand how implant costs and return to the operating room influence the most cost-effective strategy. This cost-effective analysis study explored the optimal treatment strategies by using decision analysis tools. An expected-value decision tree was constructed to estimate costs based on the 2 implant choices. Values for critical variables, such as implant removal rate, were obtained from the literature. A Monte Carlo simulation consisting of 100,000 trials was used to incorporate variability in medical costs and implant removal rates. Sensitivity analysis and strategy tables were used to show how different variables influence the most cost-effective strategy. TBW was the most cost-effective strategy, with a cost savings of approximately $1300. TBW was also the dominant strategy by being the most cost-effective solution in 63% of the Monte Carlo trials. Sensitivity analysis identified implant costs for plate fixation and surgical costs for implant removal as the most sensitive parameters influencing the cost-effective strategy. Strategy tables showed the most cost-effective solution as 2 parameters vary simultaneously. TBW is the most cost-effective strategy in treating Mayo IIA olecranon fractures despite a higher rate of return to the operating room. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
Ashford, Richard; Biswas, Shampa
The reduction of transaction costs is a commonly mentioned yet rarely elaborated goal for aid effectiveness in educational development. The casual use of the concept of transaction costs conceals which costs may be reduced, which costs are required and, indeed, what transaction costs actually are. Examining issues related to harmonizing the…
Karsina, Allen; Thompson, Rachel H; Rodriguez, Nicole M; Vanselow, Nicholas R
We evaluated the effects of differential reinforcement and accurate verbal rules with feedback on the preference for choice and the verbal reports of 6 adults. Participants earned points on a probabilistic schedule by completing the terminal links of a concurrent-chains arrangement in a computer-based game of chance. In free-choice terminal links, participants selected 3 numbers from an 8-number array; in restricted-choice terminal links participants selected the order of 3 numbers preselected by a computer program. A pop-up box then informed the participants if the numbers they selected or ordered matched or did not match numbers generated by the computer but not displayed; matching in a trial resulted in one point earned. In baseline sessions, schedules of reinforcement were equal across free- and restricted-choice arrangements and a running tally of points earned was shown each trial. The effects of differentially reinforcing restricted-choice selections were evaluated using a reversal design. For 4 participants, the effects of providing a running tally of points won by arrangement and verbal rules regarding the schedule of reinforcement were also evaluated using a nonconcurrent multiple-baseline-across-participants design. Results varied across participants but generally demonstrated that (a) preference for choice corresponded more closely to verbal reports of the odds of winning than to reinforcement schedules, (b) rules and feedback were correlated with more accurate verbal reports, and (c) preference for choice corresponded more highly to the relative number of reinforcements obtained across free- and restricted-choice arrangements in a session than to the obtained probability of reinforcement or to verbal reports of the odds of winning.
Río, Pablo del; Cerdá, Emilio
The cost-effectiveness of support for renewable electricity is a main criterion to assess the success of policy instruments, together with effectiveness. The costs of support are also a source of significant concern for governments all over the world. However, significant confusion exists in the literature on the cost-effectiveness of public support for renewable electricity. While some authors define the concept of cost-effectiveness as that which complies with the equimarginality principle, many others, including documents from relevant organisations (European Commission, International Energy Agency, Intergovernmental Panel on Climate Change) define it as “the lowest costs of support”, generally equating it with the minimisation of consumer costs. The aim of this paper is to clarify the differences between both approaches and their policy implications regarding the choice of instruments and design elements. It is shown that they partly overlap and that their policy implications clearly differ, leading to very different policy prescriptions. While the former favours technology neutral instruments and design elements, the “minimisation of consumer costs” approach favours instruments and design elements which adjust support levels to the costs of the technologies. - Highlights: • Significant confusion exists in the literature on the cost-effectiveness of public support for renewable electricity. • Clarify the differences between two main approaches to cost-effectiveness. • Policy implications clearly differ, leading to very different policy prescriptions
Full Text Available Dynamic, connectionist models of decision making, such as decision field theory (Roe, Busemeyer, and Townsend, 2001, propose that the effect of context on choice arises from a series of pairwise comparisons between attributes of alternatives across time. As such, they predict that limiting the amount of time to make a decision should decrease rather than increase the size of contextual effects. This prediction was tested across four levels of time pressure on both the asymmetric dominance (Huber, Payne, and Puto, 1982 and compromise (Simonson, 1989 decoy effects in choice. Overall, results supported this prediction, with both types of decoy effects found to be larger as time pressure decreased.
Full Text Available Since alendronate became available in generic form in the Unites States in 2008, its price has been decreasing. The objective of this study was to investigate the impact of alendronate cost on the cost-effectiveness of osteoporosis screening and treatment in postmenopausal women.Microsimulation cost-effectiveness model of osteoporosis screening and treatment for U.S. women age 65 and older. We assumed screening initiation at age 65 with central dual-energy x-ray absorptiometry (DXA, and alendronate treatment for individuals with osteoporosis; with a comparator of "no screening" and treatment only after fracture occurrence. We evaluated annual alendronate costs of $20 through $800; outcome measures included fractures; nursing home admission; medication adverse events; death; costs; quality-adjusted life-years (QALYs; and incremental cost-effectiveness ratios (ICERs in 2010 U.S. dollars per QALY gained. A lifetime time horizon was used, and direct costs were included. Base-case and sensitivity analyses were performed.Base-case analysis results showed that at annual alendronate costs of $200 or less, osteoporosis screening followed by treatment was cost-saving, resulting in lower total costs than no screening as well as more QALYs (10.6 additional quality-adjusted life-days. When assuming alendronate costs of $400 through $800, screening and treatment resulted in greater lifetime costs than no screening but was highly cost-effective, with ICERs ranging from $714 per QALY gained through $13,902 per QALY gained. Probabilistic sensitivity analyses revealed that the cost-effectiveness of osteoporosis screening followed by alendronate treatment was robust to joint input parameter estimate variation at a willingness-to-pay threshold of $50,000/QALY at all alendronate costs evaluated.Osteoporosis screening followed by alendronate treatment is effective and highly cost-effective for postmenopausal women across a range of alendronate costs, and may be cost
Ferko, Nicole C; Borisova, Natalie; Airia, Parisa; Grima, Daniel T; Thompson, Melissa F
Because of rising drug expenditures, cost considerations have become essential, necessitating the requirement for cost-effectiveness analyses for managed care organizations (MCOs). The study objective is to examine the impact of various drug-cost components, in addition to wholesale acquisition cost (WAC), on the cost-effectiveness of osteoporosis therapies. A Markov model of osteoporosis was used to exemplify different drug cost scenarios. We examined the effect of varying rebates for oral bisphosphonates--risedronate and ibandronate--as well as considering the impact of varying copayments and administration costs for intravenous zoledronate. The population modeled was 1,000 American women, > or = 50 years with osteoporosis. Patients were followed for 1 year to reflect an annual budget review of formularies by MCOs. The cost of therapy was based on an adjusted WAC, and is referred to as net drug cost. The total annual cost incurred by an MCO for each drug regimen was calculated using the net drug cost and fracture cost. We estimated cost on a quality adjusted life year (QALY) basis. When considering different rebates, results for risedronate versus ibandronate vary from cost-savings (i.e., costs less and more effective) to approximately $70,000 per QALY. With no risedronate rebate, an ibandronate rebate of approximately 65% is required before cost per QALY surpasses $50,000. With rebates greater than 25% for risedronate, irrespective of ibandronate rebates, results become cost-saving. Results also showed the magnitude of cost savings to the MCO varied by as much as 65% when considering no administration cost and the highest coinsurance rate for zoledronate. Our study showed that cost-effectiveness varies considerably when factors in addition to the WAC are considered. This paper provides recommendations for pharmaceutical manufacturers and MCOs when developing and interpreting such analyses.
Chung, Dongil; Christopoulos, George I; King-Casas, Brooks; Ball, Sheryl B; Chiu, Pearl H
Individuals' risk attitudes are known to guide choices about uncertain options. However, in the presence of others' decisions, these choices can be swayed and manifest as riskier or safer behavior than one would express alone. To test the mechanisms underlying effective social 'nudges' in human decision-making, we used functional neuroimaging and a task in which participants made choices about gambles alone and after observing others' selections. Against three alternative explanations, we found that observing others' choices of gambles increased the subjective value (utility) of those gambles for the observer. This 'other-conferred utility' was encoded in ventromedial prefrontal cortex, and these neural signals predicted conformity. We further identified a parametric interaction with individual risk preferences in anterior cingulate cortex and insula. These data provide a neuromechanistic account of how information from others is integrated with individual preferences that may explain preference-congruent susceptibility to social signals of safety and risk.
Chung, Dongil; Ball, Sheryl B; Chiu, Pearl H
Individuals’ risk attitudes are known to guide choices about uncertain options. However, in the presence of others’ decisions, these choices can be swayed and manifest as riskier or safer behavior than one would express alone. To test the mechanisms underlying effective social ‘nudges’ in human decision-making, we used functional neuroimaging and a task in which participants made choices about gambles alone and after observing others’ selections. Against three alternative explanations, we found that observing others’ choices of gambles increased the subjective value (utility) of those gambles for the observer. This ‘other-conferred utility’ was encoded in ventromedial prefrontal cortex, and these neural signals predicted conformity. We further identified a parametric interaction with individual risk preferences in anterior cingulate cortex and insula. These data provide a neuromechanistic account of how information from others is integrated with individual preferences that may explain preference-congruent susceptibility to social signals of safety and risk. PMID:25984890
McLean, Rachael; Hoek, Janet; Hedderley, Duncan
Dietary sodium reduction is a cost-effective public health intervention to reduce chronic disease. In response to calls for further research into front-of-pack labelling systems, we examined how alternative sodium nutrition label formats and nutrition claims influenced consumers' choice behaviour and whether consumers with or without a diagnosis of hypertension differed in their choice patterns. An anonymous online experiment in which participants viewed ten choice sets featuring three fictitious brands of baked beans with varied label formats and nutritional profiles (high and low sodium) and indicated which brand in each set they would purchase if shopping for this product. Participants were recruited from New Zealand's largest online nationwide research panel. Five hundred people with self-reported hypertension and 191 people without hypertension aged 18 to 79 years. The addition of a front-of-pack label increased both groups' ability to discriminate between products with high and low sodium, while the Traffic Light label enabled better identification of the high-sodium product. Both front-of-pack formats enhanced discrimination in the presence of a reduced salt claim, but the Traffic Light label also performed better than the Percentage Daily Intake label in moderating the effect of the claim for the high-sodium product. Front-of-pack labels, particularly those with simple visual cues, enhance consumers' ability to discriminate between high- and low-sodium products, even when those products feature nutrition claims.
Jones, Sandra C; Kervin, Lisa
The present study sought to determine the feasibility of an experimental research design to investigate the effects of exposure to magazine advertising on children's food choices. Children were randomized to read either a magazine with food advertisements or a magazine with no food advertisements. They then chose two food items from the intervention 'store' to eat after the session. Data were also collected on attitudes to advertising and snack food preferences. Finally, participants' parents were provided with a self-completion survey on food choices and other variables (n 24). Three vacation care centres in regional New South Wales, Australia. Children aged 5-12 years (n 47). Children in the experimental condition were more likely to choose advertised foods than those in the control group. Interestingly, the majority reported taste and healthiness as the most important factors in snack food choices; however, when faced with the actual food choice, they predominantly chose unhealthy foods (eighty-two unhealthy and only twelve healthy items were chosen). This was the first study to assess the effects on children of exposure to food advertising within the context of reading a child-targeted magazine. Importantly, even with the small sample size and venue limitations, we found that exposure to magazine advertising influenced food choices. Children's magazines are an under-researched and poorly regulated medium, with considerable potential to influence children's food choices. The present study shows that the methodology is feasible, and future studies could replicate this with larger samples.
Tintarev, Nava; Masthoff, Judith
This paper addresses research questions that are central to the area of visualization interfaces for decision support: (RQ1) whether individual user differences in working memory should be considered when choosing how to present visualizations; (RQ2) how to present the visualization to support effective decision making and processing; and (RQ3) how to evaluate the effectiveness of presentational choices. These questions are addressed in the context of presenting plans, or sequences of actions, to users. The experiments are conducted in several domains, and the findings are relevant to applications such as semi-autonomous systems in logistics. That is, scenarios that require the attention of humans who are likely to be interrupted, and require good performance but are not time critical. Following a literature review of different types of individual differences in users that have been found to affect the effectiveness of presentational choices, we consider specifically the influence of individuals' working memory (RQ1). The review also considers metrics used to evaluate presentational choices, and types of presentational choices considered. As for presentational choices (RQ2), we consider a number of variants including interactivity, aggregation, layout, and emphasis. Finally, to evaluate the effectiveness of plan presentational choices (RQ3) we adopt a layered-evaluation approach and measure performance in a dual task paradigm, involving both task interleaving and evaluation of situational awareness. This novel methodology for evaluating visualizations is employed in a series of experiments investigating presentational choices for a plan. A key finding is that emphasizing steps (by highlighting borders) can improve effectiveness on a primary task, but only when controlling for individual variation in working memory.
Full Text Available This paper addresses research questions that are central to the area of visualization interfaces for decision support: RQ1 whether individual user differences in working memory should be considered when making choosing how to present visualizations; RQ2 how to present the visualization to support effective decision making and processing; and RQ3 how to evaluate the effectiveness of presentational choices. These questions are addressed in the context of presenting plans, or sequences of actions, to users. The experiments are conducted in several domains, and the findings are relevant to applications such as semi-autonomous systems in logistics. That is, scenarios that require the attention of humans who are likely to be interrupted, and require good performance but are not time critical. Following a literature review of different types of individual differences in users that have been found to affect the effectiveness of presentational choices, we consider specifically the influence of individuals' working memory (RQ1. The review also considers metrics used to evaluate presentational choices, and types of presentational choices considered. As for presentational choices (RQ2, we consider a number of variants including interactivity, aggregation, layout, and emphasis. Finally, to evaluate the effectiveness of plan presentational choices (RQ3 we adopt a layered-evaluation approach and measure performance in a dual task paradigm, involving both task interleaving and evaluation of situational awareness. This novel methodology for evaluating visualizations is employed in a series of experiments investigating presentational choices for a plan. A key finding is that emphasizing steps (by highlighting borders can improve effectiveness on a primary task, but only when controlling for individual variation in working memory.
Coe, Richard P.
With the advent of the new millennium and energy deregulation, organizations will be challenged to be cost competitive and profitable. Deregulation in the US energy industry will force utilities and, more specifically, commercial nuclear power production to unprecedented cost control measures. It will also renew the fires of debate about costs vs. safety. With personnel costs being the single largest expenditure for most organizations management will be faced with constant dilemmas of competition for scarce resources. Salaries, benefits and training costs will be under greater scrutiny. Training resources and programs will face increased pressure to be job related, based on conservative requirements and more cost effective than in the past. For nearly two decades the US National Academy for Nuclear Training (NANT) has developed and used industry-wide accreditation and evaluation standards based on the Systematic Approach to Training (SAT). This process assures that existing and emerging technical training is constantly reviewed and evaluated against standardized criteria to assure job relatedness and enhanced job performance. The process also requires management to approve, actively participate in and support the training of NPP personnel. Instructors must be highly skilled and well trained in the SAT process and various instructional strategies. The SAT process is grounded in five interlocking keystone steps; Analysis - Design - Development - Implementation - Evaluation (ADDIE). Evaluation of training is often said to be the most crucial and most difficult step. Here is where an organization determines if the training is effective and meeting the legitimate needs of all of the stakeholders. This QA/QC aspect of training must be an ongoing process involving management, instructors and the students. It is only through the discipline of an SAT based evaluation process that an organization can truly determine if the training is efficient, effective, cost effective and
Robichaux, J.J.; Shull, L.M.; Salizzoni, L.M.
DOE Order 5630.15, ''Safeguards and Security Training Program'' is being implemented at the Savannah River Site within the Westinghouse Savannah River Company's material control and accountability program. This paper reviews the development of a material control and accountability task analysis, the development of specific material control and accountability courses, and the cost effective and innovative strategies employed to implement the training program. The paper also discusses how the site material control and accountability policies and procedures are incorporated into the Westinghouse Savannah River Company training program to ensure that personnel receive the most current information
Mar 31, 2016 ... Symptomatic uterine leiomyomas can cause pain, heavy bleeding, pressure effects and reduced fertility. ... percent of patients reported being satisfied, 12% partially satisfied and 7% not satisfied. No .... Ten (12.2%) patients reported being partially .... 6-month follow-up, they were referred back to primary.
... 10 Energy 3 2010-01-01 2010-01-01 false Presuming cost-effectiveness results. 436.13 Section 436... Methodology and Procedures for Life Cycle Cost Analyses § 436.13 Presuming cost-effectiveness results. (a) If the investment and other costs for an energy or water conservation measure considered for retrofit to...
Locey, Matthew L; Dallery, Jesse
Many drugs of abuse produce changes in impulsive choice, that is, choice for a smaller-sooner reinforcer over a larger-later reinforcer. Because the alternatives differ in both delay and amount, it is not clear whether these drug effects are due to the differences in reinforcer delay or amount. To isolate the effects of delay, we used a titrating delay procedure. In phase 1, 9 rats made discrete choices between variable delays (1 or 19 s, equal probability of each) and a delay to a single food pellet. The computer titrated the delay to a single food pellet until the rats were indifferent between the two options. This indifference delay was used as the starting value for the titrating delay for all future sessions. We next evaluated the acute effects of nicotine (subcutaneous 1.0, 0.3, 0.1, and 0.03 mg/kg) on choice. If nicotine increases delay discounting, it should have increased preference for the variable delay. Instead, nicotine had very little effect on choice. In a second phase, the titrated delay alternative produced three food pellets instead of one, which was again produced by the variable delay (1 s or 19 s) alternative. Under this procedure, nicotine increased preference for the one pellet alternative. Nicotine-induced changes in impulsive choice are therefore likely due to differences in reinforcer amount rather than differences in reinforcer delay. In addition, it may be necessary to include an amount sensitivity parameter in any mathematical model of choice when the alternatives differ in reinforcer amount.
Full Text Available Abstract Cost-effectiveness analysis (CEA is potentially an important aid to public health decision-making but, with some notable exceptions, its use and impact at the level of individual countries is limited. A number of potential reasons may account for this, among them technical shortcomings associated with the generation of current economic evidence, political expediency, social preferences and systemic barriers to implementation. As a form of sectoral CEA, Generalized CEA sets out to overcome a number of these barriers to the appropriate use of cost-effectiveness information at the regional and country level. Its application via WHO-CHOICE provides a new economic evidence base, as well as underlying methodological developments, concerning the cost-effectiveness of a range of health interventions for leading causes of, and risk factors for, disease. The estimated sub-regional costs and effects of different interventions provided by WHO-CHOICE can readily be tailored to the specific context of individual countries, for example by adjustment to the quantity and unit prices of intervention inputs (costs or the coverage, efficacy and adherence rates of interventions (effectiveness. The potential usefulness of this information for health policy and planning is in assessing if current intervention strategies represent an efficient use of scarce resources, and which of the potential additional interventions that are not yet implemented, or not implemented fully, should be given priority on the grounds of cost-effectiveness. Health policy-makers and programme managers can use results from WHO-CHOICE as a valuable input into the planning and prioritization of services at national level, as well as a starting point for additional analyses of the trade-off between the efficiency of interventions in producing health and their impact on other key outcomes such as reducing inequalities and improving the health of the poor.
Gu Aichun; Liu Jianjun; Sun Xiaoguang; Shi Yiping; Huang Gang
Objective: To evaluate the cost-effectiveness of PET and CT application for diagnosis of non-small cell lung cancer (NSCLC) in China. Methods: Using decision analysis method the diagnostic efficiency of PET and CT for diagnosis of NSCLC in china was analysed. And also the value of cost for accurate diagnosis (CAD), cost for accurate staging (CAS) and cost for effective therapy (CAT) was calculated. Results: (1) For the accurate diagnosis, CT was much more cost-effective than PET. (2) For the accurate staging, CT was still more cost-effective than PET. (3) For the all over diagnostic and therapeutic cost, PET was more cost-effective than CT. (4) The priority of PET to CT was for the diagnosis of stage I NSCLC. Conclusion: For the management of NSCLC patient in China, CT is more cost-effective for screening, whereas PET for clinical staging and monitoring therapeutic effect. (authors)
Flem, Elmira T; Latipov, Renat; Nurmatov, Zuridin S; Xue, Yiting; Kasymbekova, Kaliya T; Rheingans, Richard D
We examined the cost-effectiveness of a rotavirus immunization program in Kyrgyzstan, a country eligible for vaccine funding from the GAVI Alliance. We estimated the burden of rotavirus disease and its economic consequences by using national and international data. A cost-effectiveness analysis was conducted from government and societal perspectives, along with a range of 1-way sensitivity analyses. Rotavirus-related hospitalizations and outpatient visits cost US$580,864 annually, of which $421,658 (73%) is direct medical costs and $159,206 (27%) is nonmedical and indirect costs. With 95% coverage, vaccination could prevent 75% of rotavirus-related hospitalizations and deaths and 56% of outpatient visits and could avert $386,193 (66%) in total costs annually. The medical break-even price at which averted direct medical costs equal vaccination costs is $0.65/dose; the societal break-even price is $1.14/dose for a 2-dose regimen. At the current GAVI Alliance-subsidized vaccine price of $0.60/course, rotavirus vaccination is cost-saving for the government. Vaccination is cost-effective at a vaccine price $9.41/dose, according to the cost-effectiveness standard set by the 2002 World Health Report. Addition of rotavirus vaccines to childhood immunization in Kyrgyzstan could substantially reduce disease burden and associated costs. Vaccination would be cost-effective from the national perspective at a vaccine price $9.41 per dose.
Todd, Nick; Vyas, Urvi; de Bever, Josh; Payne, Allison; Parker, Dennis L
The purpose of this article is to quantify the effects that spatial sampling parameters have on the accuracy of magnetic resonance temperature measurements during high intensity focused ultrasound treatments. Spatial resolution and position of the sampling grid were considered using experimental and simulated data for two different types of high intensity focused ultrasound heating trajectories (a single point and a 4-mm circle) with maximum measured temperature and thermal dose volume as the metrics. It is demonstrated that measurement accuracy is related to the curvature of the temperature distribution, where regions with larger spatial second derivatives require higher resolution. The location of the sampling grid relative temperature distribution has a significant effect on the measured values. When imaging at 1.0 × 1.0 × 3.0 mm(3) resolution, the measured values for maximum temperature and volume dosed to 240 cumulative equivalent minutes (CEM) or greater varied by 17% and 33%, respectively, for the single-point heating case, and by 5% and 18%, respectively, for the 4-mm circle heating case. Accurate measurement of the maximum temperature required imaging at 1.0 × 1.0 × 3.0 mm(3) resolution for the single-point heating case and 2.0 × 2.0 × 5.0 mm(3) resolution for the 4-mm circle heating case. Copyright © 2010 Wiley-Liss, Inc.
Full Text Available Development failures and runaway projects in the information systems (IS area can result in substantial losses to organizations, either financially or to a company’s reputation. One important strategy in mitigating risk is the use of effective controls over IS projects. This research investigates the effectiveness of control mechanisms in IS projects, i.e., how they have been established, applied, and how they have evolved throughout the project. We conducted an in-depth study of six information systems projects with six different project managers. We found that formal controls were adopted on project elements with clearly defined project outcomes and informal controls were adopted mainly on project elements that were unclear and often related to people. Furthermore, formal controls were dominant at project initiation and in most cases these controls became less dominant over the project duration. These formal controls were more rigorously applied in external IS projects while informal controls increased in importance throughout the project duration in internally developed projects. We found the existence of informal controls to be very important in helping ensure successful project outcomes.
Bolhuis, D.P.; Lakemond, C.M.M.; Wijk, de R.A.; Luning, P.A.; Graaf, de C.
The effect of salt intensity on ad libitum intake of tomato soup was investigated when soup was served as a first course and as a second course. Also the effect of salt intensity in soup on subsequent sweet vs. savory choice of sandwich fillings was investigated. Forty-three healthy subjects
van Zantvliet, P.I.; Kalmijn, M.; Verbakel, E.
This study focuses on the partner choices of immigrant adolescents who are involved in a romantic relationship. We formulate hypotheses about the effect of immigrants' preferences, parental influence and structural effects of the school and neighbourhood on the likelihood of dating a native partner
van Zantvliet, P.I.; Kalmijn, M.; Verbakel, E.
This study focuses on the partner choices of immigrant adolescents who are involved in a romantic relationship. We formulate hypotheses about the effect of immigrants' preferences, parental influence and structural effects of the school and neighbourhood on the likelihood of dating a native partner
van Zandvliet, P.I.; Kalmijn, M.; Verbakel, E.
This study focuses on the partner choices of immigrant adolescents who are involved in a romantic relationship. We formulate hypotheses about the effect of immigrants' preferences, parental influence and structural effects of the school and neighbourhood on the likelihood of dating a native partner
Angevine, Peter D; Berven, Sigurd
Narrative overview. To provide clinicians with a basic understanding of economic studies, including cost-benefit, cost-effectiveness, and cost-utility analyses. As decisions regarding public health policy, insurance reimbursement, and patient care incorporate factors other than traditional outcomes such as satisfaction or symptom resolution, health economic studies are increasingly prominent in the literature. This trend will likely continue, and it is therefore important for clinicians to have a fundamental understanding of the common types of economic studies and be able to read them critically. In this brief article, the basic concepts of economic studies and the differences between cost-benefit, cost-effectiveness, and cost-utility studies are discussed. An overview of the field of health economic analysis is presented. Cost-benefit, cost-effectiveness, and cost-utility studies all integrate cost and outcome data into a decision analysis model. These different types of studies are distinguished mainly by the way in which outcomes are valued. Obtaining accurate cost data is often difficult and can limit the generalizability of a study. With a basic understanding of health economic analysis, clinicians can be informed consumers of these important studies.
Barnett, Paul G
Guidelines have helped standardize methods of cost-effectiveness analysis, allowing different interventions to be compared and enhancing the generalizability of study findings. There is agreement that all relevant services be valued from the societal perspective using a long-term time horizon and that more exact methods be used to cost services most affected by the study intervention. Guidelines are not specific enough with respect to costing methods, however. The literature was reviewed to identify the problems associated with the 4 principal methods of cost determination. Microcosting requires direct measurement and is ordinarily reserved to cost novel interventions. Analysts should include nonwage labor cost, person-level and institutional overhead, and the cost of development, set-up activities, supplies, space, and screening. Activity-based cost systems have promise of finding accurate costs of all services provided, but are not widely adopted. Quality must be evaluated and the generalizability of cost estimates to other settings must be considered. Administrative cost estimates, chiefly cost-adjusted charges, are widely used, but the analyst must consider items excluded from the available system. Gross costing methods determine quantity of services used and employ a unit cost. If the intervention will affect the characteristics of a service, the method should not assume that the service is homogeneous. Questions are posed for future reviews of the quality of costing methods. The analyst must avoid inappropriate assumptions, especially those that bias the analysis by exclusion of costs that are affected by the intervention under study.
Thavorn, Kednapa; Coyle, Doug; Hoch, Jeffrey S; Vandermeer, Lisa; Mazzarello, Sasha; Wang, Zhou; Dranitsaris, George; Fergusson, Dean; Clemons, Mark
We assessed the cost-effectiveness of a risk model-guided (RMG) antiemetic prophylaxis strategy compared with the physician's choice (PC) strategy in patients receiving chemotherapy for early-stage breast cancer. We conducted a cost-utility analysis based on a published randomized controlled trial of 324 patients with early-stage breast cancer undergoing chemotherapy at two Canadian cancer centers. Patients were randomized to receive their antiemetic treatments according to either predefined risk scores or the treating physician's preference. Effectiveness was measured as quality-adjusted life years (QALYs) gained. Cost and utility data were obtained from the Canadian published literature. We used generalized estimating equations to estimate the incremental cost-effectiveness ratios (ICERs) and 95% confidence intervals (CIs) over a range of willingness-to-pay values. The lower and upper bounds of the 95% CIs were used to characterize the statistical uncertainty for the cost-effectiveness estimates and construct cost-effectiveness acceptability curves. From the health care system's perspective, the RMG strategy was associated with greater QALYs gained (0.0016, 95% CI 0.0009, 0.0022) and higher cost ($49.19, 95% CI $24.87, $73.08) than the PC strategy, resulting in an ICER of $30,864.28 (95% CI $14,718.98, $62,789.04). At the commonly used threshold of $50,000/QALY, the probability that RMG prophylaxis is cost-effective was >94%; this probability increased with greater willingness-to-pay values. The risk-guided antiemetic prophylaxis is an economically attractive option for patients receiving chemotherapy for early-stage breast cancer. This information supports the implementation of risk prediction models to guide chemotherapy-induced nausea and vomiting prophylaxis in clinical practices.
Houlind, Kim Christian; Kjeldsen, Bo Juul; Madsen, Susanne Nørgaard
To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years.......To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years....
Discusses the five standard tests used to assess the cost-effectiveness of energy efficiency, how states are using these tests, and how the tests can be used to determine the cost-effectiveness of energy efficiency measures.
Leino, P.; Kosunen, P.; Rauhamaeki, J.
The aim of the project was to study how various tax models for power plant fuels affect the fuel consumption and emissions of particles, sulphur dioxide (SO 2 ), nitrogen oxide (NO x ) and carbon dioxide (CO 2 ). First, the development of Finnish energy taxation is discussed, followed by a survey of the energy production structure for 1994. For this purpose, it was necessary to prepare a large boiler database, which covers about 95 % of the fuel consumption of Finnish energy production. The boiler database was used to calculate the emissions of particles, SO 2 , NO x and CO 2 in 1994. The year 2010 selected under review is the year by which the Ministry of Trade and Industry has prepared their primary energy consumption estimates. Four different alternatives were studied as future tax models. In the first alternative taxation would be as it in years 1995-1996 and in the second alternative taxation would be as in January 1997. In the third alternative the Finnish application of EU taxes would be in force in full, i.e., the tax on heavy fuel oil would be 10 US dollars a barrel. In the fourth alternative there would be no taxes on fuels. The boiler database was used to find out how the consumption distribution of the fuels used in 2010 would change in the various tax models. The tax models affect most the position of fuel peat and natural gas in Finland. If the EU alternative, which is favourable for fuel peat and natural gas, comes true, the consumption of fuel peat will grow by two thirds and the consumption of natural gas will more than double from the present level. If the taxation is as 1 January 1997, the consumption of peat will remain the same as today and the consumption of natural gas will grow by about 50 %. However, if there are no taxes on fuels, the consumption of fuel peat will fall by almost a third and the consumption of natural gas will remain the same as expected at the existing and planned plants. The effect of the various tax models on emissions
Tunis, Sandra L
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
van Herpen, E.; Bosmans, Anick
Food retailers can present specific products in a separate category (e.g., separate section for organic products) or integrated into the mainstream shelf. This study investigates how assortment organization influences consumers’ variety perceptions and product choice. We argue and show that when an
Kaakko, T; Murtomaa, H; Milgrom, P; Getz, T; Ramsay, D S; Coldwell, S E
Efficiently enrolling subjects is one of the most important and difficult aspects of a clinical trial. This prospective study evaluated strategies used in the recruitment of 144 dental injection phobics for a clinical trial evaluating the effectiveness of combining alprazolam with exposure therapy. Three types of recruitment strategies were evaluated: paid advertising, free publicity, and professional referral. Sixty-three percent of subjects were enrolled using paid advertising (the majority of them from bus advertisements [27.0%], posters on the University of Washington campus [20.1%], and newspaper advertisements [13.2%]). Free publicity (eg, television coverage, word of mouth) yielded 18.8% of enrolled subjects and professionaL referrals 14.6% of subjects. The average cost (1996 dollars) of enrolling 1 subject was $79. Bus and poster advertising attracted more initial contacts and yielded the greatest enrollment.
Niaz Morshedul Haque
Full Text Available This paper deals with the design and construct of a 100 Watt 220 Volt and 50 Hz Inverter. The system is designed without any microcontroller and it has a cost-effective design architecture. The elementary purpose of this device is to transmute 12 V DC to 220 V AC. Snubber technology is used to diminish the reverse potential transients and excessive heat of transformer winding and transistor switches. Switching pulse generated by NE 555 timer circuit and comparator circuit was used to take signal strength input from its rear as well as from both sides for triggering the MOSFET switches. Another switch is used to invert pulse between two switching circuitries. A 5 volts regulator IC 7805 was used to supply fixed 5V for biasing the switching and amplifying circuitry.
Lum, Henry, Jr.; Heer, Ewald
Significant advances have occurred during the last decade in knowledge-based engineering research and knowledge-based system (KBS) demonstrations and evaluations using integrated intelligent system technologies. Performance and simulation data obtained to date in real-time operational environments suggest that cost-effective utilization of intelligent system technologies can be realized. In this paper the rationale and potential benefits for typical examples of application projects that demonstrate an increase in productivity through the use of intelligent system technologies are discussed. These demonstration projects have provided an insight into additional technology needs and cultural barriers which are currently impeding the transition of the technology into operational environments. Proposed methods which addresses technology evolution and implementation are also discussed.
... 10 Energy 3 2010-01-01 2010-01-01 false Cost-effectiveness testing. 455.63 Section 455.63 Energy..., Hospitals, Units of Local Government, and Public Care Institutions § 455.63 Cost-effectiveness testing. (a... paragraph (a) of this section, if the State plan requires the cost effectiveness of an energy conservation...
Baacke, Clifford M.; Frankel, Steven M.
The primary question posed in this study is whether premium or regular gasoline is more cost effective for the Montgomery County Public School (MCPS) bus fleet, as a whole, when miles-per-gallon, cost-per-gallon, and repair costs associated with mileage are considered. On average, both miles-per-gallon, and repair costs-per-mile favor premium…
Mangen MJJ; Havelaar AH; Nauta MJ; Koeijer AA de; Wit GA de; LEI; Animal Sciences Group; PZO; MGB
The aim of this study was the estimation of cost-effectiveness and cost-utility of various interventions to control Campylobacter contamination of broiler meat. The relative risk, the intervention costs, the disease burden (expressed in Disability Adjusted Live Years (DALYs)) and the
Jukes Matthew CH
Full Text Available Abstract Background Awareness of the potential impact of malaria among school-age children has stimulated investigation into malaria interventions that can be delivered through schools. However, little evidence is available on the costs and cost-effectiveness of intervention options. This paper evaluates the costs and cost-effectiveness of intermittent preventive treatment (IPT as delivered by teachers in schools in western Kenya. Methods Information on actual drug and non-drug associated costs were collected from expenditure and salary records, government budgets and interviews with key district and national officials. Effectiveness data were derived from a cluster-randomised-controlled trial of IPT where a single dose of sulphadoxine-pyrimethamine and three daily doses of amodiaquine were provided three times in year (once termly. Both financial and economic costs were estimated from a provider perspective, and effectiveness was estimated in terms of anaemia cases averted. A sensitivity analysis was conducted to assess the impact of key assumptions on estimated cost-effectiveness. Results The delivery of IPT by teachers was estimated to cost US$ 1.88 per child treated per year, with drug and teacher training costs constituting the largest cost components. Set-up costs accounted for 13.2% of overall costs (equivalent to US$ 0.25 per child whilst recurrent costs accounted for 86.8% (US$ 1.63 per child per year. The estimated cost per anaemia case averted was US$ 29.84 and the cost per case of Plasmodium falciparum parasitaemia averted was US$ 5.36, respectively. The cost per case of anaemia averted ranged between US$ 24.60 and 40.32 when the prices of antimalarial drugs and delivery costs were varied. Cost-effectiveness was most influenced by effectiveness of IPT and the background prevalence of anaemia. In settings where 30% and 50% of schoolchildren were anaemic, cost-effectiveness ratios were US$ 12.53 and 7.52, respectively. Conclusion This
Lopez, B.; Sciacca, F.W.
Over the past several years the NRC has developed a generic cost methodology for the quantification of cost/economic impacts associated with a wide range of new or revised regulatory requirements. This methodology has been developed to aid the NRC in preparing Regulatory Impact Analyses (RIAs). These generic costing methods can be useful in quantifying impacts both to industry and to the NRC. The FORECAST program was developed to facilitate the use of the generic costing methodology. This PC program integrates the major cost considerations that may be required because of a regulatory change. FORECAST automates much of the calculations typically needed in an RIA and thus reduces the time and labor required to perform these analysis. More importantly, its integrated and consistent treatment of the different cost elements should help assure comprehensiveness, uniformity, and accuracy in the preparation of needed cost estimates
Newall, A T; Jit, M; Hutubessy, R
The World Health Organization's CHOosing Interventions that are Cost Effective (WHO-CHOICE) thresholds for averting a disability-adjusted life-year of one to three times per capita income have been widely cited and used as a measure of cost effectiveness in evaluations of vaccination for low- and middle-income countries (LMICs). These thresholds were based upon criteria set out by the WHO Commission on Macroeconomics and Health, which reflected the potential economic returns of interventions. The CHOICE project sought to evaluate a variety of health interventions at a subregional level and classify them into broad categories to help assist decision makers, but the utility of the thresholds for within-country decision making for individual interventions (given budgetary constraints) has not been adequately explored. To examine whether the 'WHO-CHOICE thresholds' reflect funding decisions, we examined the results of two recent reviews of cost-effectiveness analyses of human papillomavirus and rotavirus vaccination in LMICs, and we assessed whether the results of these studies were reflected in funding decisions for these vaccination programmes. We found that in many cases, programmes that were deemed cost effective were not subsequently implemented in the country. We consider the implications of this finding, the advantages and disadvantages of alternative methods to estimate thresholds, and how cost perspectives and the funders of healthcare may impact on these choices.
Floyd, Katherine; Arora, V. K.; Murthy, K. J. R.; Lonnroth, Knut; Singla, Neeta; Akbar, Y.; Zignol, Matteo; Uplekar, Mukund
OBJECTIVE: To assess the cost and cost-effectiveness of the Public-Private Mix DOTS (PPM-DOTS) strategy for tuberculosis (TB) control in India. METHODS: We collected data on the costs and effects of pilot PPM-DOTS projects in Delhi and Hyderabad using documentary data and interviews. The cost of PPM-DOTS was compared with public sector DOTS (i.e. DOTS delivered through public sector facilities only) and non-DOTS treatment in the private sector. Costs for 2002 in US$ were assessed for the publ...
Yates, Brian T; Mannix, Danyelle; Freed, Michael C; Campbell, Jean; Johnsen, Matthew; Jones, Kristine; Blyler, Crystal R
Examine cost differences between Consumer Operated Service Programs (COSPs) as possibly determined by a) size of program, b) use of volunteers and other donated resources, c) cost-of-living differences between program locales, d) COSP model applied, and e) delivery system used to implement the COSP model. As part of a larger evaluation of COSP, data on operating costs, enrollments, and mobilization of donated resources were collected for eight programs representing three COSP models (drop-in centers, mutual support, and education/advocacy training). Because the 8 programs were operated in geographically diverse areas of the US, costs were examined with and without adjustment for differences in local cost of living. Because some COSPs use volunteers and other donated resources, costs were measured with and without these resources being monetized. Scale of operation also was considered as a mediating variable for differences in program costs. Cost per visit, cost per consumer per quarter, and total program cost were calculated separately for funds spent and for resources donated for each COSP. Differences between COSPs in cost per consumer and cost per visit seem better explained by economies of scale and delivery system used than by cost-of-living differences between program locations or COSP model. Given others' findings that different COSP models produce little variation in service effectiveness, minimize service costs by maximizing scale of operation while using a delivery system that allows staff and facilities resources to be increased or decreased quickly to match number of consumers seeking services.
J. Veldwijk (Jorien); M.S. Lambooij (Mattijs); E.W. de Bekker-Grob (Esther); H.A. Smit (Henriëtte); G.A. De Wit (G. Ardine)
markdownabstractObjective: to determine to what extent the inclusion of an opt-out option in a DCE may have an effect on choice behaviour and therefore might influence the attribute level estimates, the relative importance of the attributes and calculated tradeoffs. Methods: 781 Dutch Type 2
Feldman, Daniel C.; Whitcomb, Kathleen M.
Purpose: The present paper examines the effects of two decision-framing inductions on young adults' set of career options: first, whether young adults use abilities or interests as the grounds for their vocational choices and, second, whether young adults approach the decision-making task by including all career options to which they feel…
Ph.H.B.F. Franses (Philip Hans); M. Vriens
textabstractUsing weekly data on advertising expenditures in various media and response data on awareness, consideration and choice, we test the hierarchy of effects hypothesis. Our empirical results, based on a simultaneous equations model with pooled parameters across brands, suggest that we can
van de Vrande, V.; Vanhaverbeke, W.P.M.; Duijsters, G.M.
External knowledge sourcing is increasingly important for corporate entrepreneurship. In this study, we examine the effect of external and relational uncertainty on the governance choice for inter-organizational technology sourcing. We develop a number of hypotheses about the impact of environmental
Gu, Chuanhua; Hu, Bi Ying; Ngwira, Flemmings Fishani; Jing, Zhi; Zhou, Zongkui
This study investigated the effect of general creative personality and freedom of task choice on the social creativity of adolescents. The results indicated, first, that senior high school students scored higher than junior high school students. Second, girls scored higher than boys on originality, fluency, flexibility, appropriateness, and…
Parrish-Sprowl, John; And Others
Explores the relationship among compliance-gaining strategy choice, communicator image, and sales person effectiveness. Finds no statistically significant relationship between the use of compliance-gaining strategies and sales success, but indicates a link between communicator image and sales success. (SR)
Marsh, Herbert W.; Seaton, Marjorie; Kuyper, Hans; Dumas, Florence; Huguet, Pascal; Regner, Isabelle; Buunk, Abraham P.; Monteil, Jean-Marc; Gibbons, Frederick X.
Consistent with social comparison theory (SCT), Blanton, Buunk, Gibbons, and Kuyper (1999) and Huguet, Dumas, Monteil, and Genestoux (2001) found that students tended to choose comparison targets who slightly outperformed them (i.e., upward comparison choices), and this had a beneficial effect on
De Moraes Ramos, G.
Traffic congestion is experienced by a great number of travellers during peak hours and is directly influenced by travel-related decisions, such as route choice decisions. In order to minimize problems that arise from congestion, such as delays, uncertainty and environmental effects, there has been
P. Lynne Honey
Full Text Available Female dominance has not often been studied as a factor in mate choice and other social interactions. When it has been examined, there have been a number of conflicting findings. The present study was designed to clarify interpretations of a study conducted by Brown and Lewis (2004 that found that men prefer subordinate women in a workplace context. We presented participants with information about the relative rank of physically attractive targets, in two very different contexts (work-related and recreational. We found that the context in which rank cues are presented has an impact on affiliation ratings, but that cues of rank do not affect mate choice ratings. Future studies of effects of dominance must take into account the context in which they are presented, and recognize that rank may not be a sufficient indicator of dominance for the purpose of mate choice by both men and women.
Chitchumnong, Piyayut; Horan, Richard D
An individual's infectious disease risks, and hence the individual's incentives for risk mitigation, may be influenced by others' risk management choices. If so, then there will be strategic interactions among individuals, whereby each makes his or her own risk management decisions based, at least in part, on the expected decisions of others. Prior work has shown that multiple equilibria could arise in this setting, with one equilibrium being a coordination failure in which individuals make too few investments in protection. However, these results are largely based on simplified models involving a single management choice and fixed prices that may influence risk management incentives. Relaxing these assumptions, we find strategic interactions influence, and are influenced by, choices involving multiple management options and market price effects. In particular, we find these features can reduce or eliminate concerns about multiple equilibria and coordination failure. This has important policy implications relative to simpler models.
de Abreu e Silva, João; Sottile, Eleonora; Cherchi, Elisabetta
to travel. Workers who reside in more central, mixed and traditional urban spaces tend to have a higher propensity to travel. Workers who live in more diverse areas have a higher probability of engaging in more complex work related tours. Working in more suburban areas reduces the probability of engaging......The relations between travel behavior and land use patterns have been the object of intensive research in the last two decades. Due to their immediate policy implications, mode choice and vehicle miles of travel (VMT) have been the main focus of attention. Other relevant dimensions, like trip...... of the latent propensity to travel in the discrete choice among types of tours. This model is applied to a travel diary of workers collected in the Lisbon Metropolitan Area in 2009. Different model specifications were built, testing the inclusion of purportedly built land use factors, which have the advantage...
Hsu, Justine; Zinsou, Cyprien; Parkhurst, Justin; N'Dour, Marguerite; Foyet, Léger; Mueller, Dirk H
Behavioural interventions have been widely integrated in HIV/AIDS social marketing prevention strategies and are considered valuable in settings with high levels of risk behaviours and low levels of HIV/AIDS awareness. Despite their widespread application, there is a lack of economic evaluations comparing different behaviour change communication methods. This paper analyses the costs to increase awareness and the cost-effectiveness to influence behaviour change for five interventions in Benin. Cost and cost-effectiveness analyses used economic costs and primary effectiveness data drawn from surveys. Costs were collected for provider inputs required to implement the interventions in 2009 and analysed by 'person reached'. Cost-effectiveness was analysed by 'person reporting systematic condom use'. Sensitivity analyses were performed on all uncertain variables and major assumptions. Cost-per-person reached varies by method, with public outreach events the least costly (US$2.29) and billboards the most costly (US$25.07). Influence on reported behaviour was limited: only three of the five interventions were found to have a significant statistical correlation with reported condom use (i.e. magazines, radio broadcasts, public outreach events). Cost-effectiveness ratios per person reporting systematic condom use resulted in the following ranking: magazines, radio and public outreach events. Sensitivity analyses indicate rankings are insensitive to variation of key parameters although ratios must be interpreted with caution. This analysis suggests that while individual interventions are an attractive use of resources to raise awareness, this may not translate into a cost-effective impact on behaviour change. The study found that the extensive reach of public outreach events did not seem to influence behaviour change as cost-effectively when compared with magazines or radio broadcasts. Behavioural interventions are context-specific and their effectiveness influenced by a
Raaijmakers, Tamara; van den Borne, Inge
This study reviews the motivations of companies to set out a policy for controlling smoking, the economic benefits for the company resulting from such a policy and the costs, broken down by European Union countries. The literature on the costs of implementing a policy related to smoking at the workplace is reviewed. The main objective of policies related to smoking at the workplace is that of safeguarding employees from environmental tobacco smoke. Other reasons are cutting costs, improving the company image, and reducing absenteeism, occupational accidents, internal quarrels and extra costs due to cigarette smoking, protection against environmental tobacco smoke does not entail any higher costs for companies, and economic advantages are visible. The benefits are by far greater than the costs involved, particularly on a long-range basis, and seem to be greater when smoking at the workplace is completely prohibited and no smoking areas are set.
Shabat-Simon, Maytal; Shuster, Anastasia; Sela, Tal; Levy, Dino J.
Hunger is a powerful driver of human behavior, and is therefore of great interest to the study of psychology, economics, and consumer behavior. Assessing hunger levels in experiments is often biased, when using self-report methods, or complex, when using blood tests. We propose a novel way of objectively measuring subjects’ levels of hunger by identifying levels of alpha-amylase (AA) enzyme in their saliva samples. We used this measure to uncover the effect of hunger on different types of choice behaviors. We found that hunger increases risk-seeking behavior in a lottery-choice task, modifies levels of vindictiveness in a social decision-making task, but does not have a detectible effect on economic inconsistency in a budget-set choice task. Importantly, these findings were moderated by AA levels and not by self-report measures. We demonstrate the effects hunger has on choice behavior and the problematic nature of subjective measures of physiological states, and propose to use reliable and valid biologically based methods to overcome these problems. PMID:29875715
Compare differences across food groups for food cost, energy and nutrient profiles of 100 items from a cross-sectional survey of 225 stores in a representative sample of 18 counties across the [Blinded for Review]. Energy, nutrient, and cost profiles for food items were calculated using Naturally Nu...
Connell, Carol L.; Zoellner, Jamie M.; Yadrick, M. Kathleen; Chekuri, Srinivasa C.; Crook, Lashaundrea B.; Bogle, Margaret L.
Objective: To compare differences across food groups for food cost, energy, and nutrient profiles of 100 items from a cross-sectional survey of 225 stores in 18 counties across the Lower Mississippi Delta of Arkansas, Louisiana, and Mississippi. Methods: Energy, nutrient, and cost profiles for food items were calculated by using Naturally Nutrient…
van Baal, Pieter; Meltzer, David; Brouwer, Werner
Life-saving medical technologies result in additional demand for health care due to increased life expectancy. However, most economic evaluations do not include all medical costs that may result from this additional demand in health care and include only future costs of related illnesses. Although there has been much debate regarding the question to which extent future costs should be included from a societal perspective, the appropriate role of future medical costs in the widely adopted but more narrow healthcare perspective has been neglected. Using a theoretical model, we demonstrate that optimal decision rules for cost-effectiveness analyses assuming fixed healthcare budgets dictate that future costs of both related and unrelated medical care should be included. Practical relevance of including the costs of future unrelated medical care is illustrated using the example of transcatheter aortic valve implantation. Our findings suggest that guidelines should prescribe inclusion of these costs. Copyright © 2014 John Wiley & Sons, Ltd.
Trenouth, Lani; Colbourn, Timothy; Fenn, Bridget; Pietzsch, Silke; Myatt, Mark; Puett, Chloe
Cash-based interventions (CBIs) increasingly are being used to deliver humanitarian assistance and there is growing interest in the cost-effectiveness of cash transfers for preventing undernutrition in emergency contexts. The objectives of this study were to assess the costs, cost-efficiency and cost-effectiveness in achieving nutrition outcomes of three CBIs in southern Pakistan: a 'double cash' (DC) transfer, a 'standard cash' (SC) transfer and a 'fresh food voucher' (FFV) transfer. Cash and FFVs were provided to poor households with children aged 6-48 months for 6 months in 2015. The SC and FFV interventions provided $14 monthly and the DC provided $28 monthly. Cost data were collected via institutional accounting records, interviews, programme observation, document review and household survey. Cost-effectiveness was assessed as cost per case of wasting, stunting and disability-adjusted life year (DALY) averted. Beneficiary costs were higher for the cash groups than the voucher group. Net total cost transfer ratios (TCTRs) were estimated as 1.82 for DC, 2.82 for SC and 2.73 for FFV. Yet, despite the higher operational costs, the FFV TCTR was lower than the SC TCTR when incorporating the participation cost to households, demonstrating the relevance of including beneficiary costs in cost-efficiency estimations. The DC intervention achieved a reduction in wasting, at $4865 per case averted; neither the SC nor the FFV interventions reduced wasting. The cost per case of stunting averted was $1290 for DC, $882 for SC and $883 for FFV. The cost per DALY averted was $641 for DC, $434 for SC and $563 for FFV without discounting or age weighting. These interventions are highly cost-effective by international thresholds. While it is debatable whether these resource requirements represent a feasible or sustainable investment given low health expenditures in Pakistan, these findings may provide justification for continuing Pakistan's investment in national social safety
Gandjour, Afschin; Müller, Dirk
One of the major ethical concerns regarding cost-effectiveness analysis in health care has been the inclusion of life-extension costs ("it is cheaper to let people die"). For this reason, many analysts have opted to rule out life-extension costs from the analysis. However, surprisingly little has been written in the health economics literature regarding this ethical concern and the resulting practice. The purpose of this work was to present a framework and potential solution for ethical objections against life-extension costs. This work found three levels of ethical concern: (i) with respect to all life-extension costs (disease-related and -unrelated); (ii) with respect to disease-unrelated costs only; and (iii) regarding disease-unrelated costs plus disease-related costs not influenced by the intervention. Excluding all life-extension costs for ethical reasons would require-for reasons of consistency-a simultaneous exclusion of savings from reducing morbidity. At the other extreme, excluding only disease-unrelated life-extension costs for ethical reasons would require-again for reasons of consistency-the exclusion of health gains due to treatment of unrelated diseases. Therefore, addressing ethical concerns regarding the inclusion of life-extension costs necessitates fundamental changes in the calculation of cost effectiveness.
... Directly Observed Treatment Short course is more cost effective from the patients' point of view. DOTS needs to be re-focused out of the hospitals and clinics and made community based in view of the increasing TB caseload occasioned by HI V/AIDS. Key Words: Cost effectiveness, Tuberculosis treatment, personal cost, ...
Parizel, Odile; Sulmont-Rossé, Claire; Fromentin, Gilles; Delarue, Julien; Labouré, Hélène; Benamouzig, Robert; Marsset-Baglieri, Agnès
Several authors showed that providing choice may increase food liking and food intake. However, the impact of choice may be modulated by assortment's characteristics, such as the number of alternatives or their dissimilarity. The present study compared the impact of choice on food liking and intake under the two following conditions: (1) when choosing a product to consume from among similar products versus dissimilar products; and (2) when choosing a product to consume from among pleasant products versus unpleasant products. Two experiments were carried out using the same design: the "apple puree" experiment (n = 80), where the volunteers choose from among similar products (apple purees varying in texture) and the "dessert" experiment (n = 80), where the volunteers choose from among dissimilar products (fruit dessert, dairy dessert, custard, pudding). During the first session, participants rated their liking for 12 products (apples purees or desserts). Then the participants were divided into a "pleasant" group (n = 40) in which volunteers were assigned three pleasant products, and an "unpleasant" group (n = 40) in which volunteers were assigned three unpleasant products. Finally, all of the volunteers participated in a choice session - volunteers were presented with their three assigned products and asked to choose one of the products, and a no-choice session - volunteers were served with one product that was randomly selected from among their three assigned products. Providing choice led to an increase in food liking in both experiments and an increase in food intake only for the desserts, namely only when the volunteers chose the product to consume from among "not too similar" alternatives. No effect of assortment's pleasantness was observed. Copyright © 2015 Elsevier Ltd. All rights reserved.
Punt, M. J.
that for other fisheries substantial sunk investments are needed. In this paper I investigate the effect of such sunk entry costs in a sequential fisheries. I model the uncertainty as a shock to the stock dependent fishing costs, in a two player game, where one of the players faces sunk entry costs. I find that......, depending on parameters, sunk costs can i) increase the competitive pressure on the fish stock compared to a game where entry is free ii) act as a deterrence mechanism and iii) act as a commitment device. I conclude that entry costs can play a crucial role because they can change the outcome of the game...
Bayesian modelling for cost-effectiveness data has received much attention in both the health economics and the statistical literature, in recent years. Cost-effectiveness data are characterised by a relatively complex structure of relationships linking a suitable measure of clinical benefit (e.g. quality-adjusted life years) and the associated costs. Simplifying assumptions, such as (bivariate) normality of the underlying distributions, are usually not granted, particularly for the cost variable, which is characterised by markedly skewed distributions. In addition, individual-level data sets are often characterised by the presence of structural zeros in the cost variable. Hurdle models can be used to account for the presence of excess zeros in a distribution and have been applied in the context of cost data. We extend their application to cost-effectiveness data, defining a full Bayesian specification, which consists of a model for the individual probability of null costs, a marginal model for the costs and a conditional model for the measure of effectiveness (given the observed costs). We presented the model using a working example to describe its main features. © 2013 The Authors. Statistics in Medicine published by John Wiley & Sons, Ltd.
Strickland, Justin C; Feinstein, Max A; Lacy, Ryan T; Smith, Mark A
Impulsive choice is a diagnostic feature and/or complicating factor for several psychological disorders and may be examined in the laboratory using delay-discounting procedures. Recent investigators have proposed using quantitative measures of analysis to examine the behavioral processes contributing to impulsive choice. The purpose of this study was to examine the effects of physical activity (i.e., wheel running) on impulsive choice in a single-response, discrete-trial procedure using two quantitative methods of analysis. To this end, rats were assigned to physical activity or sedentary groups and trained to respond in a delay-discounting procedure. In this procedure, one lever always produced one food pellet immediately, whereas a second lever produced three food pellets after a 0, 10, 20, 40, or 80-s delay. Estimates of sensitivity to reinforcement amount and sensitivity to reinforcement delay were determined using (1) a simple linear analysis and (2) an analysis of logarithmically transformed response ratios. Both analyses revealed that physical activity decreased sensitivity to reinforcement amount and sensitivity to reinforcement delay. These findings indicate that (1) physical activity has significant but functionally opposing effects on the behavioral processes that contribute to impulsive choice and (2) both quantitative methods of analysis are appropriate for use in single-response, discrete-trial procedures. Copyright © 2016 Elsevier B.V. All rights reserved.
Eka Putra, Kaspan
For Medan citizens, the choice of residence location depends on the ability to buy a house. House price is determined by the price of land where the housing is located. The more to the edge of the city the location of a house, then the price will be lower. So that the suburbs of Medan become the residential choice for the citizens of low-income. The residential choice will affect the distance of the journey to the workplace. This study analyzed the effect of residential choice on the travel distance and the implications for the implementation of sustainable development. The data used in this study is the primary data obtained through the survey held in Medan. The research approach is quantitative with the data analysis technique of Structural Equation Model (SEM). The results show that low-income citizens tend to choose the location of suburbs, while they work in the urban area. The location of the residence affects the daily travel distance is very high. The travel distance that is the very high effect the use of private vehicle mode. The use of private vehicles for long travel distance requires a huge energy. The use of very high fuel oils is a waste of energy and can increase air pollution. This is not in accordance with the concept of sustainable development.
Distribution Unlimited UU UU UU UU 14-04-2016 1-Sep-2014 31-Dec-2015 Final Report: Understanding the effects of host evolution and skin bacteria ...S) AND ADDRESS (ES) U.S. Army Research Office P.O. Box 12211 Research Triangle Park, NC 27709-2211 mosquito, skin, bacteria , primate REPORT...reviewed journals: Final Report: Understanding the effects of host evolution and skin bacteria composition on disease vector choices Report Title Here
Keuffell, Eric; Jaskiewicz, Wanda; Theppanya, Khampasong; Tulenko, Kate
The dearth of health workers in rural settings in Lao People's Democratic Republic (PDR) and other developing countries limits healthcare access and outcomes. In evaluating non-wage financial incentive packages as a potential policy option to attract health workers to rural settings, understanding the expected costs and effects of the various programs ex ante can assist policy-makers in selecting the optimal incentive package. We use discrete choice experiments (DCEs), costing analyses and recent empirical results linking health worker density and health outcomes to estimate the future location decisions of physicians and determine the cost-effectiveness of 15 voluntary incentives packages for new physicians in Lao PDR. Our data sources include a DCE survey completed by medical students (n = 329) in May 2011 and secondary cost, economic and health data. Mixed logit regressions provide the basis for estimating how each incentive package influences rural versus urban location choice over time. We estimate the expected rural density of physicians and the cost-effectiveness of 15 separate incentive packages from a societal perspective. In order to generate the cost-effectiveness ratios we relied on the rural uptake probabilities inferred from the DCEs, the costing data and prior World Health Organization (WHO) estimates that relate health outcomes to health worker density. Relative to no program, the optimal voluntary incentive package would increase rural physician density by 15% by 2016 and 65% by 2041. After incorporating anticipated health effects, seven (three) of the 15 incentive packages have anticipated average cost-effectiveness ratio less than the WHO threshold (three times gross domestic product [GDP] per capita) over a 5-year (30 year) period. The optimal package's incremental cost-effectiveness ratio is $1454/QALY (quality-adjusted life year) over 5 years and $2380/QALY over 30 years. Capital intensive components, such as housing or facility improvement
Talmor, Daniel; Greenberg, Dan; Howell, Michael D; Lisbon, Alan; Novack, Victor; Shapiro, Nathan
Sepsis is associated with high mortality and treatment costs. International guidelines recommend the implementation of integrated sepsis protocols; however, the true cost and cost-effectiveness of these are unknown. To assess the cost-effectiveness of an integrated sepsis protocol, as compared with conventional care. Prospective cohort study of consecutive patients presenting with septic shock and enrolled in the institution's integrated sepsis protocol. Clinical and economic outcomes were compared with a historical control cohort. Beth Israel Deaconess Medical Center. Overall, 79 patients presenting to the emergency department with septic shock in the treatment cohort and 51 patients in the control group. An integrated sepsis treatment protocol incorporating empirical antibiotics, early goal-directed therapy, intensive insulin therapy, lung-protective ventilation, and consideration for drotrecogin alfa and steroid therapy. In-hospital treatment costs were collected using the hospital's detailed accounting system. The cost-effectiveness analysis was performed from the perspective of the healthcare system using a lifetime horizon. The primary end point for the cost-effectiveness analysis was the incremental cost per quality-adjusted life year gained. Mortality in the treatment group was 20.3% vs. 29.4% in the control group (p = .23). Implementing an integrated sepsis protocol resulted in a mean increase in cost of approximately $8,800 per patient, largely driven by increased intensive care unit length of stay. Life expectancy and quality-adjusted life years were higher in the treatment group; 0.78 and 0.54, respectively. The protocol was associated with an incremental cost of $11,274 per life-year saved and a cost of $16,309 per quality-adjusted life year gained. In patients with septic shock, an integrated sepsis protocol, although not cost-saving, appears to be cost-effective and compares very favorably to other commonly delivered acute care interventions.
White Michael T
Full Text Available Abstract Background The control and elimination of malaria requires expanded coverage of and access to effective malaria control interventions such as insecticide-treated nets (ITNs, indoor residual spraying (IRS, intermittent preventive treatment (IPT, diagnostic testing and appropriate treatment. Decisions on how to scale up the coverage of these interventions need to be based on evidence of programme effectiveness, equity and cost-effectiveness. Methods A systematic review of the published literature on the costs and cost-effectiveness of malaria interventions was undertaken. All costs and cost-effectiveness ratios were inflated to 2009 USD to allow comparison of the costs and benefits of several different interventions through various delivery channels, across different geographical regions and from varying costing perspectives. Results Fifty-five studies of the costs and forty three studies of the cost-effectiveness of malaria interventions were identified, 78% of which were undertaken in sub-Saharan Africa, 18% in Asia and 4% in South America. The median financial cost of protecting one person for one year was $2.20 (range $0.88-$9.54 for ITNs, $6.70 (range $2.22-$12.85 for IRS, $0.60 (range $0.48-$1.08 for IPT in infants, $4.03 (range $1.25-$11.80 for IPT in children, and $2.06 (range $0.47-$3.36 for IPT in pregnant women. The median financial cost of diagnosing a case of malaria was $4.32 (range $0.34-$9.34. The median financial cost of treating an episode of uncomplicated malaria was $5.84 (range $2.36-$23.65 and the median financial cost of treating an episode of severe malaria was $30.26 (range $15.64-$137.87. Economies of scale were observed in the implementation of ITNs, IRS and IPT, with lower unit costs reported in studies with larger numbers of beneficiaries. From a provider perspective, the median incremental cost effectiveness ratio per disability adjusted life year averted was $27 (range $8.15-$110 for ITNs, $143 (range $135
Babo Martins, S; Rushton, J
Cost-effectiveness analysis (CEA) has been extensively used in economic assessments in fields related to animal health, namely in human health where it provides a decision-making framework for choices about the allocation of healthcare resources. Conversely, in animal health, cost-benefit analysis has been the preferred tool for economic analysis. In this paper, the use of CEA in related areas and the role of this technique in assessments of animal health, welfare and production are reviewed. Cost-effectiveness analysis can add further value to these assessments, particularly in programmes targeting animal welfare or animal diseases with an impact on human health, where outcomes are best valued in natural effects rather than in monetary units. Importantly, CEA can be performed during programme implementation stages to assess alternative courses of action in real time.
Methods. The unit of effectiveness was defined as the number of cervical intraepithelial neoplasm (CIN) II or higher lesions detected. Costs were assessed retrospectively for the financial year (2010/11) from a laboratory service provider perspective. A cost-effectiveness analysis was performed by combining secondary data ...
Hunter, Leah J.; DiPerna, James C.; Hart, Susan Crandall; Crowley, Max
Although implementation of universal social-emotional learning programs is becoming more common in schools, few studies have examined the cost-effectiveness of such programs. As such, the purpose of this article is two fold. First, we provide an overview of cost-effectiveness methods for school-based programs, and second, we share results of a…
Coalter, G.C.; Metcalfe, P.E.
The use of barium based products in protective barrier materials proved successful for many years until their cost of manufacture and increases in labour costs for fixing and stopping saw the introduction of lead ply as the material of choice in diagnostic X-ray suites. Whilst the advantage of sheet lead as a barrier for diagnostic X-rays, where the photoelectric effect predominates is recognised, this precedence is somewhat negated by the high cost of manufacture and delays in supply. Lead lined ply also requires external cladding after erection for an acceptable finish to be obtained. Such cost increases have prompted us to re-evaluate the use of precast barium plaster sheets (Barytes Board) as an alternative barrier material
Holdt, Susan Løvstad; Edwards, Maeve D.
seaweed with regard to the amount of nitrogen assimilated. Furthermore, in optimized systems, areal requirement for mussels is similar to the cultivation of the same tonnage (1,000 t) of seaweed (approximately 8 ha). The cost-effectiveness of a mussel biofilter is €11–30 kg−1 nitrogen (N) removed based...... on various examples compared to production costs of €209–672 removed and €1,013 kg−1 N removed, respectively, for Laminaria digitata and Alaria esculenta from extrapolated laboratory and field trials. However, commercial seaweed (Saccharina latissima) producers claim that production costs are less than €10......–38 kg−1 N removed. These up-scaled and commercial figures make the seaweed cost competitive to mussels for removal of nitrogen. Disadvantages such as predators (e.g. eider ducks) and biofouling should also be taken into account before choice of biofilter is made. These drawbacks can reduce overall...
Jensen, Charlotte; Ross, Jamila; Feenstra, Talitha L; Raghoebar, Gerry M; Speksnijder, Caroline; Meijer, Henny J A; Cune, Marco S
The aim of this study was to conduct a cost-effectiveness analysis comparing conventional removable partial dentures (RPDs) and implant-supported RPDs (ISRPDs) treatment in patients with an edentulous maxilla and a bilateral free-ending situation in the mandible. Thirty subjects were included. A new RPD was made and implant support was provided 3 months later. Treatment costs (opportunity costs and costs based on tariffs) were calculated. Treatment effect was expressed by means of the Dutch Oral Health Impact Profile questionnaire (OHIP-NL49), a chewing ability test (Mixing Ability Index, MAI) and a short-form health survey measuring perceived general health (SF-36), which was subsequently converted into quality-adjusted-life-years (QALYs). The incremental cost-effectiveness ratio (ICER) was the primary outcome measure of cost-effectiveness, comparing both treatment strategies. The mean total opportunity costs were €981 (95% CI €971-€991) for the RPD treatment and €2.480 (95% CI €2.461-€2.500) for the ISRPD treatment. The total costs derived from the national tariff structure were €850 for the RPD treatment and €2.610 for the ISRPD treatment. The ICER for OHIP-NL49 and MAI using the opportunity costs was €80 and €786, respectively. When using the tariff structure, corresponding ICERs were €94 and €921. The effect of supporting an RPD with implants when expressed in QALYs was negligible; hence an ICER was not determined. It is concluded that depending on the choice of outcome measure and monetary threshold, supporting an RPD with implants is cost-effective when payers are willing to pay more than €80 per OHIP point gained. Per MAI point gained, an additional €786 has to be invested. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Strand, Kirsten Bjerkreim; Chisholm, Dan; Fekadu, Abebaw; Johansson, Kjell Arne
There is an immense need for scaling-up neuropsychiatric care in low-income countries. Contextualized cost-effectiveness analyses (CEAs) provide relevant information for local policies. The aim of this study is to perform a contextualized CEA of neuropsychiatric interventions in Ethiopia and to illustrate expected population health and budget impacts across neuropsychiatric disorders. A mathematical population model (PopMod) was used to estimate intervention costs and effectiveness. Existing variables from a previous WHO-CHOICE regional CEA model were substantially revised. Treatments for depression, schizophrenia, bipolar disorder and epilepsy were analysed. The best available local data on epidemiology, intervention efficacy, current and target coverage, resource prices and salaries were used. Data were obtained from expert opinion, local hospital information systems, the Ministry of Health and literature reviews. Treatment of epilepsy with a first generation antiepileptic drug is the most cost-effective treatment (US$ 321 per DALY adverted). Treatments for depression have mid-range values compared with other interventions (US$ 457-1026 per DALY adverted). Treatments for schizophrenia and bipolar disorders are least cost-effective (US$ 1168-3739 per DALY adverted). This analysis gives the Ethiopian government a comprehensive overview of the expected costs, effectiveness and cost-effectiveness of introducing basic neuropsychiatric interventions. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
Lee, Alex Hoong Onn
The emergence of low cost or no frills airlines in last decade or so have posed considerable threat to the businesses of traditional full service airlines. The competition between the different type of airlines have changed the landscape of the airline industry tremendously and have provided air travelers with options which are unprecedented. The aim of this study is to understand consumer preference between low cost and full service airlines and to determine what are the motivations or facto...
Albalate, Daniel, 1980-; Bel i Queralt, Germà, 1963-; Geddes, R. Richard
We use an ordered logistic model to empirically examine the factors that explain varying degrees of private involvement in the U.S. water sector through public-private partnerships. Our estimates suggest that a variety of factors help explain greater private participation in this sector. We find that the risk to private participants regarding cost recovery is an important driver of private participation. The relative cost of labor is also a key factor in determining the degree of private invo...
Bloom, David J; Baik, Hwa-Young; Lee, Soo-Yeun
Panelist performance in discrimination tests has been shown to increase when warm-up samples are provided prior to the actual test. Samples are used prior to the actual test for the attribute articulation process of a panelist-articulated-2-alternative forced choice (PA-2-AFC) procedure; however, it is yet unknown if the pretest articulation phase adds to the power of this testing method as with the warm-up. The goal of the study was to determine if a "warm-up" effect was displayed in the PA-2-AFC test resulting in greater power compared to the researcher-designated-2-AFC (RD-2-AFC) test. A RD-2-AFC test, with and without warm-up samples, and a PA-2-AFC test were performed by 61 panelists. A reduced calorie, citrus-flavored, and carbonated beverage was used in the tests. During RD-2-AFC testing, panelists were asked to identify which sample was more sour. For PA-2-AFC testing, panelists individually articulated the nature and direction of the difference between the 2 samples through a pretesting articulation procedure. The articulated difference was, then, used in standard 2-AFC test procedure. A warm-up effect was observed when comparing the standard RD-2-AFC with and without warm-up samples. The addition of warm up samples significantly increased the power of the test, in addition, the PA-2-AFC method had lower power than the RD-2-AFC method. The increase in power with the addition of warm-up samples for the RD-2-AFC procedure supports literature findings on the benefit of providing warm-up samples. No warm-up effect can be attributed to the PA-2-AFC method evidenced by the overall low power observed, which may be attributed to sample complexity. Selecting a specified discrimination testing method is advantageous and can reduce costs of sensory testing, but has been considered unpractical when samples may differ in unknown ways. This research explores the use of panelist derived terms to circumvent the need for researchers to identify these differences and
Mitchell Aaron P
Full Text Available Abstract Background The literature on the cost-effectiveness of statin drugs in primary prevention of coronary heart disease is complex. The objective of this study is to compare the disparate results of recent cost-effectiveness analyses of statins. Findings We conducted a systematic review of the literature on statin cost-effectiveness. The four studies that met inclusion criteria reported varying conclusions about the cost-effectiveness of statin treatment, without a clear consensus as to whether statins are cost-effective for primary prevention. However, after accounting for each study’s assumptions about statin costs, we found substantial agreement among the studies. Studies that assumed statins to be more expensive found them to be less cost-effective, and vice-versa. Furthermore, treatment of low-risk groups became cost-effective as statins became less expensive. Conclusions Drug price is the primary determinant of statin cost-effectiveness within a given risk group. As more statin drugs become generic, patients at low risk for coronary disease may be treated cost-effectively. Though many factors must be weighed in any medical decision, from a cost-effectiveness perspective, statins may now be considered an appropriate therapy for many patients at low risk for heart disease.
Hwang, Tae Kyun.
Approved for public release; distribution in unlimited. Cost and Effectiveness models are developed by using of cost-effectiveness technique for fiber optic cable and satellite communication media. The models are applied to the Korean international communication problem. Alternative selection is required since the two medias different in cost and effectiveness. The major difficulties encountered were data gathering and measuring the effectiveness of the Korean international ...
Weile, Louise K K; Kahn, James G; Marseille, Elliot
a systematic search and abstraction of cost-effectiveness and cost-utility studies from 2002 to 2014. We standardized all findings to 2014 US dollars. We found that cost-effectiveness ratios varied widely. Most variation was found to be due to differences in geographic setting, diagnostic criteria...... and intervention approaches, and outcomes (e.g., inclusion or exclusion of long-term type 2 diabetes risk and associated costs). We concluded that incorporation of long-term benefits of GDM screening and treatment has huge impact on cost-effectiveness estimates. Based on the large methodological heterogeneity...
Yechiam, Eldad; Zahavi, Gal; Arditi, Eli
While the traditional conceptualization of the effect of losses focuses on bias in the subjective weight of losses compared with respective gains, some accounts suggest more global task-related effects of losses. Based on a recent attentional theory, we predicted a positive after-effect of losses on choice switching in later tasks. In two experimental studies, we found increased choice switching rates in tasks with losses compared to tasks with no losses. Additionally, this heightened shifting behavior was maintained in subsequent tasks that do not include losses, a phenomenon we refer to as "loss restlessness." Conversely, gains were found to have an opposite "calming" effect on choice switching. Surprisingly, the loss restlessness phenomenon was observed following an all-losses payoff regime but not after a task with symmetric mixed gains and losses. This suggests that the unresolved mental account following an all-losses regime increases search behavior. Potential implications to macro level phenomena, such as the leverage effect, are discussed.
Sottile, Eleonora; Meloni, Italo; Cherchi, Elisabetta
The need to reduce private vehicle use has led to the development of soft measures aimed at re-educating car users through information processes that raise their awareness about the benefits of environmentally friendly modes, encouraging them to voluntarily change their travel choice behaviour......), carried out with the purpose of promoting the use of the light rail in Park and Ride mode. To account for all these effects in the choice between car and Park and Ride we estimate a Hybrid Choice Model where the discrete choice structure allows us to estimate the effect of awareness of environment...
Eeson, Gareth; Birabwa-Male, Doreen; Pennington, Mark; Blair, Geoffrey K
Surgically treatable diseases contribute approximately 11% of disability-adjusted life years (DALYs) worldwide yet they remain a neglected public health priority in low- and middle-income countries (LMICs). Pediatric inguinal hernia is the most common congenital abnormality in newborns and a major cause of morbidity and mortality yet elective repair remains largely unavailable in LMICs. This study is aimed to determine the costs and cost-effectiveness of pediatric inguinal hernia repair (PIHR) in a low-resource setting. Medical costs of consecutive elective PIHRs were recorded prospectively at two centers in Uganda. Decision modeling was used to compare two different treatment scenarios (adoption of PIHR and non-adoption) from a provider perspective. A Markov model was constructed to estimate health outcomes under each scenario. The robustness of the cost-effectiveness results in the base case analysis was tested in one-way and probabilistic sensitivity analysis. The primary outcome of interest was cost per DALY averted by the intervention. Sixty-nine PIHRs were performed in 65 children (mean age 3.6 years). Mean cost per procedure was $86.68 US (95% CI 83.1-90.2 USD) and averted an average of 5.7 DALYs each. Incremental cost-effectiveness ratio was $12.41 per DALY averted. The probability of cost-effectiveness was 95% at a cost-effectiveness threshold of $35 per averted DALY. Results were robust to sensitivity analysis under all considered scenarios. Elective PIHR is highly cost-effective for the treatment and prevention of complications of hernia disease even in low-resource settings. PIHR should be prioritized in LMICs alongside other cost-effective interventions.
Full Text Available Several psychosocial care interventions have been found effective in improving psychosocial outcomes in cancer patients. At present, there is increasingly being asked for information on the value for money of this type of intervention. This review therefore evaluates current evidence from studies investigating cost-effectiveness or cost-utility of psychosocial care in cancer patients. A systematic search was conducted in PubMed and Web of Science yielding 539 unique records, of which 11 studies were included in the study. Studies were mainly performed in breast cancer populations or mixed cancer populations. Studied interventions included collaborative care (four studies, group interventions (four studies, individual psychological support (two studies, and individual psycho-education (one study. Seven studies assessed the cost-utility of psychosocial care (based on quality-adjusted-life-years while three studies investigated its cost-effectiveness (based on profile of mood states [mood], Revised Impact of Events Scale [distress], 12-Item Health Survey [mental health], or Fear of Progression Questionnaire [fear of cancer progression]. One study did both. Costs included were intervention costs (three studies, intervention and direct medical costs (five studies, or intervention, direct medical, and direct nonmedical costs (three studies. In general, results indicated that psychosocial care is likely to be cost-effective at different, potentially acceptable, willingness-to-pay thresholds. Further research should be performed to provide more clear information as to which psychosocial care interventions are most cost-effective and for whom. In addition, more research should be performed encompassing potential important cost drivers from a societal perspective, such as productivity losses or informal care costs, in the analyses.
Utsuki, Narisuke; Takeuchi, Yoshinori; Nomiyama, Takenori
Recent technologies have realized talking advisory/guidance systems in which machines give advice and guidance to operators in speech. However, nonverbal aspects of spoken messages may have significant effects on an operator's behavior. Twelve subjects participated in a TV game-like choice response task where they were asked to choose a 'true' target from three invader-like figures displayed on a CRT screen. The subjects had received a prerecorded advice designating either left, center, or right target that would be true before each choice. The position of the 'true' targets and advice were preprogrammed in pseudorandom sequences. In other words, there was no way for the subjects to predict the 'true' target and there was no relationship between spoken advice and the true target position. The subjects tended to make more choices corresponding to the presented messages when the messages were presented in a louder voice than in a softer voice. Choice response time was significantly shorter when the response was the same as the advice indicated. The shortening of response time was slightly greater when advice was presented in a louder voice. This study demonstrates that spoken advice may result in faster and less deliberate reponses in accordance with the presented messages which are given by talking guidance systems.
Gueye, Aliou B; Trigo, Jose M; Vemuri, Kiran V; Makriyannis, Alexandros; Le Foll, Bernard
It is estimated that 0.6-1% of the population in the USA and Canada fulfil the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) criteria for gambling disorders (GD). To date, there are no approved pharmacological treatments for GD. The rat gambling task (rGT) is a recently developed rodent analogue of the Iowa gambling task in which rats are trained to associate four response holes with different magnitudes and probabilities of food pellet rewards and punishing time-out periods. Similar to healthy human volunteers, most rats adopt the optimal strategies (optimal group). However, a subset of animals show preference for the disadvantageous options (suboptimal group), mimicking the choice pattern of patients with GD. Here, we explored for the first time the effects of various cannabinoid ligands (WIN 55,212-2, AM 4113, AM 630 and URB 597) on the rGT. Administration of the cannabinoid agonist CB1/CB2 WIN 55,212-2 improved choice strategy and increased choice latency in the suboptimal group, but only increased perseverative behaviour, when punished, in the optimal group. Blockade of CB1 or CB2 receptors or inhibition of fatty-acid amide hydrolase did not affect rGT performance. These results suggest that stimulation of cannabinoid receptors could affect gambling choice behaviours differentially in some subgroups of subjects.
Kable, Joseph W; Caulfield, M Kathleen; Falcone, Mary; McConnell, Mairead; Bernardo, Leah; Parthasarathi, Trishala; Cooper, Nicole; Ashare, Rebecca; Audrain-McGovern, Janet; Hornik, Robert; Diefenbach, Paul; Lee, Frank J; Lerman, Caryn
Increased preference for immediate over delayed rewards and for risky over certain rewards has been associated with unhealthy behavioral choices. Motivated by evidence that enhanced cognitive control can shift choice behavior away from immediate and risky rewards, we tested whether training executive cognitive function could influence choice behavior and brain responses. In this randomized controlled trial, 128 young adults (71 male, 57 female) participated in 10 weeks of training with either a commercial web-based cognitive training program or web-based video games that do not specifically target executive function or adapt the level of difficulty throughout training. Pretraining and post-training, participants completed cognitive assessments and functional magnetic resonance imaging during performance of the following validated decision-making tasks: delay discounting (choices between smaller rewards now vs larger rewards in the future) and risk sensitivity (choices between larger riskier rewards vs smaller certain rewards). Contrary to our hypothesis, we found no evidence that cognitive training influences neural activity during decision-making; nor did we find effects of cognitive training on measures of delay discounting or risk sensitivity. Participants in the commercial training condition improved with practice on the specific tasks they performed during training, but participants in both conditions showed similar improvement on standardized cognitive measures over time. Moreover, the degree of improvement was comparable to that observed in individuals who were reassessed without any training whatsoever. Commercial adaptive cognitive training appears to have no benefits in healthy young adults above those of standard video games for measures of brain activity, choice behavior, or cognitive performance. SIGNIFICANCE STATEMENT Engagement of neural regions and circuits important in executive cognitive function can bias behavioral choices away from immediate
Konnopka, Alexander; Leichsenring, Falk; Leibing, Eric; König, Hans-Helmut
To review cost-of-illness studies (COI) and cost-effectiveness analyses (CEA) conducted for anxiety disorders. Based on a database search in Pubmed, PsychINFO and NHS EED, studies were classified according to various criteria. Cost data were inflated and converted to 2005 US-$ purchasing power parities (PPP). We finally identified 20 COI and 11 CEA of which most concentrated on panic disorder (PD) and generalized anxiety disorder (GAD). Differing inclusion of cost categories limited comparability of COI. PD and GAD tended to show higher direct costs per case, but lower direct cost per inhabitant than social and specific phobias. Different measures of effectiveness severely limited comparability of CEA. Overall CEA analysed 26 therapeutic or interventional strategies mostly compared to standard treatment, 8 of them resulting in lower better effectiveness and costs than the comparator. Anxiety disorders cause considerable costs. More research on phobias, more standardised inclusion of cost categories in COI and a wider use of comparable effectiveness measures (like QALYs) in CEA is needed.
Warren, C G
In order to develop and maintain a viable service delivery program, the realities of cost effectiveness and cost efficiency in providing assistive technology must be addressed. Cost effectiveness relates to value of the outcome compared to the expenditures. Cost efficiency analyzes how a provider uses available resources to supply goods and services. This paper describes how basic business principles of benefit/cost analysis can be used to determine cost effectiveness. In addition, basic accounting principles are used to illustrate methods of evaluating a program's cost efficiency. Service providers are encouraged to measure their own program's effectiveness and efficiency (and potential viability) in light of current trends. This paper is meant to serve as a catalyst for continued dialogue on this topic.
Full Text Available The cost of antennas for instrumentation radars are determined by the development cost. By re-use of the reflector system cost effective antennas can be designed. The factors governing the design of such antennas are described here....
This paper presents the effects of Collaborative Cost Reduction Model (CCRM) as a control Approach to reduce the high cost implication that causes the slow pace of migration process from IPV4 to IPV6 in Nigeria. This study reveals that CCRM can be applied to achieve Cost Reduction in collocation efforts in ...
Conclusion: At a cost per vaccine course of US$31.5 for monovalent and US$38 for pentavalent vaccine, routine RV vaccination could be potentially cost effective and also cost saving in Turkey. National RV vaccinations will play a significant role in preventing RV infections.
Jeffery Robert W; Story Mary T; Oakes J Michael; French Simone A; Harnack Lisa J; Rydell Sarah A
Abstract Background Although point-of-purchase calorie labeling at restaurants has been proposed as a strategy for improving consumer food choices, a limited number of studies have evaluated this approach. Likewise, little research has been conducted to evaluate the influence of value size pricing on restaurant meal choices. Methods To examine the effect of point-of-purchase calorie information and value size pricing on fast food meal choices a randomized 2 × 2 factorial experiment was conduc...
Banks, Matthew L; Blough, Bruce E
Preclinical and human laboratory choice procedures have been invaluable in improving our knowledge of the neurobiological mechanisms of drug reinforcement and in the drug development process for candidate medications to treat drug addiction. However, little is known about the neuropharmacological mechanisms of methamphetamine vs food choice. The aims of this study were to develop a methamphetamine vs food choice procedure and determine treatment effects with two clinically relevant compounds:...
Kim, Heejung S; Sherman, David K
Whereas self-expression is valued in the United States, it is not privileged with such a cultural emphasis in East Asia. Four studies demonstrate the psychological implications of this cultural difference. Studies 1 and 2 found that European Americans value self-expression more than East Asians/East Asian Americans. Studies 3 and 4 examined the roles of expression in preference judgments. In Study 3, the expression of choice led European Americans but not East Asian Americans to be more invested in what they chose. Study 4 examined the connection between the value of expression and the effect of choice expression and showed that European Americans place greater emphasis on self-expression than East Asian Americans, and this difference explained the cultural difference in Study 3. This research highlights the importance of the cultural meanings of self-expression and the moderating role of cultural beliefs on the psychological effect of self-expression. 2007 APA, all rights reserved
Larrat, E P
The cost-assessment technology of decision analysis was applied to isosorbide dinitrate (ISDN), the standard therapy for angina; isosorbide mononitrate (ISMO), approved mid-1992; and nitroglycerin patches to measure the effect of economics on clinical practice and administrative choices. The evaluation was conducted to illustrate the utility of this method for decision makers in various sectors of the health care system, including physicians, pharmacy benefit administrators, formulary committees, and manufacturers. Findings indicate that despite a higher unit cost for ISMO, total anticipated treatment costs with this new long-acting nitrate are lower than those associated with ISDN (28%) and nitroglycerin patch (16%) therapy in patients with stable angina, and ISMO requires less dosing titration and is associated with fewer tolerance effects.
The more health care is socialized, the more cost-effectiveness is an appropriate criterion for expenditure. Utility-maximizing individuals, facing divisibility of health care purchases and declining marginal health gains, and complete information about probable health improvements, should buy health care according to its cost-effectiveness. Absent these features, individual health spending will not be cost-effective; and in any case, differences in personal utilities and risk aversion will not lead to the same ranking of health care interventions for everyone. Private insurance frees consumers from concern for cost, which undermines cost-effectiveness, but lets them emphasize effectiveness, which favors value for money. This is most important for costly and cost-effective interventions, especially for poor people. Cost-effectiveness is more appropriate and easier to achieve under second-party insurance. More complete socialization of health care, via public finance, can yield greater efficiency by making insurance compulsory. Cost-effectiveness is also more attractive when taxpayers subsidize others' care: needs (effectiveness) take precedence over wants (utility). The gain in effectiveness may be greater, and the welfare loss from Pareto non-optimality smaller, in poor countries than in rich ones.
The author discusses the future of the nuclear power industry from an economics and cost-factor point of view, from the point of view of plant management, as it affects and requires personnel training, as R and D cost and competition is involved, as end-user cost is involved, and as efficiency and cost effectiveness of nuclear power fare in comparison with other sources of electrical energy
Duran, B.S.; Campbell, K.
Statistical tolerance limits are estimates of large (or small) quantiles of a distribution, quantities which are very sensitive to the shape of the tail of the distribution. The exact nature of this tail behavior cannot be ascertained brom small samples, so statistical tolerance limits are frequently computed using a statistical model chosen on the basis of theoretical considerations or prior experience with similar populations. This report illustrates the effects of such choices on the computations
Zimmerman, Frederick J; Shimoga, Sandhya V
Background Advertising has been implicated in the declining quality of the American diet, but much of the research has been conducted with children rather than adults. This study tested the effects of televised food advertising on adult food choice. Methods Participants (N = 351) were randomized into one of 4 experimental conditions: exposure to food advertising vs. exposure to non-food advertising, and within each of these groups, exposure to a task that was either cognitively demanding or n...
The increasing market share of light trucks in the U.S. in recent years has been characterized as an “arms race” where individual purchase of light trucks for better self-protection in collisions nevertheless leads to worse traffic safety for the society. This paper investigates the interrelation between traffic safety and vehicle choice by quantifying the effects of the arms race on vehicle demand, producer performance, and traffic safety. The empirical analysis shows that the accident exter...
Full Text Available Despite recent advances, there is a high degree of uncertainty concerning the climate change that would result from increasing atmospheric greenhouse gas concentrations. Also, opponents of the Kyoto Protocol raised the key objection that reducing emissions would impose an unacceptable economic burden on businesses and consumers. Based on an analysis of alternative scenarios for electricity generation in Italy, we show that if the costs in terms of damage to human health, material goods, agriculture, and the environment caused by greenhouse gas emissions are included in the balance, the economic argument against Kyoto is untenable. Most importantly, the argument holds true even if we exclude global external costs (those due to global warming, and account for local external costs only (such as those due to acidic precipitation and lung diseases resulting from air pollution.
Le Surf, J.E.; Weyman, G.D.
The origin and basic principles of the dilute chemical decontamination (DCD) concept are described and illustrated by reference to the CAN-DECON process. The estimated dose savings from the actual application of the process at several reactors are presented and discussed. Two methods of performing a cost/benefit appraisal are described and discussed. This methodology requires more study by the nuclear industry, including collection by station staff of relevant data on which future cost/benefit appraisals may be based. Finally, three illustrative cases are examinated to show the breakeven point and potential savings achievable by DCD with different initial radiation fields and different amounts of work to be done. The overall conclusion is that there are many situations in which DCD is desirable to reduce radiation exposure of workers, to save costs to the station, and to ease the performance of maintenance and repair work on reactor systems
Sheckter, Clifford C; Matros, Evan; Momeni, Arash
Breast reconstruction is one of the most common procedures performed by plastic surgeons and is achieved through various choices in both technology and method. Cost-effectiveness analyses are increasingly important in assessing differences in value between treatment options, which is relevant in a world of confined resources. A thorough evaluation of the cost-effectiveness literature can assist surgeons and health systems evaluate high-value care models. A systematic review of PubMed, Web of Science, and the Cost-Effectiveness Analysis Registry was conducted. Two reviewers independently evaluated all publications up until August 17, 2017. After removal of duplicates, 1996 records were screened, from which 53 studies underwent full text review. All the 13 studies included for final analysis mention an incremental cost-effectiveness ratio. Five studies evaluated the cost-effectiveness of technologies including acellular dermal matrix (ADM) in staged prosthetic reconstruction, ADM in direct-to-implant (DTI) reconstruction, preoperative computed tomography angiography in autologous reconstruction, indocyanine green dye angiography in evaluating anastomotic patency, and abdominal mesh reinforcement in abdominal tissue transfer. The remaining eight studies evaluated the cost-effectiveness of different reconstruction methods. Cost-effective strategies included free vs. pedicled abdominal tissue transfer, DTI vs. staged prosthetic reconstruction, and fascia-sparing variants of free abdominal tissue transfer. Current evidence demonstrates multiple cost-effective technologies and methods in accomplishing successful breast reconstruction. Plastic surgeons should be well informed of such economic models when engaging payers and policymakers in discussions regarding high-value breast reconstruction. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
Department of Energy, Washington, DC.
This guide addresses contributions that school facility administrators and business officials can make in an effort to reduce operating costs and free up money for capital improvements. The guide explores opportunities available to utilize energy-saving strategies at any stage in a building's life, from its initial design phase through renovation.…
Nordmann, P; Schaffner, A; Dazzi, H
Although the rise in health costs is a widely debated issue, in Switzerland it was until recently taken for granted that patients are given the best available treatment regardless of cost. An example of a disease requiring costly treatment is acute myelogenous leukaemia (AML). To relate cost to benefit we calculated expenditure per life years gained. To assess costs we determined the real cost of treatment up to total remission, followed by consolidation or withdrawal of treatment or death. For survival time exceeding the 2-year observation period we used data from recent literature. The average cost of treatment ranges up to 107,592 Swiss francs (CHF). In 1997 we treated 23 leukaemia patients at Zurich University Hospital and gained a total of 210 life years. This represents an average cost of CHF 11,741 per life year gained. Chief cost items were therapy and personnel costs for nursing staff, followed by hotel business and personnel costs for doctors and diagnosis. Our results for AML treatment are far removed from the $61,500 ranging up to $166,000 discussed in the literature as the "critical" QALY (quality adjusted life years) value. This is the first time the actual costs of AML therapy have been shown for a Swiss cohort. Despite high initial treatment costs and success only in a limited number of patients, the expenditure per QALY is surprisingly low and shows clearly the effectiveness of apparently costly acute medicine.
Peng, Jiaxi; Jiang, Yuan; Miao, Danmin; Li, Rui; Xiao, Wei
To verify whether three different framing effects (risky choice, attribute and goal) exist in simulated medical situations and to analyse any differences. Medical decision-making problems were established, relating to medical skill evaluation, patient compliance and a selection of treatment options. All problems were described in positive and negative frame conditions. Significantly more positive evaluations were made if the doctor's medical records were described as 'of 100 patients, 70 patients became better' compared with those described as 'of 100 patients, 30 patients didn't become better'. Doctor's advice described in a negative frame resulted in significantly more decisions to comply, compared with advice described in a positive frame. Treatment options described in terms of survival rates resulted in significantly more adventurous choices compared with options described in terms of mortality rates. Decision-making reversal appeared in the risky choice and attribute frames, but not the goal frame. Framing effects were shown to exist in simulated medical situations, but there were significant differences among the three kinds of such effects.
Cost-effectiveness, feed utilization and body composition of african sharptooth catfish ( Clarias gariepinus , Burchell 1822) fingerlings fed locally formulated and commercial pelleted diets in tarpaulin tanks.
This paper uses survey data from 133 Dutch, medium-sized manufacturing firms to examine the associations between cost system complexity (in terms of the applied overhead absorption procedures), purposes of use, and cost system effectiveness. First, factor analysis identifies two underlying
Myren, Karl-Johan; Thernlund, Gunilla; Nylen, Asa; Schacht, Alexander; Svanborg, Par
Objective: To compare societal costs between patients treated with atomoxetine and placebo in Sweden. Method: Ninety-nine pediatric ADHD patients were randomized to a 10-week double-blind treatment with atomoxetine (n = 49) or placebo (n = 50). All parents received four sessions of psycho-education. Parents filled out a resource utilization…
Elizabeth Dodson; Dana Mitchell
Fire managers are continuously looking for improved methods to construct fireline with minimal resource damage. One option for fireline construction that has so far received limited attention is the use of mastication equipment. This study evaluated a masticating disk mounted on a self-leveling feller- buncher for the cost, speed, and adherence to fireline...
LeSurf, J.E.; Weyman, G.D.
The basic principles of dilute chemical decontamination are described, as well as the method of application. Methods of computing savings in radiation dose and costs are presented, with results from actual experience and illustrative examples. It is concluded that dilute chemical decontamination is beneficial in many cases. It reduces radiation exposure of workers, saves money, and simplifies maintenance work
Deibel, Scott H; Thorpe, Christina M
Two theories that have been hypothesized to mediate acquisition in daily time-place learning (TPL) tasks were investigated in a free operant daily TPL task: the response cost hypothesis and the species-typical behavior hypothesis. One lever at the end of one of the choice arms of a T-maze provided food in the morning, and 6 h later, a lever in the other choice arm provided food. Four groups were used to assess the effect of two possible sources of response cost: physical effort of the task and costs associated with foraging ecology. One group was used to assess the effect of explicitly allowing for species-typical behaviors. If only first arm choice data were considered, there was little evidence of learning. However, both first press and percentage of presses on the correct lever prior to the first reinforcement revealed evidence of TPL in most rats tested. Unexpectedly, the high response cost groups for both of the proposed sources did not perform better than the low response cost groups. The groups that allowed animals to display species-typical behaviors performed the worst. Skip session probe trials confirmed that the majority of the rats that acquired the task were using a circadian timing strategy. The results from the present study suggest that learning in free operant daily TPL tasks might not be dependent on response cost.
Rakotonarivo, Onjamirindra Sarobidy
and comprises a systematic review and three field tests of DCE in a new REDD+ (Reducing Emissions from Deforestation and forest Degradation) project and national park in eastern Madagascar. I first conducted a systematic review of empirical evidence on the reliability and validity of DCEs when valuing non-market...... the validity of DCE in estimating the costs of conservation restrictions ex-ante. I found that experience of forest protection matters; households who have been exposed to forest protection for a comparatively longer period had significantly higher welfare costs for restricting forest clearance than those who...... techniques. It also has major implications for how forest conservation policy may be devised in low-income countries, including devolution of secure forestland tenure to local people and genuinely negotiating conservation with forest users....
Energy Smart Schools Team
Most K-12 schools could save 25% of their energy costs by being smart about energy. Nationwide, the savings potential is$6 billion. While improving energy use in buildings and busses, schools are likely to create better places for teaching and learning, with better lighting, temperature control, acoustics, and air quality. This brochure, targeted to school facilities managers and business officials, describes how schools can become more energy efficient
Li, Jing; Su, Wei
The allocentric system computes and represents general object-to-object spatial relationships to provide a spatial frame of reference other than the egocentric system. The intrinsic frame-of-reference system theory, which suggests people learn the locations of objects based upon an intrinsic axis, is important in research about the allocentric system. The purpose of the current study was to determine whether the effect of coincident orientation on the choice of intrinsic axis was limited. Two groups of participants (24 men, 24 women; M age = 24 yr., SD = 2) encoded different spatial layouts in which the objects shared the coincident orientation of 315° and 225° separately at learning perspective (0°). The response pattern of partial-scene-recognition task following learning reflected different strategies for choosing the intrinsic axis under different conditions. Under the 315° object-orientation condition, the objects' coincident orientation was as important as the symmetric axis in the choice of the intrinsic axis. However, participants were more likely to choose the symmetric axis as the intrinsic axis under the 225° object-orientation condition. The results suggest the effect of coincident orientation on the choice of intrinsic axis is limited.
William W. N. Tsang
Full Text Available Background. This cross-sectional study examined the effect of aging on performing finger-pointing tasks involving choices and whether experienced older Tai Chi practitioners perform better than healthy older controls in such tasks. Methods. Thirty students and 30 healthy older controls were compared with 31 Tai Chi practitioners. All the subjects performed a rapid index finger-pointing task. The visual signal appeared randomly under 3 conditions: (1 to touch a black ball as quickly and as accurately as possible, (2 not to touch a white ball, (3 to touch only the white ball when a black and a white ball appeared simultaneously. Reaction time (RT of anterior deltoid electromyogram, movement time (MT from electromyogram onset to touching of the target, end-point accuracy from the center of the target, and the number of wrong movements were recorded. Results. Young students displayed significantly faster RT and MT, achieving significantly greater end-point accuracy and fewer wrong movements than older controls. Older Tai Chi practitioners had significantly faster MT than older controls. Conclusion. Finger-pointing tasks with a choice paradigm became slower and less accurate with age. Positive findings suggest that Tai Chi may slow down the aging effect on eye-hand coordination tasks involving choices that require more cognitive progressing.
Bolhuis, Dieuwerke P; Lakemond, Catriona M M; de Wijk, Rene A; Luning, Pieternel A; de Graaf, Cees
The effect of salt intensity on ad libitum intake of tomato soup was investigated when soup was served as a first course and as a second course. Also the effect of salt intensity in soup on subsequent sweet vs. savory choice of sandwich fillings was investigated. Forty-three healthy subjects consumed ad libitum a low-salt (LS), ideal-salt (IS) and high-salt (HS) tomato soup in both meal settings. The salt concentrations were selected on an individual basis, in a way that IS was most pleasant and LS and HS were similar in pleasantness. The ad libitum intake of IS soup was higher than that of LS and HS soup, and the ad libitum intake of LS soup was higher than that of HS soup. The meal setting, soup as a first or as a second course, did not affect ad libitum intake. Salt intensity in soup did not predict sweet vs. savory choice of fillings in grams or energy, although most sodium from fillings was consumed after intake of HS soup. In conclusion, a higher salt intensity lead to lower ad libitum intake of soup similar in palatability (LS vs. HS). In addition, salt intensity in soup does not predict sweet vs. savory food choice. Copyright © 2011 Elsevier Ltd. All rights reserved.
Xiang, Yan Hui; Wu, Hao; Shang, Rui Hong; Chao, Xiaomei; Ren, Ting Ting; Zheng, Li Ling; Mo, Lei
Two main theories have been used to explain the arithmetic split effect: decision-making process theory and strategy choice theory. Using the inequality paradigm, previous studies have confirmed that individuals tend to adopt a plausibility-checking strategy and a whole-calculation strategy to solve large and small split problems in complex addition arithmetic, respectively. This supports strategy choice theory, but it is unknown whether this theory also explains performance in solving different split problems in complex subtraction arithmetic. This study used small, intermediate and large split sizes, with each split condition being further divided into problems requiring and not requiring borrowing. The reaction times (RTs) for large and intermediate splits were significantly shorter than those for small splits, while accuracy was significantly higher for large and middle splits than for small splits, reflecting no speed-accuracy trade-off. Further, RTs and accuracy differed significantly between the borrow and no-borrow conditions only for small splits. This study indicates that strategy choice theory is suitable to explain the split effect in complex subtraction arithmetic. That is, individuals tend to choose the plausibility-checking strategy or the whole-calculation strategy according to the split size. © 2016 International Union of Psychological Science.
Skov, Peter Rohde
as a point of comparison. I investigate this theory using a school-by-grade fixed effects model and comprehensive administrative data. I examine the non-linear relationships between peers educational achievement on choice of secondary education. I show that the relative rank in the classroom have......In this paper I investigate whether a social contrast mechanism affects the choice of secondary schooling. Based on a theory of relative deprivation, a strand of research in social inequality of educational attainment shows that, controlling for the students ability, students who attends schools...... with more privileged peers have lower educational attainment and less prestigious labor market careers. This theory shows that students with similar ability may be regarded differently depending on context, which may affect the students' academic self-image. This also means that the students use their peers...
Hummel, J. Marjan; van Rossum, Wouter; Verkerke, Gijsbertus Jacob; Rakhorst, G.
This study analyses the effects of Team Expert Choice on group decision-making in collaborative new product development. We applied Team Expert Choice to support a product evaluation conducted by a new product development group composed of professionally diverse members. The evaluation resulted in
Patall, Erika A.; Cooper, Harris; Robinson, Jorgianne Civey
A meta-analysis of 41 studies examined the effect of choice on intrinsic motivation and related outcomes in a variety of settings with both child and adult samples. Results indicated that providing choice enhanced intrinsic motivation, effort, task performance, and perceived competence, among other outcomes. Moderator tests revealed the effect…
Wade-Galuska, Tammy; Galuska, Chad M.; Winger, Gail
Choice procedures have indicated that the relative reinforcing effectiveness of opioid drugs increases during opioid withdrawal. The demand curve, an absolute measure of reinforcer value, has not been applied to this question. The present study assessed whether mild morphine withdrawal would increase demand for or choice of remifentanil or…
The problem of radon 222 in buildings as a contributor to radiation exposure is described. Five different control methods and the dose reductions that would result from each are analysed. The annualized cost for each control measure was evaluated and the cost effectiveness of each control measure was calculated on the basis of dollars per person-sievert dose reduction. The use of unipolar ion generators for particle removal appears to be the most cost effective and the use of ceiling fans to increase air circulation the least cost effective. 3 figs., 1 tab
Stephen D. Walter
Full Text Available Abstract Background In the two-stage randomised trial design, a randomly sampled subset of study participants are permitted to choose their own treatment, while the remaining participants are randomised to treatment in the usual way. Appropriate analysis of the data from both arms of the study allows investigators to estimate the impact on study outcomes of treatment preferences that patients may have, in addition to evaluating the usual direct effect of treatment. In earlier work, we showed how to optimise this design by making a suitable choice of the proportion of participants who should be assigned to the choice arm of the trial. However, we ignored the possibility of some participants being indifferent to the treatments under study. In this paper, we extend our earlier work to consider the analysis of two-stage randomised trials when some participants have no treatment preference, even if they are assigned to the choice arm and allowed to choose. Methods We compare alternative characterisations of the response profiles of the indifferent or undecided participants, and derive estimates of the treatment and preference effects on study outcomes. We also present corresponding test statistics for these parameters. The methods are illustrated with data from a clinical trial contrasting medical and surgical interventions. Results Expressions are obtained to estimate and test the impact of treatment choices on study outcomes, as well as the impact of the actual treatment received. Contrasts are defined between patients with stated treatment preferences and those with no preference. Alternative assumptions concerning the outcomes of undecided participants are described, and an approach leading to unbiased estimation and testing is identified. Conclusions Use of the two-stage design can provide important insights into determinants of study outcomes that are not identifiable with other designs. The design can remain attractive even in the presence of
Full Text Available Background and Objective: Commitment to spouse, marriage, and family is one of the most important factors ensuring the continuity of marriage and strength of family bonds that has attracted considerable attention in the contemporary family and marriage studies. In this study, we sought to determine the effect of couple therapy based on the choice theory on the social commitment of couples. Materials and Methods: This was a quasi-experimental study with pretest-posttest design and a control group that was performed among volunteer couples visiting Isfahan Counseling and Psychology Centers in Isfahan, Iran, during 2015. The subjects consisted of 32 incompatible couples who were selected through convenience sampling and were randomly assigned into experimental (16 couples and control (16 couples groups. Then, the experimental group received nine sessions of group couple therapy during three months on family life skills based on choice theory. It is worth mentioning that the dependent variable was the social commitment of couples evaluated by the dimensions of commitment inventory of Adams and Jones (1997. The collected data were analyzed by multivariate analysis of covariance in SPSS, version 20. Results: At the post-test stage, couple therapy based on choice theory significantly enhanced social commitment in the experimental group compared to the control group (P<0.001. Conclusion: According to the findings of this study, couple therapy based on the choice theory is an effective strategy in promoting commitment and loyalty to spouse, marriage, and family and can decrease and prevent family-related problems and threats such as divorce and marital infidelity.
van Kleef, Ellen; Seijdell, Karen; Vingerhoeds, Monique H; de Wijk, René A; van Trijp, Hans C M
Consumer choices are often influenced by the default option presented. This study examines the effect of whole wheat bread as a default option in a sandwich choice situation. Whole wheat bread consists of 100% whole grain and is healthier than other bread types that are commonly consumed, such as brown or white bread. A pilot survey (N = 291) examined the strength of combinations of toppings and bread type as carrier to select stimuli for the main study. In the main experimental study consisting of a two (bread type) by two (topping type) between-subjects design, participants (N = 226) were given a free sandwich at a university stand with either a relatively unhealthy deep-fried snack (croquette) or a healthy topping. About half of the participants were offered a whole wheat bun unless they asked for white bun, and the other half were offered a white bun unless they asked for a whole wheat bun. Regardless of the topping, the results show that when the whole wheat bun was the default option, 108 out of 115 participants (94%) decided to stick with this default option. When the default of bread offered was white, 89 out of 111 participants (80%) similarly chose to stick with this default. Across conditions, participants felt equally free to make a choice. The attractiveness of and willingness to pay for the sandwich were not affected by default type of bread. This study demonstrated a strong default effect of bread type. This clearly shows the benefit of steering consumers towards a healthier bread choice, by offering healthier default bread at various locations such as restaurants, schools and work place canteens. Copyright © 2017 Elsevier Ltd. All rights reserved.
Glassman, Amanda; Cañón, Oscar; Silverman, Rachel
In middle-income countries, vaccines against pneumococcal disease, rotavirus, and human papilloma virus are in general more costly, not necessarily cost saving, and less consistently cost-effective than earlier generation vaccines against measles, diphtheria, tetanus, and pertussis. Budget impact is also substantial; public spending on vaccines in countries adopting new vaccines is, on average, double the amount of countries that have not adopted. Policymakers must weigh the costs and benefits of the adoption decision carefully, given the low coverage of other kinds of cost-effective health and nonhealth interventions in these same settings and relatively flat overall public spending on health as a share of gross domestic product (GDP) over time. This paper considers lessons learned from recent vaccine cost-effectiveness analyses and subsequent adoption decisions in Latin America a, largely under the auspices of the Pro Vac Initiative. The paper illustrates how small methodological choices and seemingly minor technical limitations of cost-effectiveness models can have major implications for the studies' conclusions, potentially influencing countries' subsequent vaccine adoption decisions. We evaluate the ProVac models and technical outputs against the standards and framework set out by the International Decision Support Initiative Reference Case for economic evaluation and consider the practical effects of deviations from those standards. Lessons learned are discussed, including issues of appropriate comparators, GDP-based thresholds, and use of average versus incremental cost-effectiveness ratios as a convention are assessed. The article ends with recommendations for the future. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Wisløff, Torbjørn; Atar, Dan
Clopidogrel has, for long time, been accepted as the standard treatment for patients who have undergone a percutaneous coronary intervention (PCI). The introduction of prasugrel-and more recently, ticagrelor-has introduced a decision-making problem for clinicians and governments worldwide: to use the cheaper clopidogrel or the more effective, and also more expensive prasugrel or ticagrelor. We aim to give helpful contributions to this debate by analysing the cost-effectiveness of clopidogrel, prasugrel, and ticagrelor compared with each other. We modified a previously developed Markov model of cardiac disease progression. In the model, we followed up cohorts of patients who have recently had a PCI until 100 years or death. Possible events are revascularization, bleeding, acute myocardial infarction, and death. Our analysis shows that ticagrelor is cost-effective in 77% of simulations at an incremental cost-effectiveness ratio of €7700 compared with clopidogrel. Ticagrelor was also cost-effective against prasugrel at a cost-effectiveness ratio of €7800. Given a Norwegian cost-effectiveness threshold of €70 000, both comparisons appear to be clearly cost-effective in favour of ticagrelor. Ticagrelor is cost-effective compared with both clopidogrel and prasugrel for patients who have undergone a PCI.
Fiddelers, A A A; Land, J A; Voss, G; Kessels, A G H; Severens, J L
For the evaluation of tubal function, Chlamydia antibody testing (CAT) has been introduced as a screening test. We compared six CAT screening strategies (five CAT tests and one combination of tests), with respect to their cost-effectiveness, by using IVF pregnancy rate as outcome measure. A decision analytic model was developed based on a source population of 1715 subfertile women. The model incorporates hysterosalpingography (HSG), laparoscopy and IVF. To calculate IVF pregnancy rates, costs, effects, cost-effectiveness and incremental costs per effect of the six different CAT screening strategies were determined. pELISA Medac turned out to be the most cost-effective CAT screening strategy (15 075 per IVF pregnancy), followed by MIF Anilabsystems (15 108). A combination of tests (pELISA Medac and MIF Anilabsystems; 15 127) did not improve the cost-effectiveness of the single strategies. Sensitivity analyses showed that the results are robust for changes in the baseline values of the model parameters. Only small differences were found between the screening strategies regarding the cost-effectiveness, although pELISA Medac was the most cost-effective strategy. Before introducing a particular CAT test into clinical practice, one should consider the effects and consequences of the entire screening strategy, instead of only the diagnostic accuracy of the test used.
Kotnis, Bhushan; Kuri, Joy
Campaigners are increasingly using online social networking platforms for promoting products, ideas and information. A popular method of promoting a product or even an idea is incentivizing individuals to evangelize the idea vigorously by providing them with referral rewards in the form of discounts, cash backs, or social recognition. Due to budget constraints on scarce resources such as money and manpower, it may not be possible to provide incentives for the entire population, and hence incentives need to be allocated judiciously to appropriate individuals for ensuring the highest possible outreach size. We aim to do the same by formulating and solving an optimization problem using percolation theory. In particular, we compute the set of individuals that are provided incentives for minimizing the expected cost while ensuring a given outreach size. We also solve the problem of computing the set of individuals to be incentivized for maximizing the outreach size for given cost budget. The optimization problem turns out to be non trivial; it involves quantities that need to be computed by numerically solving a fixed point equation. Our primary contribution is, that for a fairly general cost structure, we show that the optimization problems can be solved by solving a simple linear program. We believe that our approach of using percolation theory to formulate an optimization problem is the first of its kind.
Savitz, Lucy A; Savitz, Samuel T
Understanding costs and ensuring that we demonstrate value in healthcare is a foundational presumption as we transform the way we deliver and pay for healthcare in the U.S. With a focus on population health and payment reforms underway, there is increased pressure to examine cost-effectiveness in healthcare delivery. Cost-effectiveness analysis (CEA) is a type of economic analysis comparing the costs and effects (i.e. health outcomes) of two or more treatment options. The result is expressed as a ratio where the denominator is the gain in health from a measure (e.g. years of life or quality-adjusted years of life) and the numerator is the incremental cost associated with that health gain. For higher cost interventions, the lower the ratio of costs to effects, the higher the value. While CEA is not new, the approach continues to be refined with enhanced statistical techniques and standardized methods. This article describes the CEA approach and also contrasts it to optional approaches, in order for readers to fully appreciate caveats and concerns. CEA as an economic evaluation tool can be easily misused owing to inappropriate assumptions, over reliance, and misapplication. Twelve issues to be considered in using CEA results to drive healthcare delivery decision-making are summarized. Appropriately recognizing both the strengths and the limitations of CEA is necessary for informed resource allocation in achieving the maximum value for healthcare services provided.
Adla, Deepthi N; Rowsell, Mark; Pandey, Radhakant
Economic evaluation of surgical procedures is necessary in view of more expensive newer techniques emerging in an increasingly cost-conscious health care environment. This study compares the cost-effectiveness of open rotator cuff repair with arthroscopic repair for moderately size tears. This was a prospective study of 30 consecutive patients, of whom 15 had an arthroscopic repair and 15 had an open procedure. Clinical effectiveness was assessed using Oxford and Constant shoulder scores. Costs were estimated from departmental and hospital financial data. At last follow-up, no difference Oxford and Constant shoulder scores was noted between the 2 methods of repair. There was no significant difference between the groups in the cost of time in the operating theater, inpatient time, amount of postoperative analgesia, number of postoperative outpatient visits, physiotherapy costs, and time off work. The incremental cost of each arthroscopic rotator cuff repair was pound675 ($1248.75) more than the open procedure. This was mainly in the area of direct health care costs, instrumentation in particular. Health care policy makers are increasingly demanding evidence of cost-effectiveness of a procedure. This study showed both methods of repair provide equivalent clinical results. Open cuff repair is more cost-effective than arthroscopic repair and is likely to have lower cost-utility ratio. In addition, the tariff for the arthroscopic procedure in some health care systems is same as open repair. Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.
Yasutaka, T.; Naito, W. [National Institute of Advanced Industrial Science and Technology (Japan)
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
Kessler, Andrew C.; Merchant, James W.; Shultz, Steven D.; Allen, Craig R.
Invasive species often threaten native wildlife populations and strain the budgets of agencies charged with wildlife management. We demonstrate the potential of cost-effectiveness analysis to improve the efficiency and value of efforts to enhance sandhill crane (Grus canadensis) roosting habitat. We focus on the central Platte River in Nebraska (USA), a region of international ecological importance for migrating avian species including sandhill cranes. Cost-effectiveness analysis is a valuation process designed to compare alternative actions based on the cost of achieving a pre-determined objective. We estimated costs for removal of invasive vegetation using geographic information system simulations and calculated benefits as the increase in area of sandhill crane roosting habitat. We generated cost effectiveness values for removing invasive vegetation on 7 land parcels and for the entire central Platte River to compare the cost-effectiveness of management at specific sites and for the central Platte River landscape. Median cost effectiveness values for the 7 land parcels evaluated suggest that costs for creating 1 additional hectare of sandhill crane roosting habitat totaled US $1,595. By contrast, we found that creating an additional hectare of sandhill crane roosting habitat could cost as much as US $12,010 for some areas in the central Platte River, indicating substantial cost savings can be achieved by using a cost effectiveness analysis to target specific land parcels for management. Cost-effectiveness analysis, used in conjunction with geographic information systems, can provide decision-makers with a new tool for identifying the most economically efficient allocation of resources to achieve habitat management goals.
Wells, James D
Promoting a theory with a finite number of terms into an effective field theory with an infinite number of terms worsens simplicity, predictability, falsifiability, and other attributes often favored in theory choice. However, the importance of these attributes pales in comparison with consistency, both observational and mathematical consistency, which propels the effective theory to be superior to its simpler truncated version of finite terms, whether that theory be renormalizable (e.g., Standard Model of particle physics) or nonrenormalizable (e.g., gravity). Some implications for the Large Hadron Collider and beyond are discussed, including comments on how directly acknowledging the preeminence of consistency can affect future theory work.
Bandla, Hari; Franco, Rose A; Simpson, Deborah; Brennan, Kimberly; McKanry, Jennifer; Bragg, Dawn
Sleep disorders are highly prevalent across all age groups but often remain undiagnosed and untreated, resulting in significant health consequences. To overcome an inadequacy of available curricula and learner and instructor time constraints, this study sought to determine if an online sleep medicine curriculum would achieve equivalent learner outcomes when compared with traditional, classroom-based, face-to-face instruction at equivalent costs. Medical students rotating on a required clinical clerkship received instruction in 4 core clinical sleep-medicine competency domains in 1 of 2 delivery formats: a single 2.5-hour face-to-face workshop or 4 asynchronous e-learning modules. Immediate learning outcomes were assessed in a subsequent clerkship using a multiple-choice examination and standardized patient station, with long-term outcomes assessed through analysis of students' patient write-ups for inclusion of sleep complaints and diagnoses before and after the intervention. Instructional costs by delivery format were tracked. Descriptive and inferential statistical analyses compared learning outcomes and costs by instructional delivery method (face-to-face versus e-learning). Face-to-face learners, compared with online learners, were more satisfied with instruction. Learning outcomes (i.e., multiple-choice examination, standardized patient encounter, patient write-up), as measured by short-term and long-term assessments, were roughly equivalent. Design, delivery, and learner-assessment costs by format were equivalent at the end of 1 year, due to higher ongoing teaching costs associated with face-to-face learning offsetting online development and delivery costs. Because short-term and long-term learner performance outcomes were roughly equivalent, based on delivery method, the cost effectiveness of online learning is an economically and educationally viable instruction platform for clinical clerkships.
Lippert, B; Berger, K; Berntorp, E; Giangrande, P; van den Berg, M; Schramm, W; Siebert, U
The aim of this study was to assess the incremental cost effectiveness of on-demand versus prophylactic haemophilia therapy in Germany, Sweden, the United Kingdom and The Netherlands from the third-party payers' perspective. Using a decision tree model, the cost effectiveness of on-demand versus
Batura, N P; Bocharov, V V
The method for a complete analysis of the factors determining cost effectiveness of a drilling rig fleet is examined. The system of calculating production indexes from statistical reports is relatively simple and is not difficult to use for production organizations. The analytical results may be used to develop actual measures used to increase cost effectiveness of drilling operations.
Baltussen, R.M.P.M.; Sylla, M.; Frick, K.D.; Mariotti, S.P.
BACKGROUND/AIMS: The fight against blinding trachoma is being addressed with an integrated strategy of surgery, antibiotics, hygiene promotion, and environmental improvement-the SAFE strategy, but its cost-effectiveness is largely unknown. This paper estimates the cost effectiveness of surgery and
Yeh, Stuart S.
A cost-effectiveness analysis of the National Board for Professional Teaching Standards (NBPTS) program suggests that Board certification is less cost-effective than a range of alternative approaches for raising student achievement, including comprehensive school reform, class size reduction, a 10% increase in per pupil expenditure, the use of…
Changing feeding practices is beneficial, depending on context. Breastfeeding is dominant (less costly, more effective) in rural settings, whilst formula feeding is a dominant strategy in urban settings. Cost-effectiveness was most sensitive to proportion of women on lifelong antiretroviral therapy (ART) and infant mortality rate ...
health outcomes and wasted resources.4-5 It was found that the cost- effectiveness of South ... Priorities for Developing Countries Project was that emergency (and even some elective) ... to control air pollutants found that in South Africa the most cost- effective ..... outdoor air pollution in South Africa in 2000. S Afr Med J ...
Fitzpatrick, Christopher; Floyd, Katherine
Around 0.4 million cases of multidrug-resistant tuberculosis (MDR-TB) occur each year. Only a small fraction of these cases are treated according to international guidelines. Evidence relevant to decisions about whether to scale-up treatment for MDR-TB includes cost and cost-effectiveness data. Up to 2010, no systematic review of this evidence has been available. Our objective was to conduct a systematic review of the cost and cost effectiveness of treatment for MDR-TB and synthesize the available data. We searched for papers published or prepared for publication in peer-review journals and grey literature using search terms in five languages: English, French, Portuguese, Russian and Spanish. From an initial set of 420 studies, four were included, from Peru, the Philippines, Estonia and Tomsk Oblast in the Russian Federation. Results on costs, effectiveness and cost effectiveness were extracted. Assessment of the quality of each economic evaluation was guided by two existing checklists around which there is broad consensus. Costs were adjusted to a common year of value (2005) to remove distortions caused by inflation, and calculated in two common currencies: $US and international dollars (I$), to standardize for purchasing power parity. Data from the four identified studies were then synthesized using probabilistic sensitivity analysis, to appraise the likely cost and cost effectiveness of MDR-TB treatment in other settings, relative to WHO benchmarks for assessing whether or not an intervention is cost effective. Best estimates are provided as means, with 5th and 95th percentiles of the distributions. The cost per patient for MDR-TB treatment in Estonia, Peru, the Philippines and Tomsk was $US10 880, $US2423, $US3613 and $US14 657, respectively. Best estimates of the cost per disability-adjusted life-year (DALY) averted were $US598 (I$960), $US163 (I$291), $US143 (I$255) and $US745 (I$1059), respectively. The main influences on costs were (i) the model of care
Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy.
Schroeck, Florian Rudolf; Jacobs, Bruce L; Bhayani, Sam B; Nguyen, Paul L; Penson, David; Hu, Jim
Some of the high costs of robot-assisted radical prostatectomy (RARP), intensity-modulated radiotherapy (IMRT), and proton beam therapy may be offset by better outcomes or less resource use during the treatment episode. To systematically review the literature to identify the key economic trade-offs implicit in a particular treatment choice for prostate cancer. We systematically reviewed the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and protocol. We searched Medline, Embase, and Web of Science for articles published between January 2001 and July 2016, which compared the treatment costs of RARP, IMRT, or proton beam therapy to the standard treatment. We identified 37, nine, and three studies, respectively. RARP is costlier than radical retropubic prostatectomy for hospitals and payers. However, RARP has the potential for a moderate cost advantage for payers and society over a longer time horizon when optimal cancer and quality-of-life outcomes are achieved. IMRT is more expensive from a payer's perspective compared with three-dimensional conformal radiotherapy, but also more cost effective when defined by an incremental cost effectiveness ratio new versus traditional technologies is costlier. However, given the low quality of evidence and the inconsistencies across studies, the precise difference in costs remains unclear. Attempts to estimate whether this increased cost is worth the expense are hampered by the uncertainty surrounding improvements in outcomes, such as cancer control and side effects of treatment. If the new technologies can consistently achieve better outcomes, then they may be cost effective. We review the cost and cost effectiveness of robot-assisted radical prostatectomy, intensity-modulated radiotherapy, and proton beam therapy in prostate cancer treatment. These technologies are costlier than their traditional counterparts. It remains unclear whether their use is associated
Hektoen, Liv F; Aas, Eline; Lurås, Hilde
The aim of this study was to estimate the cost-effectiveness of implementing an exercise-based fall prevention programme for home-dwelling women in the > or = 80-year age group in Norway. The impact of the home-based individual exercise programme on the number of falls is based on a New Zealand study. On the basis of the cost estimates and the estimated reduction in the number of falls obtained with the chosen programme, we calculated the incremental costs and the incremental effect of the exercise programme as compared with no prevention. The calculation of the average healthcare cost of falling was based on assumptions regarding the distribution of fall injuries reported in the literature, four constructed representative case histories, assumptions regarding healthcare provision associated with the treatment of the specified cases, and estimated unit costs from Norwegian cost data. We calculated the average healthcare costs per fall for the first year. We found that the reduction in healthcare costs per individual for treating fall-related injuries was 1.85 times higher than the cost of implementing a fall prevention programme. The reduction in healthcare costs more than offset the cost of the prevention programme for women aged > or = 80 years living at home, which indicates that health authorities should increase their focus on prevention. The main intention of this article is to stipulate costs connected to falls among the elderly in a transparent way and visualize the whole cost picture. Cost-effectiveness analysis is a health policy tool that makes politicians and other makers of health policy conscious of this complexity.
Initial responses of naïve individuals to critical environmental stimuli provide important information about the innate contribution to behaviour, and subsequent responses to the same stimuli may show the role of experience in mediating those initial responses. To test the role of these factors, I measured initial patch choices and giving-up responses of just-emerged, naïve, second-instar crab spiders, Misumena vatia, on several hunting sites they encountered after leaving their natal nests. In follow-up tests I measured the effects of these experiences on subsequent patch choice decisions. The choice of hunting sites is a vital decision at all stages of the life cycle for sit-and-wait predators such as Misumena. In their initial tests these spiderlings remained more frequently on goldenrod (Solidago spp.) flowers than on green or yellow goldenrod buds, a preference they retained through tests run on 5 consecutive days. Individuals on green and yellow buds shifted sites more quickly and frequently than those from flowers, and made most of these moves to flowers, which attracted many more prey than did buds. These differences were not affected by age, energetic condition, or loss of information over the period of the experiment. Once spiderlings moved from buds, they showed a high, increasing tendency to move from buds in subsequent runs, those from flowers showed a consistently low tendency. These results suggest that spiderlings retain their innate behavioural patterns through the second instar, but that experience also plays a modest role in patch choice at this stage. Copyright 2000 The Association for the Study of Animal Behaviour.
Van Voorhis, B J; Syrop, C H
Although the evaluation of cost-effective approaches to infertility treatment remains in its infancy, several important principles have emerged from the initial studies in this field. Currently, in treating couples with infertility without tubal disease or severe male-factor infertility, the most cost-effective approach is to start with IUI or superovulation-IUI treatments before resorting to IVF procedures. The woman's age and number of sperm present for insemination are significant factors influencing cost-effectiveness. The influence of certain diagnoses on the cost-effectiveness of infertility treatments requires further study. Even when accounting for the costs associated with multiple gestations and premature deliveries, the cost of IVF decreases within the range of other cost-effective medical procedures and decreases to less than the willingness to pay for these procedures. Indeed, for patients with severe tubal disease, IVF has been found to be more cost-effective than surgical repair. The cost-effectiveness of IVF will likely improve as success rates show continued improvements over the course of time. In addition, usefulness of embryo selection and practices to reduce the likelihood of high-order multiple pregnancies, without reductions in pregnancy rates, will significantly impact cost-effectiveness. The exclusion of infertility treatments from insurance plans is unfortunate and accentuates the importance of physicians understanding the economics of infertility treatment with costs that are often passed directly to the patient. The erroneous economic policies and judgments that have led to inequities in access to infertility health care should not be tolerated.
Shang, Zhe; Tao, Tuoxin; Wang, Lei
Choice effect is a robust phenomenon in which even “mere choice” that does not include actual choosing actions could result in more preference for the self-chosen objects over other-chosen objects. In the current research, we proposed that autonomy would impact the mere choice effect. We conducted two studies to examine the hypothesis. The results showed that the mere choice effect measured by Implicit Association Test (IAT) significantly decreased for participants with lower levels of trait autonomy (Study 1) and when participants were primed to experience autonomy deprivation (Study 2). The theoretical and practical implications are discussed. PMID:27148132
Bower, P; Rowland, N; Mellor, C l; Heywood, P; Godfrey, C; Hardy, R
Counsellors are prevalent in primary care settings. However, there are concerns about the clinical and cost-effectiveness of the treatments they provide, compared with alternatives such as usual care from the general practitioner, medication or other psychological therapies. To assess the effectiveness and cost effectiveness of counselling in primary care by reviewing cost and outcome data in randomised controlled trials, controlled clinical trials and controlled patient preference trials of counselling interventions in primary care, for patients with psychological and psychosocial problems considered suitable for counselling. The original search strategy included electronic searching of databases (including the CCDAN Register of RCTs and CCTs) along with handsearching of a specialist journal. Published and unpublished sources (clinical trials, books, dissertations, agency reports etc.) were searched, and their reference lists scanned to uncover further controlled trials. Contact was made with subject experts and CCDAN members in order to uncover further trials. For the updated review, searches were restricted to those databases judged to be high yield in the first version of the review: MEDLINE, EMBASE, PSYCLIT and CINAHL, the Cochrane Controlled Trials register and the CCDAN trials register. All controlled trials comparing counselling in primary care with other treatments for patients with psychological and psychosocial problems considered suitable for counselling. Trials completed before the end of June 2001 were included in the review. Data were extracted using a standardised data extraction sheet. The relevant data were entered into the Review Manager software. Trials were quality rated, using CCDAN criteria, to assess the extent to which their design and conduct were likely to have prevented systematic error. Continuous measures of outcome were combined using standardised mean differences. An overall effect size was calculated for each outcome with 95
Kapel, David E.; And Others
This study investigated possible effects of school choice programs by surveying 200 private schools in large urban areas. The survey instrument requested information on school demography, possible effects of participation in a Choice program, costs, selection of students participating in Choice, and climate and parental involvement. Analysis of…
Edidin, Avram A; Ong, Kevin L; Lau, Edmund; Schmier, Jordana K; Kemner, Jason E; Kurtz, Steven M
Vertebral compression fractures (VCFs) can be treated by nonsurgical management or by minimally invasive surgical treatment including vertebroplasty and balloon kyphoplasty. The purpose of the present study was to characterize the cost to Medicare for treating VCF-diagnosed patients by nonsurgical management, vertebroplasty, or kyphoplasty. We hypothesized that surgical treatments for VCFs using vertebroplasty or kyphoplasty would be a cost-effective alternative to nonsurgical management for the Medicare patient population. Cost per life-year gained for VCF patients in the US Medicare population was compared between operated (kyphoplasty and vertebroplasty) and non-operated patients and between kyphoplasty and vertebroplasty patients, all as a function of patient age and gender. Life expectancy was estimated using a parametric Weibull survival model (adjusted for comorbidities) for 858 978 VCF patients in the 100% Medicare dataset (2005-2008). Median payer costs were identified for each treatment group for up to 3 years following VCF diagnosis, based on 67 018 VCF patients in the 5% Medicare dataset (2005-2008). A discount rate of 3% was used for the base case in the cost-effectiveness analysis, with 0% and 5% discount rates used in sensitivity analyses. After accounting for the differences in median costs and using a discount rate of 3%, the cost per life-year gained for kyphoplasty and vertebroplasty patients ranged from $US1863 to $US6687 and from $US2452 to $US13 543, respectively, compared with non-operated patients. The cost per life-year gained for kyphoplasty compared with vertebroplasty ranged from -$US4878 (cost saving) to $US2763. Among patients for whom surgical treatment was indicated, kyphoplasty was found to be cost effective, and perhaps even cost saving, compared with vertebroplasty. Even for the oldest patients (85 years of age and older), both interventions would be considered cost effective in terms of cost per life-year gained.
/Integrated Set of Information System (CDS/ISIS) application software in the library and its effectiveness in performance operations was evaluated to determine the cost – effectiveness. The study population was made up of all the staff involved ...
Gomez, G B; Dowdy, D W; Bastos, M L; Zwerling, A; Sweeney, S; Foster, N; Trajman, A; Islam, M A; Kapiga, S; Sinanovic, E; Knight, G M; White, R G; Wells, W A; Cobelens, F G; Vassall, A
Despite improvements in treatment success rates for tuberculosis (TB), current six-month regimen duration remains a challenge for many National TB Programmes, health systems, and patients. There is increasing investment in the development of shortened regimens with a number of candidates in phase 3 trials. We developed an individual-based decision analytic model to assess the cost-effectiveness of a hypothetical four-month regimen for first-line treatment of TB, assuming non-inferiority to current regimens of six-month duration. The model was populated using extensive, empirically-collected data to estimate the economic impact on both health systems and patients of regimen shortening for first-line TB treatment in South Africa, Brazil, Bangladesh, and Tanzania. We explicitly considered 'real world' constraints such as sub-optimal guideline adherence. From a societal perspective, a shortened regimen, priced at USD1 per day, could be a cost-saving option in South Africa, Brazil, and Tanzania, but would not be cost-effective in Bangladesh when compared to one gross domestic product (GDP) per capita. Incorporating 'real world' constraints reduces cost-effectiveness. Patient-incurred costs could be reduced in all settings. From a health service perspective, increased drug costs need to be balanced against decreased delivery costs. The new regimen would remain a cost-effective option, when compared to each countries' GDP per capita, even if new drugs cost up to USD7.5 and USD53.8 per day in South Africa and Brazil; this threshold was above USD1 in Tanzania and under USD1 in Bangladesh. Reducing the duration of first-line TB treatment has the potential for substantial economic gains from a patient perspective. The potential economic gains for health services may also be important, but will be context-specific and dependent on the appropriate pricing of any new regimen.
Soliño, Mario; Farizo, Begoña A.; Vázquez, María X.; Prada, Albino
This paper presents a choice experiment analyzing the consumers' preferences towards a policy for replacing conventional electricity with electricity generated from forest biomass. The results show that consumers specially prefer the effects related to the lower risk of forest fires and to the decrease in pressure on non-renewable resources. The article also presents a methodological test in relation to the payment timeframe and its effect on marginal willingness to pay and consistency of responses using choice experiments. The most frequent and realistic payments are associated with lower presence of inconsistent responses. Finally, we cannot reject the null hypothesis of no effects of payment timeframe on marginal willingness to pay. - Highlights: ▶ Analysis of preferences towards electricity generated from forest biomass. ▶ Lowering the risk of forest fires is a high valued external effect. ▶ Less pressure on non-renewable resources is highly valued. ▶ Frequent payments are associated with lower presence of inconsistent responses. ▶ Effects of payment timeframe on marginal willingness to pay.
Killie, M K; Kjeldsen-Kragh, J; Husebekk, A
OBJECTIVES: To estimate the costs and health consequences of three different screening strategies for neonatal alloimmune thrombocytopenia (NAIT). DESIGN: Cost-utility analysis on the basis of a decision tree that incorporates the relevant strategies and outcomes. SETTING: Three health regions......-4 weeks before term. Severely thrombocytopenic newborn were transfused immediately with compatible platelets. MAIN OUTCOME MEASUREMENTS: Quality-adjusted life years (QALYs) and costs. RESULTS: Compared with no screening, a programme of screening and subsequent treatment would generate between 210 and 230...... additional QALYs among 100,000 pregnant women, and at the same time, reduce health care costs by approximately 1.7 million euros. The sensitivity analyses indicate that screening is cost effective or even cost saving within a wide range of probabilities and costs. CONCLUSION: Our calculations indicate...
Rendas-Baum, Regina; Yang, Min; Gricar, Joseph; Wallenstein, Gene V
Premenstrual syndrome (PMS) is reported to affect between 13% and 31% of women. Between 3% and 8% of women are reported to meet criteria for the more severe form of PMS, premenstrual dysphoric disorder (PMDD). Although PMDD has received increased attention in recent years, the cost effectiveness of treatments for PMDD remains unknown. To evaluate the cost effectiveness of the four medications with a US FDA-approved indication for PMDD: fluoxetine, sertraline, paroxetine and drospirenone plus ethinyl estradiol (DRSP/EE). A decision-analytic model was used to evaluate both direct costs (medication and physician visits) and clinical outcomes (treatment success, failure and discontinuation). Medication costs were based on average wholesale prices of branded products; physician visit costs were obtained from a claims database study of PMDD patients and the Agency for Healthcare Research and Quality. Clinical outcome probabilities were derived from published clinical trials in PMDD. The incremental cost-effectiveness ratio (ICER) was calculated using the difference in costs and percentage of successfully treated patients at 6 months. Deterministic and probabilistic sensitivity analyses were used to assess the impact of uncertainty in parameter estimates. Threshold values where a change in the cost-effective strategy occurred were identified using a net benefit framework. Starting therapy with DRSP/EE dominated both sertraline and paroxetine, but not fluoxetine. The estimated ICER of initiating treatment with fluoxetine relative to DRSP/EE was $US4385 per treatment success (year 2007 values). Cost-effectiveness acceptability curves revealed that for ceiling ratios>or=$US3450 per treatment success, fluoxetine had the highest probability (>or=0.37) of being the most cost-effective treatment, relative to the other options. The cost-effectiveness acceptability frontier further indicated that DRSP/EE remained the option with the highest expected net monetary benefit for
Maletz, J.J.; Marston, M.J.
This paper describes a new computerized database method to create/edit/view specification technical data sheets (mini-specifications) for procurement of spare parts for nuclear facility maintenance and to develop information that could support possible future facility life extension efforts. This method may reduce cost when compared with current manual methods. The use of standardized technical data sheets (mini-specifications) for items of the same category improves efficiency. This method can be used for a variety of tasks, including: Nuclear safety-related procurement; Non-safety related procurement; Commercial grade item procurement/dedication; Evaluation of replacement items. This program will assist the nuclear facility in upgrading its procurement activities consistent with the recent NUMARC Procurement Initiative. Proper utilization of the program will assist the user in assuring that the procured items are correct for the applications, provide data to assist in detecting fraudulent materials, minimize human error in withdrawing database information, improve data retrievability, improve traceability, and reduce long-term procurement costs
Buckle, Abigail; Taylor, Celia
Necrotizing enterocolitis (NEC) is a costly gastrointestinal disorder that mainly affects preterm and low-birth-weight infants and can lead to considerable morbidity and mortality. Mother's own milk is protective against NEC but is not always available. In such cases, donor human milk has also been shown to be protective (although to a lesser extent) compared with formula milk, but it is more expensive. This systematic review aimed at evaluating the cost of donor milk, the cost of treating NEC, and the cost-effectiveness of exclusive donor milk versus formula milk feeding to reduce the short-term health and treatment costs of NEC. We systematically searched five relevant databases to find studies with verifiable costs or charges of donor milk and/or treatment of NEC and any economic evaluations comparing exclusive donor milk with exclusive formula milk feeding. All search results were double screened. Seven studies with verifiable donor milk costs and 17 with verifiable NEC treatment costs were included. The types of cost or charge included varied considerably across studies, so quantitative synthesis was not attempted. Estimates of the incremental length of stay associated with NEC were ∼18 days for medical NEC and 50 days for surgical NEC. Two studies claimed to report economic evaluations but did not do so in practice. It is likely that donor milk provides short-term cost savings by reducing the incidence of NEC. Future studies should provide more details on cost components included and a full economic evaluation, including long-term outcomes, should be undertaken.
Wijk, de R.A.; Zijlstra, S.
Background Aromas have been associated with physiological, psychological affective and behavioral effects. We tested whether effects of low-level exposure to two ambient food-related aromas (citrus and vanilla) could be measured with small numbers of subjects, low-cost physiological sensors and
Peter J Neumann
Full Text Available Calculating the cost per disability-adjusted life years (DALYs averted associated with interventions is an increasing popular means of assessing the cost-effectiveness of strategies to improve population health. However, there has been no systematic attempt to characterize the literature and its evolution.We conducted a systematic review of cost-effectiveness studies reporting cost-per-DALY averted from 2000 through 2015. We developed the Global Health Cost-Effectiveness Analysis (GHCEA Registry, a repository of English-language cost-per-DALY averted studies indexed in PubMed. To identify candidate studies, we searched PubMed for articles with titles or abstracts containing the phrases "disability-adjusted" or "DALY". Two reviewers with training in health economics independently reviewed each article selected in our abstract review, gathering information using a standardized data collection form. We summarized descriptive characteristics on study methodology: e.g., intervention type, country of study, study funder, study perspective, along with methodological and reporting practices over two time periods: 2000-2009 and 2010-2015. We analyzed the types of costs included in analyses, the study quality on a scale from 1 (low to 7 (high, and examined the correlation between diseases researched and the burden of disease in different world regions.We identified 479 cost-per-DALY averted studies published from 2000 through 2015. Studies from Sub-Saharan Africa comprised the largest portion of published studies. The disease areas most commonly studied were communicable, maternal, neonatal, and nutritional disorders (67%, followed by non-communicable diseases (28%. A high proportion of studies evaluated primary prevention strategies (59%. Pharmaceutical interventions were commonly assessed (32% followed by immunizations (28%. Adherence to good practices for conducting and reporting cost-effectiveness analysis varied considerably. Studies mainly included
Bellows, Brandon K; Tak, Casey R; Sanders, Jessica N; Turok, David K; Schwarz, Eleanor B
The copper intrauterine device is the most effective form of emergency contraception and can also provide long-term contraception. The levonorgestrel intrauterine device has also been studied in combination with oral levonorgestrel for women seeking emergency contraception. However, intrauterine devices have higher up-front costs than oral methods, such as ulipristal acetate and levonorgestrel. Health care payers and decision makers (eg, health care insurers, government programs) with financial constraints must determine if the increased effectiveness of intrauterine device emergency contraception methods are worth the additional costs. We sought to compare the cost-effectiveness of 4 emergency contraception strategies-ulipristal acetate, oral levonorgestrel, copper intrauterine device, and oral levonorgestrel plus same-day levonorgestrel intrauterine device-over 1 year from a US payer perspective. Costs (2017 US dollars) and pregnancies were estimated over 1 year using a Markov model of 1000 women seeking emergency contraception. Every 28-day cycle, the model estimated the predicted number of pregnancy outcomes (ie, live birth, ectopic pregnancy, spontaneous abortion, or induced abortion) resulting from emergency contraception failure and subsequent contraception use. Model inputs were derived from published literature and national sources. An emergency contraception strategy was considered cost-effective if the incremental cost-effectiveness ratio (ie, the cost to prevent 1 additional pregnancy) was less than the weighted average cost of pregnancy outcomes in the United States ($5167). The incremental cost-effectiveness ratios and probability of being the most cost-effective emergency contraception strategy were calculated from 1000 probabilistic model iterations. One-way sensitivity analyses were used to examine uncertainty in the cost of emergency contraception, subsequent contraception, and pregnancy outcomes as well as the model probabilities. In 1000 women
Magalhães, Paula; Geoffrey White, K
The sunk cost effect is the bias or tendency to persist in a course of action due to prior investments of effort, money or time. At the time of the only review on the sunk cost effect across species (Arkes & Ayton, 1999), research with nonhuman animals had been ecological in its nature, and the findings about the effect of past investments on current choice were inconclusive. However, in the last decade a new line of experimental laboratory-based research has emerged with the promise of revolutionizing the way we approach the study of the sunk cost effect in nonhumans. In the present review we challenge Arkes and Ayton's conclusion that the sunk cost effect is exclusive to humans, and describe evidence for the sunk cost effect in nonhuman animals. By doing so, we also challenge the current explanations for the sunk cost effect in humans, as they are not applicable to nonhumans. We argue that a unified theory is called for, because different independent variables, in particular, investment amount, have the same influence on the sunk cost effect across species. Finally, we suggest possible psychological mechanisms shared across different species, contrast and depreciation, that could explain the sunk cost effect. © 2016 Society for the Experimental Analysis of Behavior.
Fleurence, Rachael L
The cost-effectiveness of alternating pressure-relieving devices, mattress replacements, and mattress overlays compared with a standard hospital (high-specification foam mattress) for the prevention and treatment of pressure ulcers in hospital patients in the United Kingdom was investigated. A decision-analytic model was constructed to evaluate different strategies to prevent or treat pressure ulcers. Three scenarios were evaluated: the prevention of pressure ulcers, the treatment of superficial ulcers, and the treatment of severe ulcers. Epidemiological and effectiveness data were obtained from the clinical literature. Expert opinion using a rating scale technique was used to obtain quality of life data. Costs of the devices were obtained from manufacturers, whereas costs of treatment were obtained from the literature. Uncertainty was explored through probabilistic sensitivity analysis. Using 30,000 pounds sterling/QALY (quality-adjusted life year) as the decision-maker's cut off point (the current UK standard), in scenario 1 (prevention), the cost-effective strategy was the mattress overlay at 1, 4, and 12 weeks. In scenarios 2 and 3, the cost-effective strategy was the mattress replacement at 1, 4, and 12 weeks. Standard care was a dominated intervention in all scenarios for values of the decision-maker's ceiling ratio ranging from 5,000 pounds sterling to 100,000 pounds sterling/QALY. However, the probabilistic sensitivity analysis results reflected the high uncertainty surrounding the choice of devices. Current information suggests that alternating pressure mattress overlays may be cost-effective for the prevention of pressure ulcers, whereas alternating pressure mattress replacements appears to be cost-effective for the treatment of superficial and severe pressure ulcers.
Background Advertising has been implicated in the declining quality of the American diet, but much of the research has been conducted with children rather than adults. This study tested the effects of televised food advertising on adult food choice. Methods Participants (N = 351) were randomized into one of 4 experimental conditions: exposure to food advertising vs. exposure to non-food advertising, and within each of these groups, exposure to a task that was either cognitively demanding or not cognitively demanding. The number of unhealthy snacks chosen was subsequently measured, along with total calories of the snacks chosen. Results Those exposed to food advertising chose 28% more unhealthy snacks than those exposed to non-food-advertising (95% CI: 7% - 53%), with a total caloric value that was 65 kcal higher (95% CI: 10-121). The effect of advertising was not significant among those assigned to the low-cognitive-load group, but was large and significant among those assigned to the high-cognitive-load group: 43% more unhealthy snacks (95% CI: 11% - 85%) and 94 more total calories (95% CI: 19-169). Conclusions Televised food advertising has strong effects on individual food choice, and these effects are magnified when individuals are cognitively occupied by other tasks. PMID:24721289
Zimmerman, Frederick J; Shimoga, Sandhya V
Advertising has been implicated in the declining quality of the American diet, but much of the research has been conducted with children rather than adults. This study tested the effects of televised food advertising on adult food choice. Participants (N = 351) were randomized into one of 4 experimental conditions: exposure to food advertising vs. exposure to non-food advertising, and within each of these groups, exposure to a task that was either cognitively demanding or not cognitively demanding. The number of unhealthy snacks chosen was subsequently measured, along with total calories of the snacks chosen. Those exposed to food advertising chose 28% more unhealthy snacks than those exposed to non-food-advertising (95% CI: 7% - 53%), with a total caloric value that was 65 kcal higher (95% CI: 10-121). The effect of advertising was not significant among those assigned to the low-cognitive-load group, but was large and significant among those assigned to the high-cognitive-load group: 43% more unhealthy snacks (95% CI: 11% - 85%) and 94 more total calories (95% CI: 19-169). Televised food advertising has strong effects on individual food choice, and these effects are magnified when individuals are cognitively occupied by other tasks.
Palmer, Matthew A; Sauer, James D; Holt, Glenys A
Choices from arrays are often characterized by position effects, such as edge-aversion. We investigated position effects when participants attempted to pick a suspect from an array similar to a police photo lineup. A reanalysis of data from 2 large-scale field studies showed that choices made under realistic conditions-closely matching eyewitness identification decisions in police investigations-displayed edge-aversion and bias to choose from the top row (Study 1). In a series of experiments (Studies 2a-2c and 3), participants guessing the location of a suspect exhibited edge-aversion regardless of whether the lineup was constructed to maximize the chances of the suspect being picked, to ensure the suspect did not stand out, or randomly. Participants favored top locations only when the lineup was constructed to maximize the chances of the suspect being picked. In Studies 4 and 5, position effects disappeared when (a) response options were presented in an array with no obvious center, edges, or corners, and (b) instructions stated that the suspect was placed randomly. These findings show that position effects are influenced by a combination of task instructions and array shape. Randomizing the location of the suspect and modifying the shape of the lineup array may reduce misidentification. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Full Text Available Abstract Background Information on cost-effectiveness of interventions to treat schizophrenia can assist health policy decision making, particularly given the lack of health resources in developing countries like Thailand. This study aims to determine the optimal treatment package, including drug and non-drug interventions, for schizophrenia in Thailand. Methods A Markov model was used to evaluate the cost-effectiveness of typical antipsychotics, generic risperidone, olanzapine, clozapine and family interventions. Health outcomes were measured in disability adjusted life years. We evaluated intervention benefit by estimating a change in disease severity, taking into account potential side effects. Intervention costs included outpatient treatment costs, hospitalization costs as well as time and travel costs of patients and families. Uncertainty was evaluated using Monte Carlo simulation. A sensitivity analysis of the expected range cost of generic risperidone was undertaken. Results Generic risperidone is more cost-effective than typicals if it can be produced for less than 10 baht per 2 mg tablet. Risperidone was the cheapest treatment with higher drug costs offset by lower hospital costs in comparison to typicals. The most cost-effective combination of treatments was a combination of risperidone (dominant intervention. Adding family intervention has an incremental cost-effectiveness ratio of 1,900 baht/DALY with a 100% probability of a result less than a threshold for very cost-effective interventions of one times GDP or 110,000 baht per DALY. Treating the most severe one third of patients with clozapine instead of risperidone had an incremental cost-effectiveness ratio of 320,000 baht/DALY with just over 50% probability of a result below three times GDP per capita. Conclusions There are good economic arguments to recommend generic risperidone as first line treatment in combination with family intervention. As the uncertainty interval indicates
Phanthunane, Pudtan; Vos, Theo; Whiteford, Harvey; Bertram, Melanie
Information on cost-effectiveness of interventions to treat schizophrenia can assist health policy decision making, particularly given the lack of health resources in developing countries like Thailand. This study aims to determine the optimal treatment package, including drug and non-drug interventions, for schizophrenia in Thailand. A Markov model was used to evaluate the cost-effectiveness of typical antipsychotics, generic risperidone, olanzapine, clozapine and family interventions. Health outcomes were measured in disability adjusted life years. We evaluated intervention benefit by estimating a change in disease severity, taking into account potential side effects. Intervention costs included outpatient treatment costs, hospitalization costs as well as time and travel costs of patients and families. Uncertainty was evaluated using Monte Carlo simulation. A sensitivity analysis of the expected range cost of generic risperidone was undertaken. Generic risperidone is more cost-effective than typicals if it can be produced for less than 10 baht per 2 mg tablet. Risperidone was the cheapest treatment with higher drug costs offset by lower hospital costs in comparison to typicals. The most cost-effective combination of treatments was a combination of risperidone (dominant intervention). Adding family intervention has an incremental cost-effectiveness ratio of 1,900 baht/DALY with a 100% probability of a result less than a threshold for very cost-effective interventions of one times GDP or 110,000 baht per DALY. Treating the most severe one third of patients with clozapine instead of risperidone had an incremental cost-effectiveness ratio of 320,000 baht/DALY with just over 50% probability of a result below three times GDP per capita. There are good economic arguments to recommend generic risperidone as first line treatment in combination with family intervention. As the uncertainty interval indicates the addition of clozapine may be dominated and there are serious
Background Information on cost-effectiveness of interventions to treat schizophrenia can assist health policy decision making, particularly given the lack of health resources in developing countries like Thailand. This study aims to determine the optimal treatment package, including drug and non-drug interventions, for schizophrenia in Thailand. Methods A Markov model was used to evaluate the cost-effectiveness of typical antipsychotics, generic risperidone, olanzapine, clozapine and family interventions. Health outcomes were measured in disability adjusted life years. We evaluated intervention benefit by estimating a change in disease severity, taking into account potential side effects. Intervention costs included outpatient treatment costs, hospitalization costs as well as time and travel costs of patients and families. Uncertainty was evaluated using Monte Carlo simulation. A sensitivity analysis of the expected range cost of generic risperidone was undertaken. Results Generic risperidone is more cost-effective than typicals if it can be produced for less than 10 baht per 2 mg tablet. Risperidone was the cheapest treatment with higher drug costs offset by lower hospital costs in comparison to typicals. The most cost-effective combination of treatments was a combination of risperidone (dominant intervention). Adding family intervention has an incremental cost-effectiveness ratio of 1,900 baht/DALY with a 100% probability of a result less than a threshold for very cost-effective interventions of one times GDP or 110,000 baht per DALY. Treating the most severe one third of patients with clozapine instead of risperidone had an incremental cost-effectiveness ratio of 320,000 baht/DALY with just over 50% probability of a result below three times GDP per capita. Conclusions There are good economic arguments to recommend generic risperidone as first line treatment in combination with family intervention. As the uncertainty interval indicates the addition of clozapine
Ruddock, Helen K; Hardman, Charlotte A
Despite being widely debated throughout the scientific community, the concept of food addiction remains a popular explanation for overeating and obesity amongst the lay public. Overeating is often accompanied by feelings of guilt and dietary concern, and this may lead people to attribute their eating to an addiction in order to minimise personal responsibility. Research also indicates that food addiction attributions and dietary concern may lead people to limit their exposure to tempting foods. To test these ideas, we examined the effect of perceived overeating on food addiction attributions and snack choice. Subjective ratings of guilt and dietary concern were indirectly manipulated by leading female participants (N=90) to believe they had eaten more than (overeating condition), less than (undereating condition), or roughly the same (control condition) amount of palatable foods in relation to their own estimated consumption and to previous participants. Participants then rated the relative importance of a list of explanations for their eating (including "the foods were really addictive") and selected a snack to take home with them. Ratings of guilt and dietary concern were highest in the overeating condition, and lowest in the undereating condition, indicating that the manipulation had been successful. However, findings revealed no effect of condition on food addiction attributions. As predicted, participants in the overeating condition selected less tempting snacks than in the undereating condition. However, this effect was not mediated by guilt/dietary concern. There was also no association between food-addiction attributions and snack choice. These findings suggest that perceived overeating affects snack choice but not food addiction attributions. Future research should investigate whether food addiction attributions may be driven by feelings of guilt and dietary concern following longer-term disinhibited eating patterns. Copyright © 2017 The Authors
Doumit, Rita; Long, JoAnn; Kazandjian, Chant; Gharibeh, Nathalie; Karam, Lina; Song, Huaxin; Boswell, Carol; Zeeni, Nadine
The well-documented increases in obesity and unhealthy dietary practices substantiate the need for evidence-based tools that can help people improve their dietary habits. The current spread of mobile phone-embedded cameras offers new opportunities for recording food intake. Moreover, the act of taking pictures of food consumed may enhance visual consciousness of food choice and quantity. The present study aimed to assess the effect of using cell phone pictures to record food intake on energy intake and food choice in college students. The effectiveness and acceptability of cell phone picture-based diet recording also was assessed. A repeated measures crossover design was used. One group of participants entered their food intake online during 3 days based on their memory, although a second group recorded their food intake using cell phone pictures as their reference. Participants then crossed over to complete 3 more days of diet recording using the alternate method. Focus groups were conducted to obtain feedback on the effectiveness and acceptability of cell phone picture-based diet recording. Intake of meat and vegetable servings were significantly higher in the memory period compared with the cell phone period, regardless of the order. Results from the focus group indicated a positive attitude toward the use of cell phone pictures in recording food intake and an increased awareness of food choice and portion size. Cell phone pictures may be an easy, relevant, and accessible method of diet self-monitoring when aiming at dietary changes. Future trials should combine this technique with healthy eating education. © 2015 Sigma Theta Tau International.
Schwendicke, Falk; Göstemeyer, Gerd
With a growing number of individuals retaining their teeth lifelong, often with periodontitis-induced root surface exposure, there is the need for cost-effective management strategies for root caries lesions. The present study aimed to assess the cost-effectiveness of root caries preventive treatments. Patients were simulated over 10 years using a Markov model. Four treatments were compared: No treatment, daily 225-800ppm fluoride rinses, chlorhexidine (CHX) varnish (2×/year), silver diamine fluoride (SDF) varnish (2×/year). Data from a systematic review were submitted to network meta-analysis for inferring relative efficacies of treatments. The health outcome was years of teeth being free of root caries. A mixed public-private payer perspective within 2016 German healthcare was taken, with costs being estimated from fee item catalogues or based on market prices. Populations with different numbers of teeth and tooth-level risks were modelled. Monte-Carlo microsimulations, univariate- and probabilistic sensitivity analyses were performed. In populations with 16 teeth at risk and low tooth-level risk for root caries, providing no preventive treatment was least costly, but also least effective (130 Euro, 144 years). SDF ranked next, being more costly (180 Euro), but also more effective (151 years). Payers willing to invest 8.30 Euro per root caries-free tooth-year found SDF most cost-effective. CHX varnish and fluoride rinse were not cost-effective. In populations with more teeth and high tooth-level risk, SDF was the most effective and least costly option. Root caries preventive treatments (like SDF) are effective and might even be cost-saving in high risk populations. Application of SDF can be recommended as a cost-saving treatment for prevention of root caries in patients with high risk of root caries. Copyright © 2016 Elsevier Ltd. All rights reserved.
Hatz, Maximilian H M; Schremser, Katharina; Rogowski, Wolf H
Individualized medicine (IM) is a rapidly evolving field that is associated with both visions of more effective care at lower costs and fears of highly priced, low-value interventions. It is unclear which view is supported by the current evidence. Our objective was to systematically review the health economic evidence related to IM and to derive general statements on its cost-effectiveness. A literature search of MEDLINE database for English- and German-language studies was conducted. Cost-effectiveness and cost-utility studies for technologies meeting the MEDLINE medical subject headings (MeSH) definition of IM (genetically targeted interventions) were reviewed. This was followed by a standardized extraction of general study characteristics and cost-effectiveness results. Most of the 84 studies included in the synthesis were from the USA (n = 43, 51 %), cost-utility studies (n = 66, 79 %), and published since 2005 (n = 60, 71 %). The results ranged from dominant to dominated. The median value (cost-utility studies) was calculated to be rounded $US22,000 per quality-adjusted life year (QALY) gained (adjusted to $US, year 2008 values), which is equal to the rounded median cost-effectiveness in the peer-reviewed English-language literature according to a recent review. Many studies reported more than one strategy of IM with highly varying cost-effectiveness ratios. Generally, results differed according to test type, and tests for disease prognosis or screening appeared to be more favorable than tests to stratify patients by response or by risk of adverse effects. However, these results were not significant. Different definitions of IM could have been used. Quality assessment of the studies was restricted to analyzing transparency. IM neither seems to display superior cost-effectiveness than other types of medical interventions nor to be economically inferior. Instead, rather than 'whether' healthcare was individualized, the question of 'how' it was individualized was
Berven, B.A.; Little, C.A.; Swaja, R.E.
Successful chemical and radiological site characterizations are complex activities which require meticulously detailed planning. Each layer of investigation is based upon previously generated information about the site. Baseline historical, physical, geological, and regulatory information is prerequisite for preliminary studies at a site. Preliminary studies then provide samples and measurements which define the identity of potential contaminants and define boundaries around the area to be investigated. The goal of a full site characterization is to accurately determine the extent and magnitude of contaminants and carefully define the site conditions such that the future movements of site contaminants can be assessed for potential exposure to human occupants and/or environmental impacts. Critical to this process is the selection of appropriate measurement and sampling methodology, selection and use of appropriate instrumentation and management/interpretation of site information. Site investigations require optimization between the need of information to maximize the understanding of site conditions and the cost of acquiring that information. 5 refs., 1 tab
Full Text Available The present study investigates acceptance of intervention strategies for low-calorie snack choices that vary regarding the effect they have on consumers’ freedom of choice (providing information, guiding choice through (disincentives, and restricting choice. We examine the mediating effects of perceived effectiveness and perceived fairness, and the moderating effects of barriers to choose low-calorie snacks and perceived responsibility for food choice. Data was collected through an online survey, involving three waves that were completed over a seven week timespan. Information was collected on barriers and perceived responsibility, and evaluations of a total of 128 intervention strategies with varying levels of intrusiveness that were further systematically varied in terms of source, location, approach/avoidance, type, and severity. A total of 1173 respondents completed all three waves. We found that the effect of intervention intrusiveness on acceptance was mediated by the perceived personal- and societal effectiveness, and the perceived fairness of interventions. For barriers and perceived responsibility, only main effects on intervention-specific beliefs were found. Government interventions were accepted less than interventions by food manufacturers. In conclusion, the present study shows that acceptance of interventions depends on perceptions of personal- and societal effectiveness and fairness, thereby providing novel starting points for increasing acceptance of both existing and new food choice interventions.
Bos, Colin; Van Der Lans, Ivo; Van Rijnsoever, Frank; Van Trijp, Hans
The present study investigates acceptance of intervention strategies for low-calorie snack choices that vary regarding the effect they have on consumers’ freedom of choice (providing information, guiding choice through (dis)incentives, and restricting choice). We examine the mediating effects of perceived effectiveness and perceived fairness, and the moderating effects of barriers to choose low-calorie snacks and perceived responsibility for food choice. Data was collected through an online survey, involving three waves that were completed over a seven week timespan. Information was collected on barriers and perceived responsibility, and evaluations of a total of 128 intervention strategies with varying levels of intrusiveness that were further systematically varied in terms of source, location, approach/avoidance, type, and severity. A total of 1173 respondents completed all three waves. We found that the effect of intervention intrusiveness on acceptance was mediated by the perceived personal- and societal effectiveness, and the perceived fairness of interventions. For barriers and perceived responsibility, only main effects on intervention-specific beliefs were found. Government interventions were accepted less than interventions by food manufacturers. In conclusion, the present study shows that acceptance of interventions depends on perceptions of personal- and societal effectiveness and fairness, thereby providing novel starting points for increasing acceptance of both existing and new food choice interventions. PMID:26389949
Bos, Colin; Lans, Ivo Van Der; Van Rijnsoever, Frank; Van Trijp, Hans
The present study investigates acceptance of intervention strategies for low-calorie snack choices that vary regarding the effect they have on consumers' freedom of choice (providing information, guiding choice through (dis)incentives, and restricting choice). We examine the mediating effects of perceived effectiveness and perceived fairness, and the moderating effects of barriers to choose low-calorie snacks and perceived responsibility for food choice. Data was collected through an online survey, involving three waves that were completed over a seven week timespan. Information was collected on barriers and perceived responsibility, and evaluations of a total of 128 intervention strategies with varying levels of intrusiveness that were further systematically varied in terms of source, location, approach/avoidance, type, and severity. A total of 1173 respondents completed all three waves. We found that the effect of intervention intrusiveness on acceptance was mediated by the perceived personal- and societal effectiveness, and the perceived fairness of interventions. For barriers and perceived responsibility, only main effects on intervention-specific beliefs were found. Government interventions were accepted less than interventions by food manufacturers. In conclusion, the present study shows that acceptance of interventions depends on perceptions of personal- and societal effectiveness and fairness, thereby providing novel starting points for increasing acceptance of both existing and new food choice interventions.
Goldstein, Daniel A; Ahmad, Bilal B; Chen, Qiushi; Ayer, Turgay; Howard, David H; Lipscomb, Joseph; El-Rayes, Bassel F; Flowers, Christopher R
Regorafenib is a standard-care option for treatment-refractory metastatic colorectal cancer that increases median overall survival by 6 weeks compared with placebo. Given this small incremental clinical benefit, we evaluated the cost-effectiveness of regorafenib in the third-line setting for patients with metastatic colorectal cancer from the US payer perspective. We developed a Markov model to compare the cost and effectiveness of regorafenib with those of placebo in the third-line treatment of metastatic colorectal cancer. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Drug costs were based on Medicare reimbursement rates in 2014. Model robustness was addressed in univariable and probabilistic sensitivity analyses. Regorafenib provided an additional 0.04 QALYs (0.13 life-years) at a cost of $40,000, resulting in an incremental cost-effectiveness ratio of $900,000 per QALY. The incremental cost-effectiveness ratio for regorafenib was > $550,000 per QALY in all of our univariable and probabilistic sensitivity analyses. Regorafenib provides minimal incremental benefit at high incremental cost per QALY in the third-line management of metastatic colorectal cancer. The cost-effectiveness of regorafenib could be improved by the use of value-based pricing. © 2015 by American Society of Clinical Oncology.
Full Text Available Shao-Hsi Chung,1 Kuo-Chih Cheng2 1Department of Business Administration, Meiho University, Pingtung, Taiwan; 2Department of Accounting, National Changhua University of Education, Changhua City, Taiwan Background: The sunk cost effect is the scenario when individuals are willing to continue to invest capital in a failing project. The purpose of this study was to explain such irrational behavior by exploring how sunk costs affect individuals’ willingness to continue investing in an unfavorable project and to understand the role of cognitive dissonance on the sunk cost effect. Methods: This study used an experimental questionnaire survey on managers of firms listed on the Taiwan Stock Exchange and Over-The-Counter. Results: The empirical results show that cognitive dissonance does not mediate the relationship between sunk costs and willingness to continue an unfavorable investment project. However, cognitive dissonance has a moderating effect, and only when the level of cognitive dissonance is high does the sunk cost have significantly positive impacts on willingness to continue on with an unfavorable investment. Conclusion: This study offers psychological mechanisms to explain the sunk cost effect based on the theory of cognitive dissonance, and it also provides some recommendations for corporate management. Keywords: sunk costs, sunk cost effect, cognitive dissonance, behavior, unfavorable investment
At the request of nine political parties, CPB Netherlands Bureau for Economic Policy Analysis and PBL Netherlands Environmental Assessment Agency have mapped out the effects of the respective election platforms on the economy and the environment. The analysis shows that each of the proposed policy measures included in the platforms has both advantages and disadvantages. The platforms thus reflect the diverse choices that have been made by the parties. The publication presents the impact of party programs on public finances, purchasing power and employment. Also included in the publication are analyses in the field of mobility, energy and climate, nature, education, housing and healthcare. [nl
Griffith, Rachel; von Hinke, Stephanie; Smith, Sarah
There is growing policy interest in encouraging better dietary choices. We study a nationally-implemented policy - the UK Healthy Start scheme - that introduced vouchers for fruit, vegetables and milk. We show that the policy has increased spending on fruit and vegetables and has been more effective than an equivalent-value cash benefit. We also show that the policy improved the nutrient composition of households' shopping baskets, with no offsetting changes in spending on other foodstuffs. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.
Bialkova, Svetlana; Grunert, Klaus G; Juhl, Hans Jørn
, or colorcoded GDA label) communicated the product’s nutrient profile. In study 1, participants had to select from 4 products differentiated, in addition to the nutrition information, by flavor (strawberry, muesli, apple, chocolate; varied within participants) and brand (local vs. global, varied between...... participants). Study 2 further explored brand effect within-participants, and thus only 2 flavors (strawberry, chocolate) were presented within an assortment. Actual choice made, response time and eye movements were recorded. Respondents fixated longer and more often on products with color-coded GDAs label...
Bedard, Kelly; Kuhn, Peter
We study the effects of the Nutricate receipt, which makes personalized recommendations to switch from unhealthy to healthier items at a restaurant chain. We find that the receipts shifted the mix of items purchased towards the healthier alternatives. For example, the share of adult main dishes requesting “no sauce” increased by 6.8 percent, the share of kids’ meals with apples (instead of fries) rose by 7.0 percent and the share of breakfast sandwiches without sausage increased by 3.8 percent. The results illustrate the potential of emerging information technologies, which allow retailers to tailor product marketing to individual consumers, to generate healthier choices. PMID:25544398
Revicki, D A; Brown, R E; Palmer, W; Bakish, D; Rosser, W W; Anton, S F; Feeny, D
The aim of this study was to estimate the cost effectiveness of nefazodone compared with imipramine or fluoxetine in treating women with major depressive disorder. Clinical decision analysis and a Markov state-transition model were used to estimate the lifetime health outcomes and medical costs of 3 antidepressant treatments. The model, which represents ideal primary care practice, compares treatment with nefazodone to treatment with either imipramine or fluoxetine. The economic analysis was based on the healthcare system of the Canadian province of Ontario, and considered only direct medical costs. Health outcomes were expressed as quality-adjusted life years (QALYs) and costs were in 1993 Canadian dollars ($Can; $Can1 = $US0.75, September 1995). Incremental cost-utility ratios were calculated comparing the relative lifetime discounted medical costs and QALYs associated with nefazodone with those of imipramine or fluoxetine. Data for constructing the model and estimating necessary parameters were derived from the medical literature, clinical trial data, and physician judgement. Data included information on: Ontario primary care physicians' clinical management of major depression; medical resource use and costs; probabilities of recurrence of depression; suicide rates; compliance rates; and health utilities. Estimates of utilities for depression-related hypothetical health states were obtained from patients with major depression (n = 70). Medical costs and QALYs were discounted to present value using a 5% rate. Sensitivity analyses tested the assumptions of the model by varying the discount rate, depression recurrence rates, compliance rates, and the duration of the model. The base case analysis found that nefazodone treatment costs $Can1447 less per patient than imipramine treatment (discounted lifetime medical costs were $Can50,664 vs $Can52,111) and increases the number of QALYs by 0.72 (13.90 vs 13.18). Nefazodone treatment costs $Can14 less than fluoxetine
Kaper, Janneke; Wagena, Edwin J; van Schayck, Constant P; Severens, Johan L
Smoking cessation should be encouraged in order to increase life expectancy and reduce smoking-related healthcare costs. Results of a randomised trial suggested that reimbursing the costs of smoking cessation treatment (SCT) may lead to an increased use of SCT and an increased number of quitters versus no reimbursement. To assess whether reimbursement for SCT is a cost-effective intervention (from the Dutch societal perspective), we calculated the incremental costs per quitter and extrapolated this outcome to incremental costs per QALY saved versus no reimbursement. In the reimbursement trial, 1266 Dutch smokers were randomly assigned to the intervention or control group using a randomised double consent design. Reimbursement for SCT was offered to the intervention group for a period of 6 months. No reimbursement was offered to the control group. Prolonged abstinence from smoking was determined 6 months after the end of the reimbursement period. The QALYs gained from quitting were calculated until 80 years of age using data from the US. Costs (year 2002 values) were determined from the societal perspective during the reimbursement period (May-November 2002). Benefits were discounted at 4% per annum. The uncertainty of the incremental cost-effectiveness ratios was estimated using non-parametric bootstrapping. Eighteen participants in the control group (2.8%) and 35 participants in the intervention group (5.5%) successfully quit smoking. The costs per participant were 291 euro and 322 euro, respectively. If society is willing to pay 1000 euro or 10,000 euro for an additional 12-month quitter, the probability that reimbursement for SCT would be cost effective was 50% or 95%, respectively. If society is willing to pay 18,000 euro for a QALY, the probability that reimbursement for SCT would be cost effective was 95%. However, the external validity of the extrapolation from quitters to QALYs is uncertain and several assumptions had to be made. Reimbursement for SCT may
Zeinstra, G.G.; Renes, R.J.; Koelen, M.A.; Kok, F.J.; Graaf, de C.
Background: Children's vegetable consumption is below recommended amounts. According to self-determination theory, stimulating children's feelings of autonomy by offering a choice of vegetables may be a valuable strategy to increase their vegetable liking and consumption. The effect of
Hjorth-Jensen, M.; Osnes, E.; Muether, H.; Schmid, K.W.
The convergence of the expansion for the effective interaction is studied considering as example the shell model for the nuclei 18 O and 18 F. In this work the effective interaction is computed through third order in the Brueckner G matrix, using both a harmonic-oscillator (HO) basis and a Brueckner-Hartree-Fock (BHF) basis. The significant differences in the convergence behavior of the effective interaction in these two cases are reported. The results indicate that the choice of the BHF single-particle potential facilitates the convergence of the effective interaction in low-orders of the expansion, whereas the HO results exhibit a non-convergent behavior. The implications for the HO approach are discussed. All calculations have been performed considering a modern version of the Bonn one-boson-exchange potential for the nucleon-nucleon interaction. 23 refs., 4 figs., 2 tabs
Ladenburg, Jacob; Dahlgaard, Jens Olav; Bonnichsen, Ole
as hypothetical bias. The present paper attempts to frame the description of the hypothetical market so as to induce more “true market behaviour” in the respondents by including a short Cheap Talk script. The script informs respondents that in similar studies using stated preference methods, people have...... to be a preference mover, but does not affect preferences significantly. Significant effects are found when relating the effect of the Cheap Talk script to the cost levels of the alternatives, in that female respondents are found to choose higher cost alternatives less frequently when presented with the Cheap Talk...
Ladenburg, Jacob; Bonnichsen, Ole; Dahlgaard, Jens Olav
as hypothetical bias. The present paper attempts to frame the description of the hypothetical market so as to induce more “true market behaviour” in the respondents by including a short Cheap Talk script. The script informs respondents that in similar studies using stated preference methods, people have...... the demand for visual impact mitigation, but does not affect preferences significantly. Significant effects are found when relating the effect of the Cheap Talk script to the cost levels of the alternatives, in that female respondents are found to choose higher cost alternatives less frequently when...
John, D; Parikh, R
Studies in several countries have demonstrated the cost-effectiveness of population-based screening for glaucoma when targeted at high-risk groups such as older adults and with familial history of disease. This study conducts a cost-effective analysis of a hypothetical community screening and subsequent treatment programme in comparison to opportunistic case finding for glaucoma in rural India. A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in rural areas of India. A decision analytical model was built to model events, costs and treatment pathways with and without a hypothetical screening programme for glaucoma for a rural-based population aged between 40 and 69 years in India. The treatment pathway included both primary open-angle glaucoma and angle-closure disease. The data on costs of screening and treatment were provided by an administrator of a tertiary eye hospital in Eastern India. The probabilities for the screening and treatment pathway were derived from published literature and a glaucoma specialist. The glaucoma prevalence rates were adapted from the Chennai Glaucoma Study findings. An incremental cost-effectiveness ratio value of ₹7292.30 per quality-adjusted life-year was calculated for a community-screening programme for glaucoma in rural India. The community screening for glaucoma would treat an additional 2872 cases and prevent 2190 person-years of blindness over a 10-year period. Community screening for glaucoma in rural India appears to be cost-effective when judged by a ratio of willingness-to-pay thresholds as per WHO-CHOICE guidelines. For community screening to be cost-effective, adequate resources, such as trained medical personnel and equipment would need to be made available. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Novak, Petra Krau; Gruden, Kristina; Morisset, Dany; Lavrac, Nada; Stebih, Dejan; Rotter, Ana; Zel, Jana
Commercialization of numerous genetically modified organisms (GMOs) has already been approved worldwide, and several additional GMOs are in the approval process. Many countries have adopted legislation to deal with GMO-related issues such as food safety, environmental concerns, and consumers' right of choice, making GMO traceability a necessity. The growing extent of GMO testing makes it important to study optimal GMO detection and identification strategies. This paper formally defines the problem of routine laboratory-level GMO tracking as a cost optimization problem, thus proposing a shift from "the same strategy for all samples" to "sample-centered GMO testing strategies." An algorithm (GMOtrack) for finding optimal two-phase (screening-identification) testing strategies is proposed. The advantages of cost optimization with increasing GMO presence on the market are demonstrated, showing that optimization approaches to analytic GMO traceability can result in major cost reductions. The optimal testing strategies are laboratory-dependent, as the costs depend on prior probabilities of local GMO presence, which are exemplified on food and feed samples. The proposed GMOtrack approach, publicly available under the terms of the General Public License, can be extended to other domains where complex testing is involved, such as safety and quality assurance in the food supply chain.
Rose, Lucy E; Heard, Geoffrey W; Chee, Yung En; Wintle, Brendan A
How should managers choose among conservation options when resources are scarce and there is uncertainty regarding the effectiveness of actions? Well-developed tools exist for prioritizing areas for one-time and binary actions (e.g., protect vs. not protect), but methods for prioritizing incremental or ongoing actions (such as habitat creation and maintenance) remain uncommon. We devised an approach that combines metapopulation viability and cost-effectiveness analyses to select among alternative conservation actions while accounting for uncertainty. In our study, cost-effectiveness is the ratio between the benefit of an action and its economic cost, where benefit is the change in metapopulation viability. We applied the approach to the case of the endangered growling grass frog (Litoria raniformis), which is threatened by urban development. We extended a Bayesian model to predict metapopulation viability under 9 urbanization and management scenarios and incorporated the full probability distribution of possible outcomes for each scenario into the cost-effectiveness analysis. This allowed us to discern between cost-effective alternatives that were robust to uncertainty and those with a relatively high risk of failure. We found a relatively high risk of extinction following urbanization if the only action was reservation of core habitat; habitat creation actions performed better than enhancement actions; and cost-effectiveness ranking changed depending on the consideration of uncertainty. Our results suggest that creation and maintenance of wetlands dedicated to L. raniformis is the only cost-effective action likely to result in a sufficiently low risk of extinction. To our knowledge we are the first study to use Bayesian metapopulation viability analysis to explicitly incorporate parametric and demographic uncertainty into a cost-effective evaluation of conservation actions. The approach offers guidance to decision makers aiming to achieve cost-effective
In the operative group 24 patients had union with one delayed union while in the traction group 12 patients had union, 9 with mal union and 4 delayed union. Conclusion: Intramedullary nailing is more cost-effective than skeletal traction. It met the dominant strategy, because it was significantly less costly than skeletal ...
Iglesias, Cynthia; Nixon, Jane; Cranny, Gillian; Nelson, E Andrea; Hawkins, Kim; Phillips, Angela; Torgerson, David; Mason, Su; Cullum, Nicky
To assess the cost effectiveness of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers in patients admitted to hospital. Cost effectiveness analysis carried out alongside the pressure relieving support surfaces (PRESSURE) trial; a multicentre UK based pragmatic randomised controlled trial. 11 hospitals in six UK NHS trusts. Intention to treat population comprising 1971 participants. Kaplan Meier estimates of restricted mean time to development of pressure ulcers and total costs for treatment in hospital. Alternating pressure mattresses were associated with lower overall costs (283.6 pounds sterling per patient on average, 95% confidence interval--377.59 pounds sterling to 976.79 pounds sterling) mainly due to reduced length of stay in hospital, and greater benefits (a delay in time to ulceration of 10.64 days on average,--24.40 to 3.09). The differences in health benefits and total costs for hospital stay between alternating pressure mattresses and alternating pressure overlays were not statistically significant; however, a cost effectiveness acceptability curve indicated that on average alternating pressure mattresses compared with alternating pressure overlays were associated with an 80% probability of being cost saving. Alternating pressure mattresses for the prevention of pressure ulcers are more likely to be cost effective and are more acceptable to patients than alternating pressure overlays.
Objectives. To describe the pattern of prescribing for hypertension at a community health centre (CHC) and to evaluate the impact of introducing treatment guidelines and restricting availability of less cost-effective antihypertensive drugs on prescribing patterns, costs of drug treatment and blood pressure (BP) control. Design ...
Drake, R.H.; Williams, D.S.
There are technologies in use for cleaning up concentrated tritiated process water. These are not cost effective for tritiated water with low concentrations of tritium. There are currently no cost-effective technologies for cleaning up low-tritium-concentration tritiated water, such as most tritiated groundwater, spent fuel storage basin water, or underground storage tank water. Resin removal of tritium from tritiated water at low concentrations (near the order of magnitude of drinking water standard maximums) is being tested on TA-SO (Los Alamos National Laboratory's Liquid Radioactive Waste Treatment Facility) waste streams. There are good theoretical and test indications that this may be a technologically effective means of removing tritium from tritiated water. Because of likely engineering design similarity, it is reasonable to anticipate that a resin column system's costs will be similar to some common commercial water treatment systems. Thus, the potential cost effectiveness of a resin treatment system offers hope for treating tritiated water at affordable costs. The TA-50 resin treatment cost projection of $18 per 1,000 gallons is within the same order of magnitude as cost data for typical commercial groundwater cleanup projects. The prospective Los Alamos National Laboratory (LANL) resin treatment system at $18 per 1,000 gallons appears to have a likely cost advantage of at least an order of magnitude over the competing, developmental, water detritiation technologies
Muta, Hiromitsu; Kikuta, Reiko; Hamano, Takashi; Maesako, Takanori
Compares distance education using PictureTel, a compressed-digital-video system via telephone lines (audio and visual interactive communication) in terms of its costs and effectiveness with traditional in-class education. Costing less than half the traditional approach, the study suggested distance education would be economical if used frequently.…
The paper work investigates the effect of software cost drivers on project schedule estimation of software development projects in Nigeria. Specifically, the paper determines the extent to which software cost variables affect our software project time schedule in our environment. Such studies are lacking in the recent ...
Jensen, Jørgen Dejgård; Lawson, Lartey Godwin; Lund, Mogens
stage are considered. Cost analyses are conducted for different risk reduction targets and for three alternative scenarios concerning the acceptable range of interventions. Results demonstrate that using a system-wide policy approach to risk reduction can be more cost-effective than a policy focusing...
This review considers the recently released study by Susan Aud of the Milton & Rose D. Friedman Foundation, concerning the fiscal effects of school vouchers policies. Aud calculates the simple difference between, on the one hand, state and local government spending on students attending traditional public schools, and, on the other, the government…
Lijesen, M.; Korteweg, J.A.; Derriks, H.
The effect of passing through the cost of external effects such as accidents, environment and noise to traffic and transport have been mapped. In nine out of the ten examined variants this 'internalization' will lead to an increase in welfare in the Netherlands. Internalization leads to a decrease of external costs of over 100 million to more than 1.7 billion euros annually. Internalization also brings about collection costs, international transfers and logistic adjustments. The balance of these effects varies from a welfare loss of 20 million euros to a welfare increase of 1.2 billion euros annually. [nl
Ernst, M; Hogue, R; Hollowell, C; Strecker-Kellog, W; Wong, A; Zaytsev, A
The advent of cloud computing centres such as Amazon's EC2 and Google's Computing Engine has elicited comparisons with dedicated computing clusters. Discussions on appropriate usage of cloud resources (both academic and commercial) and costs have ensued. This presentation discusses a detailed analysis of the costs of operating and maintaining the RACF (RHIC and ATLAS Computing Facility) compute cluster at Brookhaven National Lab and compares them with the cost of cloud computing resources under various usage scenarios. An extrapolation of likely future cost effectiveness of dedicated computing resources is also presented.
Ernst, M.; Hogue, R.; Hollowell, C.; Strecker-Kellog, W.; Wong, A.; Zaytsev, A.
The advent of cloud computing centres such as Amazon's EC2 and Google's Computing Engine has elicited comparisons with dedicated computing clusters. Discussions on appropriate usage of cloud resources (both academic and commercial) and costs have ensued. This presentation discusses a detailed analysis of the costs of operating and maintaining the RACF (RHIC and ATLAS Computing Facility) compute cluster at Brookhaven National Lab and compares them with the cost of cloud computing resources under various usage scenarios. An extrapolation of likely future cost effectiveness of dedicated computing resources is also presented.
The article is based on an interview with Juhani Hakkarainen of Vapo Oy. Wood pellets are used in Finland primarily to heat buildings such as schools and offices and in the home. They are equally suitable for use in larger installations such as district heating plants and power stations. According to him wood pellets are suitable for use in coal-fired units generating heat, power, and steam. Price-wise, wood pellets are a particularly competitive alternative for small coal-fired plants away from the coast. Price is not the only factor on their side, however. Wood pellets also offer a good environmental profile, as they burn cleanly and generate virtually no dust, an important plus in urban locations. The fact that pellets are a domestically produced fuel is an added benefit, as their price does not fluctuate in the same way that the prices of electricity, oil, coal, and natural gas do. The price of pellets is largely based on direct raw material and labour costs, which are much less subject to ups and downs
Pisu, Maria; Meltzer, Martin Isaac; Lyerla, Rob
The purpose of this paper is to determine the cost-effectiveness of vaccinating inmates against hepatitis B. From the prison perspective, vaccinating inmates at intake is not cost-saving. It could be economically beneficial when the cost of a vaccine dose is US dollars 30 per dose, or there is no prevalence of infection upon intake, or the costs of treating acute or chronic disease are about 70% higher than baseline costs, or the incidence of infection during and after custody were >1.6 and 50%, respectively. The health care system realizes net savings even when there is no incidence in prison, or there is no cost of chronic liver disease, or when only one dose of vaccine is administered. Thus, while prisons might not have economic incentives to implement hepatitis B vaccination programs, the health care system would benefit from allocating resources to them.
Hollingsworth, Bruce; Harris, Anthony; Mortimer, Duncan
To estimate the incremental cost effectiveness of ICSI, and total costs for the population of Australia. Treatment effects for three patient groups were drawn from a published systematic review and meta-analysis of trials comparing fertilisation outcomes for ICSI. Incremental costs derived from resource-based costing of ICSI and existing practice comparators for each patient group. Incremental cost per live birth for patients unsuited to IVF is estimated between A$8,500 and 13,400. For the subnormal semen indication, cost per live birth could be as low as A$3,600, but in the worst case scenario, there would just be additional incremental costs of A$600 per procedure. Multiplying out the additional costs of ICSI over the relevant target populations in Australia gives potential total financial implications of over A$31 million per annum. While there are additional benefits from ICSI procedure, particularly for those with subnormal sperm, the additional cost for the health care system is substantial.
There are so many different methods of diagnostic imaging that medical practitioners may need guidance to choose the best through the maze of options for each clinical problem. Advice may be required for more than just the first choice, because the first imaging procedure does not always give the desired answer and, depending on the results, further imaging may have to undertaken. The alternative is to submit the patient to a barrage of imaging and hope that one type, at least provides the diagnosis. This is a quite unacceptable way to practice medicine because of the cost and the risk of radiation damage from unnecessary examinations. The choice of the most effective imaging is often difficult and frequently controversial. The sequence to be followed vries with many factors: the equipment available, the skills of the practitioner, the expected quality of the results, the quality of interpretation, and conclusion which can be drawn
Hoyer, Wayne D; Brown, Steven P
Results of a controlled experiment on the role of brand awareness in the consumer choice process showed that brand awareness was a dominant choice heuristic among awareness-group subjects. Subjects with no brand awareness tended to sample more brands and selected the high-quality brand on the final choice significantly more often than those with brand awareness. Thus, when quality differences exist among competing brands, consumers may "pay a price" for employing simple choice heuristics such...
Numerous sites within the U.S. Department of Energy (DOE) complex have been contaminated with various radioactive and hazardous materials by defense-related activities during the post-World War II era. The perception is that characterization and remediation of these contaminated sites will be too costly using currently available technology. Consequently, the DOE Office of Technology Development has funded development of a number of alternative processes for characterizing and remediating these sites. The former Feed-Materials Processing Center near Fernald, Ohio (USA), was selected for demonstrating several innovative technologies. Contamination at the Fernald site consists principally of particulate uranium and derivative compounds in surficial soil. A field-characterization demonstration program was conducted during the summer of 1994 specifically to demonstrate the relative economic performance of seven proposed advanced-characterization tools for measuring uranium activity of in-situ soils. These innovative measurement technologies are principally radiation detectors of varied designs. Four industry-standard measurement technologies, including conventional, regulatory-agency-accepted soil sampling followed by laboratory geochemical analysis, were also demonstrated during the program for comparative purposes. A risk-based economic-decision model has been used to evaluate the performance of these alternative characterization tools. The decision model computes the dollar value of an objective function for each of the different characterization approaches. The methodology not only can assist site operators to choose among engineering alternatives for site characterization and/or remediation, but also can provide an objective and quantitative basis for decisions with respect to the completeness of site characterization
Kakoschke, Naomi; Kemps, Eva; Tiggemann, Marika
Continual exposure to food cues in the environment contributes to unhealthy eating behaviour. According to dual-process models, such behaviour is partly determined by automatic processing of unhealthy food cues (e.g., approach bias), which fails to be regulated by controlled processing (e.g., inhibitory control). The current study aimed to investigate the effect of combined avoidance and control training on implicit evaluation (liking), choice, and consumption of unhealthy snack food. Participants were 240 undergraduate women who were randomly allocated to one of four experimental conditions of a 2 (avoidance training: training versus control) x 2 (control training: training versus control) between-subjects design. The combined training group had a more negative implicit evaluation of unhealthy food than either of the two training conditions alone or the control condition. In addition, participants trained to avoid unhealthy food cues subsequently made fewer unhealthy snack food choices. No significant group differences were found for food intake. Participants were women generally of a healthy weight. Overweight or obese individuals may derive greater benefit from combined training. Results lend support to the theoretical predictions of dual-process models, as the combined training reduced implicit liking of unhealthy food. At a practical level, the findings have implications for the effectiveness of interventions targeting unhealthy eating behaviour. Copyright © 2017 Elsevier Ltd. All rights reserved.
Quaife, Matthew; Terris-Prestholt, Fern; Eakle, Robyn; Cabrera Escobar, Maria A; Kilbourne-Brook, Maggie; Mvundura, Mercy; Meyer-Rath, Gesine; Delany-Moretlwe, Sinead; Vickerman, Peter
A number of antiretroviral HIV prevention products are efficacious in preventing HIV infection. However, the sexual and reproductive health needs of many women extend beyond HIV prevention, and research is ongoing to develop multi-purpose prevention technologies (MPTs) that offer dual HIV and pregnancy protection. We do not yet know if these products will be an efficient use of constrained health resources. In this paper, we estimate the cost-effectiveness of combinations of candidate multi-purpose prevention technologies (MPTs), in South Africa among general population women and female sex workers (FSWs). We combined a cost model with a static model of product impact based on incidence data in South Africa to estimate the cost-effectiveness of five candidate co-formulated or co-provided MPTs: oral PrEP, intravaginal ring, injectable ARV, microbicide gel and SILCS diaphragm used in concert with gel. We accounted for the preferences of end-users by predicting uptake using a discrete choice experiment (DCE). Product availability and protection were systematically varied in five potential rollout scenarios. The impact model estimated the number of infections averted through decreased incidence due to product use over one year. The comparator for each scenario was current levels of male condom use, while a health system perspective was used to estimate discounted lifetime treatment costs averted per HIV infection. Product benefit was estimated in disability-adjusted life years (DALYs) averted. Benefits from contraception were incorporated through adjusting the uptake of these products based on the DCE and through estimating the costs averted from avoiding unwanted pregnancies. We explore the additional impact of STI protection through increased uptake in a sensitivity analysis. At central incidence rates, all single- and multi-purpose scenarios modelled were cost-effective among FSWs and women aged 16-24, at a governmental willingness-to-pay threshold of $1175/DALY
Lam, Hwai-Tai Chen
In view of the increasing costs of hospital care, it is essential to investigate methods to improve the labor efficiency and the cost-effectiveness of the hospital technical core in order to control costs while maintaining the quality of care. This study was conducted to develop indices to measure efficiency, cost-effectiveness, and the quality of blood banks; to identify factors associated with efficiency, cost-effectiveness, and quality; and to generate strategies to improve blood bank labor efficiency and cost-effectiveness. Indices developed in this study for labor efficiency and cost-effectiveness were not affected by patient case mix and illness severity. Factors that were associated with labor efficiency were identified as managerial styles, and organizational designs that balance workload and labor resources. Medical directors' managerial involvement was not associated with labor efficiency, but their continuing education and specialty in blood bank were found to reduce the performance of unnecessary tests. Surprisingly, performing unnecessary tests had no association with labor efficiency. This suggested the existence of labor slack in blood banks. Cost -effectiveness was associated with workers' benefits, wages, and the production of high-end transfusion products by hospital-based donor rooms. Quality indices used in this study included autologous transfusion rates, platelet transfusion rates, and the check points available in an error-control system. Because the autologous transfusion rate was related to patient case mix, severity of illness, and possible inappropriate transfusion, it was not recommended to be used for quality index. Platelet-pheresis transfusion rates were associated with the transfusion preferences of the blood bank medical directors. The total number of check points in an error -control system was negatively associated with government ownership and workers' experience. Recommendations for improving labor efficiency and cost-effectiveness
Gould, Michael K; Sanders, Gillian D; Barnett, Paul G; Rydzak, Chara E; Maclean, Courtney C; McClellan, Mark B; Owens, Douglas K
Positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) is a potentially useful but expensive test to diagnose solitary pulmonary nodules. To evaluate the cost-effectiveness of strategies for pulmonary nodule diagnosis and to specifically compare strategies that did and did not include FDG-PET. Decision model. Accuracy and complications of diagnostic tests were estimated by using meta-analysis and literature review. Modeled survival was based on data from a large tumor registry. Cost estimates were derived from Medicare reimbursement and other sources. All adult patients with a new, noncalcified pulmonary nodule seen on chest radiograph. Patient lifetime. Societal. 40 clinically plausible combinations of 5 diagnostic interventions, including computed tomography, FDG-PET, transthoracic needle biopsy, surgery, and watchful waiting. Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. The cost-effectiveness of strategies depended critically on the pretest probability of malignancy. For patients with low pretest probability (26%), strategies that used FDG-PET selectively when computed tomography results were possibly malignant cost as little as 20 000 dollars per QALY gained. For patients with high pretest probability (79%), strategies that used FDG-PET selectively when computed tomography results were benign cost as little as 16 000 dollars per QALY gained. For patients with intermediate pretest probability (55%), FDG-PET strategies cost more than 220 000 dollars per QALY gained because they were more costly but only marginally more effective than computed tomography-based strategies. The choice of strategy also depended on the risk for surgical complications, the probability of nondiagnostic needle biopsy, the sensitivity of computed tomography, and patient preferences for time spent in watchful waiting. In probabilistic sensitivity analysis, FDG-PET strategies were cost saving or cost less than 100 000 dollars per QALY
Diepenbroek, Charlene; Eggels, Leslie; Ackermans, Mariëtte T.; Fliers, Eric; Kalsbeek, Andries; Serlie, Mireille J.; la Fleur, Susanne E.
We showed previously that rats on a free-choice high-fat, high-sugar (fcHFHS) diet become rapidly obese and develop glucose intolerance within a week. Interestingly, neither rats on a free-choice high-fat diet (fcHF), although equally obese and hyperphagic, nor rats on a free-choice high-sugar
Sweeney, Mary M.; Meredith, Steven E.; Evatt, Daniel P.; Griffiths, Roland R.
Rationale Combining alcohol and caffeine is associated with increased alcohol consumption, but no prospective experimental studies have examined whether added caffeine increases alcohol consumption. Objectives This study examined how caffeine alters alcohol self-administration and subjective reinforcing effects in healthy adults. Methods Thirty-one participants completed six double-blind alcohol self-administration sessions: three sessions with alcohol only (e.g., Beverage A) and three sessions with alcohol and caffeine (e.g., Beverage B). Participants chose which beverage to consume on a subsequent session (e.g., Beverage A or B). Effects of caffeine on overall beverage choice, number of self-administered drinks, subjective ratings (e.g., Biphasic Alcohol Effects Scale), and psychomotor performance were examined. Results A majority of participants (65%) chose to drink the alcohol beverage containing caffeine on their final self-administration session. Caffeine did not increase the number of self-administered drinks. Caffeine significantly increased stimulant effects, decreased sedative effects, and attenuated decreases in psychomotor performance attributable to alcohol. Relative to nonchoosers, caffeine choosers reported overall lower stimulant ratings, and reported greater drinking behavior prior to the study. Conclusions Although caffeine did not increase the number of self-administered drinks, most participants chose the alcohol beverage containing caffeine. Given the differences in subjective ratings and pre-existing differences in self-reported alcohol consumption for caffeine choosers and nonchoosers, these data suggest decreased stimulant effects of alcohol and heavier self-reported drinking may predict subsequent choice of combined caffeine and alcohol beverages. These predictors may identify individuals who would benefit from efforts to reduce risk behaviors associated with combining alcohol and caffeine. PMID:28108773
Jit, Mark; Yuzbashyan, Ruzanna; Sahakyan, Gayane; Avagyan, Tigran; Mosina, Liudmila
The cost-effectiveness of introducing infant rotavirus vaccination in Armenia in 2012 using Rotarix(R) was evaluated using a multiple birth cohort model. The model considered the cost and health implications of hospitalisations, primary health care consultations and episodes not leading to medical care in children under five years old. Rotavirus vaccination is expected to cost the Ministry of Health $220,000 in 2012, rising to $830,000 in 2016 following termination of GAVI co-financing, then declining to $260,000 in 2025 due to vaccine price maturity. It may reduce health care costs by $34,000 in the first year, rising to $180,000 by 2019. By 2025, vaccination may be close to cost saving to the Ministry of Health if the vaccine purchase price declines as expected. Once coverage has reached high levels, vaccination may prevent 25,000 cases, 3000 primary care consultations, 1000 hospitalisations and 8 deaths per birth cohort vaccinated. The cost per disability-adjusted life year (DALY) saved is estimated to be about $650 from the perspective of the Ministry of Health, $850 including costs accrued to both the Ministry and to GAVI, $820 from a societal perspective excluding indirect costs and $44 from a societal perspective including indirect costs. Since the gross domestic product per capita of Armenia in 2008 was $3800, rotavirus vaccination is likely to be regarded as "very cost-effective" from a WHO standpoint. Vaccination may still be "very cost-effective" if less favourable assumptions are used regarding vaccine price and disease incidence, as long as DALYs are not age-weighted. Copyright © 2011 Elsevier Ltd. All rights reserved.
Søgaard, Rikke; Laurberg, Ida; Christensen, Finn B
Recently, Christensen et al. reported the clinical effects of a low-cost rehabilitation program equally efficient to a relatively intensive program of individual, physiotherapist-guided exercise therapy. Yet, the low-cost approach is not fully supported as an optimal strategy until a full......-scale economic evaluation, including extra-hospital effects such as service utilization in the primary health care sector and return-to-work, is conducted. The objective of this study was to conduct such evaluation i.e. investigate the cost-effectiveness of (1) a low-cost rehabilitation regimen...... with a behavioural element and (2) a regimen of individual exercise therapy, both in comparison with usual practice, from a health economic, societal perspective. Study design was a cost-effectiveness evaluation of an RCT with a 2-year follow-up. Ninety patients having had posterolateral or circumferential fusion...
Broughton, Edward Ivor; Hameed, Waqas; Gul, Xaher; Sarfraz, Shabnum; Baig, Imam Yar; Villanueva, Monica
This study reports on the effectiveness and efficiency from the program funder's perspective of the Suraj Social Franchise (SSF) voucher program in which private health-care providers in remote rural areas were identified, trained, upgraded, and certified to deliver family planning services to underserved women of reproductive age in 29 districts of Sindh and 3 districts of Punjab province, Pakistan between October 2013 and June 2016. A decision tree compared the cost of implementing SSF to the program funder and its effects of providing additional couple years of protection (CYPs) to targeted women, compared to business-as-usual. Costs included vouchers given to women to receive a free contraceptive method of their choice from the SSF provider. The vouchers were then reimbursed to the SSF provider by the program. A total of 168,206 married women of reproductive age (MWRA) received SSF vouchers between October 2013 and June 2016, costing $3,278,000 ($19.50/recipient). The average effectiveness of the program per voucher recipient was an additional 1.66 CYPs, giving an incremental cost-effectiveness of the program of $4.28 per CYP compared to not having the program (95% CI: $3.62-5.31). The result compares favorably to other interventions with similar objectives and appears affordable for the Pakistan national health-care system. It is therefore recommended to help address the unmet need for contraception among MWRA in these areas of Pakistan and is worthy of trial implementation in the country more widely.
Hojjat, Houmehr; Svider, Peter F; Folbe, Adam J; Raza, Syed N; Carron, Michael A; Shkoukani, Mahdi A; Merati, Albert L; Mayerhoff, Ross M
To evaluate the cost-effectiveness of routine computed tomography (CT) in individuals with unilateral vocal fold paralysis (UVFP) STUDY DESIGN: Health Economics Decision Tree Analysis METHODS: A decision tree was constructed to determine the incremental cost-effectiveness ratio (ICER) of CT imaging in UVFP patients. Univariate sensitivity analysis was utilized to calculate what the probability of having an etiology of the paralysis discovered would have to be to make CT with contrast more cost-effective than no imaging. We used two studies examining findings in UVFP patients. The decision pathways were utilizing CT neck with intravenous contrast after diagnostic laryngoscopy versus laryngoscopy alone. The probability of detecting an etiology for UVFP and associated costs were extracted to construct the decision tree. The only incorrect diagnosis was missing a mass in the no-imaging decision branch, which rendered an effectiveness of 0. The ICER of using CT was $3,306, below most acceptable willingness-to-pay (WTP) thresholds. Additionally, univariate sensitivity analysis indicated that at the WTP threshold of $30,000, obtaining CT imaging was the most cost-effective choice when the probability of having a lesion was above 1.7%. Multivariate probabilistic sensitivity analysis with Monte Carlo simulations also showed that at the WTP of $30,000, CT scanning is more cost-effective, with 99.5% certainty. Particularly in the current healthcare environment characterized by increasing consciousness of utilization defensive medicine, economic evaluations represent evidence-based findings that can be employed to facilitate appropriate decision making and enhance physician-patient communication. This economic evaluation strongly supports obtaining CT imaging in patients with newly diagnosed UVFP. 2c. Laryngoscope, 2016 127:440-444, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.
Nishie, Akihiro; Goshima, Satoshi; Haradome, Hiroki; Hatano, Etsuro; Imai, Yasuharu; Kudo, Masatoshi; Matsuda, Masanori; Motosugi, Utaroh; Saitoh, Satoshi; Yoshimitsu, Kengo; Crawford, Bruce; Kruger, Eliza; Ball, Graeme; Honda, Hiroshi
The objective of the study was to evaluate the cost-effectiveness of gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis and treatment of hepatocellular carcinoma (HCC) in Japan compared with extracellular contrast media-enhanced MRI (ECCM-MRI) and contrast media-enhanced computed tomography (CE-CT) scanning. A 6-stage Markov model was developed to estimate lifetime direct costs and clinical outcomes associated with EOB-MRI. Diagnostic sensitivity and specificity, along with clinical data on HCC survival, recurrence, treatment patterns, costs, and health state utility values, were derived from predominantly Japanese publications. Parameters unavailable from publications were estimated in a Delphi panel of Japanese clinical experts who also confirmed the structure and overall approach of the model. Sensitivity analyses, including one-way, probabilistic, and scenario analyses, were conducted to account for uncertainty in the results. Over a lifetime horizon, EOB-MRI was associated with lower direct costs (¥2,174,869) and generated a greater number of quality-adjusted life years (QALYs) (9.502) than either ECCM-MRI (¥2,365,421, 9.303 QALYs) or CE-CT (¥2,482,608, 9.215 QALYs). EOB-MRI was superior to the other diagnostic strategies considered, and this finding was robust over sensitivity and scenario analyses. A majority of the direct costs associated with HCC in Japan were found to be costs of treatment. The model results revealed the superior cost-effectiveness of the EOB-MRI diagnostic strategy compared with ECCM-MRI and CE-CT. EOB-MRI could be the first-choice imaging modality for medical care of HCC among patients with hepatitis or liver cirrhosis in Japan. Widespread implementation of EOB-MRI could reduce health care expenditures, particularly downstream treatment costs, associated with HCC. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.
Burkhalter, J C; Lockwood, J L; Maslo, B; Fenn, K H; Leu, K
A common goal in conservation planning is to acquire areas that are critical to realizing biodiversity goals in the most cost-effective manner. The way monetary acquisition costs are represented in such planning is an understudied but vital component to realizing cost efficiencies. We sought to design a protected-area network within a forested urban region that would protect 17 birds of conservation concern. We compared the total costs and spatial structure of the optimal protected-area networks produced using three acquisition-cost surrogates (area, agricultural land value, and tax-assessed land value). Using the tax-assessed land values there was a 73% and 78% cost savings relative to networks derived using area or agricultural land value, respectively. This cost reduction was due to the considerable heterogeneity in acquisition costs revealed in tax-assessed land values, especially for small land parcels, and the corresponding ability of the optimization algorithm to identify lower-cost parcels for inclusion that had equal value to our target species. Tax-assessed land values also reflected the strong spatial differences in acquisition costs (US$0.33/m(2)-$55/m(2)) and thus allowed the algorithm to avoid inclusion of high-cost parcels when possible. Our results add to a nascent but growing literature that suggests conservation planners must consider the cost surrogate they use when designing protected-area networks. We suggest that choosing cost surrogates that capture spatial- and size-dependent heterogeneity in acquisition costs may be relevant to establishing protected areas in urbanizing ecosystems. © 2015 Society for Conservation Biology.
Panlilio, Leigh V; Secci, Maria E; Schindler, Charles W; Bradberry, Charles W
Addiction involves maladaptive choice behavior in which immediate drug effects are valued more than delayed nondrug rewards. To model this behavior and extend our earlier work with the prescription opioid oxycodone, we allowed rats to choose between immediate intravenous delivery of the short-acting opioid remifentanil and delayed delivery of highly palatable food pellets. Treatment drugs were tested on a baseline where remifentanil was preferred over food. Treatment with a high dose of the opioid antagonist naltrexone decreased but did not reverse the preference for remifentanil. Treatment with the serotonin 5-HT 2C agonist lorcaserin decreased remifentanil and food self-administration nonselectively. Across conditions in which the alternative to delayed food was either a moderate dose of oxycodone, a moderate or high dose of remifentanil, a smaller more immediate delivery of food, or timeout with no primary reinforcement, choice was determined by both the length of the delay and the nature of the alternative option. Delayed food was discounted most steeply when the alternative was a high dose of remifentanil, which was preferred over food when food was delayed by 30 s or more. Within-subject comparisons showed no evidence for trait-like impulsivity or sensitivity to delay across these conditions. Choice was determined more by the current contingencies of reinforcement than by innate individual differences. This finding suggests that people might develop steep delay-discounting functions because of the contingencies in their environment, and it supports the use of contingency management to enhance the relative value of delayed nondrug reinforcers.
Ahmeti, Albana; Preza, Iria; Simaku, Artan; Nelaj, Erida; Clark, Andrew David; Felix Garcia, Ana Gabriela; Lara, Carlos; Hoestlandt, Céline; Blau, Julia; Bino, Silvia
Rotavirus vaccines have been introduced in several European countries but can represent a considerable cost, particularly for countries that do not qualify for any external financial support. This study aimed to evaluate the cost-effectiveness of introducing rotavirus vaccination into Albania's national immunization program and to inform national decision-making by improving national capacity to conduct economic evaluations of new vaccines. The TRIVAC model was used to assess vaccine impact and cost-effectiveness. The model estimated health and economic outcomes attributed to 10 successive vaccinated birth cohorts (2013-2022) from a government and societal perspective. Epidemiological and economic data used in the model were based on national cost studies, and surveillance data, as well as estimates from the scientific literature. Cost-effectiveness was estimated for both the monovalent (RV1) and pentavalent vaccines (RV5). A multivariate scenario analysis (SA) was performed to evaluate the uncertainty around the incremental cost-effectiveness ratios (ICERs). With 3% discounting of costs and health benefits over the period 2013-2022, rotavirus vaccination in Albania could avert 51,172 outpatient visits, 14,200 hospitalizations, 27 deaths, 950 disability-adjusted life-years (DALYs), and gain 801 life-years. When both vaccines were compared to no vaccination, the discounted cost per DALY averted was US$ 2008 for RV1 and US$ 5047 for RV5 from a government perspective. From the societal perspective the values were US$ 517 and US$ 3556, respectively. From both the perspectives, the introduction of rotavirus vaccine to the Albanian immunization schedule is either cost-effective or highly cost-effective for a range of plausible scenarios. In most scenarios, including the base-case scenario, the discounted cost per DALY averted was less than three times the gross domestic product (GDP) per capita. However, rotavirus vaccination was not cost-effective when rotavirus cases
When planning a uranium exploration survey the question always arises as to how to take advantage of the different exploration methods and equipment for maximum probability of success. Discussed here are the choice of radiometric geophysical equipment, its effectiveness in identifying targets, its limitations, and the criteria for selection. Particular attention is given to systems that are suitable for the exploration programmes of small size and on a small budget, that are common in Latin America. (author)
Cost effectiveness of facility and home based HIV voluntary counseling and ... Background: In Uganda, the main stay for provision of human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) ... AJOL African Journals Online.
Base cost effectiveness risk associated with radiological screening for tuberculosis and lung tumor the Government of Netherlands advised against mass screening. However, mass screening remains an important method in the case of breast cancer
Bioinformatics tools for development of fast and cost effective simple sequence repeat ... comparative mapping and exploration of functional genetic diversity in the ... Already, a number of computer programs have been implemented that aim at ...
Determining the Effect (the Social Costs) of Exclusion under the South African Exclusionary Rule: Should Factual Guilt Tilt the Scales in Favour of the Admission of Unconstitutionally Obtained Evidence?
Dong, Di; Tan, Anna; Mehta, Jodhbir S; Tan, Donald; Finkelstein, Eric Andrew
To determine the long-term cost-effectiveness of osteo-odonto keratoprosthesis (OOKP) relative to no treatment among patients with end-stage corneal and ocular surface diseases in Singapore. Cost-effectiveness analysis based on data from a retrospective cohort study. From a health system perspective, we calculated the incremental cost-effectiveness ratio of OOKP treatment relative to no treatment over a 30-year horizon, based on data from a cohort of 23 patients who underwent OOKP surgery between 2004 and 2009 at Singapore National Eye Centre. Preoperative and postoperative vision-related quality-of-life values were estimated from patients' visual outcomes and were used to calculate the gain in quality-adjusted life years (QALYs) resulting from OOKP treatment. Unsubsidized costs for surgery, consultations, examinations, medications, follow-up visits, and treatments for complications were retrieved from patients' bills to estimate the total costs associated with OOKP treatment. Sensitivity analyses were conducted to test the robustness of the model. Over a 30-year period, OOKP treatment, compared with no treatment, improved QALYs by 3.991 among patients with end-stage corneal and ocular surface diseases at an additional cost of S$67 840 (US$55 150), resulting in an incremental cost-effectiveness ratio of S$17 000/QALY (US$13 820/QALY). Based on commonly cited cost-effectiveness benchmarks, the OOKP is a cost-effective treatment for patients with end-stage corneal and ocular surface diseases. Copyright © 2014 Elsevier Inc. All rights reserved.
Liu, C Carrie; Rudmik, Luke
The timing of tracheostomy in critically ill patients requiring mechanical ventilation is controversial. An important consideration that is currently missing in the literature is an evaluation of the economic impact of an early tracheostomy strategy vs a late tracheostomy strategy. To evaluate the cost-effectiveness of the early tracheostomy strategy vs the late tracheostomy strategy. This economic analysis was performed using a decision tree model with a 90-day time horizon. The economic perspective was that of the US health care third-party payer. The primary outcome was the incremental cost per tracheostomy avoided. Probabilities were obtained from meta-analyses of randomized clinical trials. Costs were obtained from the published literature and the Healthcare Cost and Utilization Project database. A multivariate probabilistic sensitivity analysis was performed to account for uncertainty surrounding mean values used in the reference case. The reference case demonstrated that the cost of the late tracheostomy strategy was $45 943.81 for 0.36 of effectiveness. The cost of the early tracheostomy strategy was $31 979.12 for 0.19 of effectiveness. The incremental cost-effectiveness ratio for the late tracheostomy strategy compared with the early tracheostomy strategy was $82 145.24 per tracheostomy avoided. With a willingness-to-pay threshold of $50 000, the early tracheostomy strategy is cost-effective with 56% certainty. The adaptation of an early vs a late tracheostomy strategy depends on the priorities of the decision-maker. Up to a willingness-to-pay threshold of $80 000 per tracheostomy avoided, the early tracheostomy strategy has a higher probability of being the more cost-effective intervention.
Full Text Available Bispectral analysis is a signal processing technique that makes it possible to capture the non-linear and non-Gaussian properties of the EEG signals. It has found various applications in EEG research and clinical practice, including the assessment of anesthetic depth, the identification of epileptic seizures, and more recently, the evaluation of non-linear cross-frequency brain functional connectivity. However, the validity and reliability of the indices drawn from bispectral analysis of EEG signals are potentially biased by the use of a non-neutral EEG reference. The present study aims at investigating the effects of the reference choice on the analysis of the non-linear features of EEG signals through bicoherence, as well as on the estimation of cross-frequency EEG connectivity through two different non-linear measures, i.e., the cross-bicoherence and the antisymmetric cross-bicoherence. To this end, four commonly used reference schemes were considered: the vertex electrode (Cz, the digitally linked mastoids, the average reference, and the Reference Electrode Standardization Technique (REST. The reference effects were assessed both in simulations and in a real EEG experiment. The simulations allowed to investigated: (i the effects of the electrode density on the performance of the above references in the estimation of bispectral measures; and (ii the effects of the head model accuracy in the performance of the REST. For real data, the EEG signals recorded from 10 subjects during eyes open resting state were examined, and the distortions induced by the reference choice in the patterns of alpha-beta bicoherence, cross-bicoherence, and antisymmetric cross-bicoherence were assessed. The results showed significant differences in the findings depending on the chosen reference, with the REST providing superior performance than all the other references in approximating the ideal neutral reference. In conclusion, this study highlights the importance of
Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P
OBJECTIVE. This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. DATA SOURCES/STUDY SETTING. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and ...
Kaimal, Anjali J; Smith, Catherine C; Laros, Russell K; Caughey, Aaron B; Cheng, Yvonne W
To investigate the cost-effectiveness of private umbilical cord blood banking. A decision-analytic model was designed comparing private umbilical cord blood banking with no umbilical cord blood banking. Baseline assumptions included a cost of $3,620 for umbilical cord blood banking and storage for 20 years, a 0.04% chance of requiring an autologous stem cell transplant, a 0.07% chance of a sibling requiring an allogenic stem cell transplant, and a 50% reduction in risk of graft-versus-host disease if a sibling uses banked umbilical cord blood. Private cord blood banking is not cost-effective because it cost an additional $1,374,246 per life-year gained. In sensitivity analysis, if the cost of umbilical cord blood banking is less than $262 or the likelihood of a child needing a stem cell transplant is greater than 1 in 110, private umbilical cord blood banking becomes cost-effective. Currently, private umbilical cord blood banking is cost-effective only for children with a very high likelihood of needing a stem cell transplant. Patients considering private blood banking should be informed of the remote likelihood that a unit will be used for a child or another family member. III.
Full Text Available The need for more cost-effective and pedagogically acceptable combinations of teaching and learning methods to sustain increasing student numbers means that the use of innovative methods, using technology, is accelerating. There is an expectation that economies of scale might provide greater cost-effectiveness whilst also enhancing student learning. The difficulties and complexities of these expectations are considered in this paper, which explores the challenges faced by those wishing to evaluate the costeffectiveness of computer-based assessment (CBA. The paper outlines the outcomes of a survey which attempted to gather information about the costs and benefits of CBA.
Rogowski, Wolf H
Genetic tests for hereditary hemochromatosis (HH) are currently included in the German ambulatory care reimbursement scheme but only for symptomatic individuals and the offspring of HH patients. This study synthesizes the most current evidence to examine whether screening in the broader population is cost-effective and to identify the best choice of initial and follow-up screening tests. A probabilistic decision-analytic model was constructed to calculate cost per life year gained (LYG) for HH screening among male Caucasians aged 30. Three strategies were considered in both the general population and male offspring of HH patients: phenotypic (transferrin saturation, TS), genotypic (C282Y mutation), and sequential (genotype if TS is elevated) screening. The incremental cost-effectiveness of sequential screening among male offspring, sequential population-wide screening, and genotypic screening is 41000, 124000, and 161000 Eero/LYG, respectively. All other strategies were subject to simple or extended dominance. The results are subject to high uncertainty. The most influential parameters in the deterministic one-way sensitivity analysis are discounting of life years gained and the adherence of patients to preventive phlebotomy. The current German policy of only screening at-risk individuals is consistent with health economic decision making based on typically accepted thresholds. However, conducting the DNA test after the first elevated TS result is more cost-effective than waiting for a second TS result as recommended by the German guidelines. Further empirical work regarding adherence to long-term prevention recommendations and explicit and well-justified guidance for the choice of discount rates in German economic evaluation are needed.
Full Text Available Dear Editor, Gender equality amongst healthcare professionals is no doubt paramount to allow both equal opportunity and provision of good quality healthcare. The General Medical Council encourages that all colleagues should be treated fairly, but studies have previously demonstrated gender bias against female medical students (1. Whether this might have any impact on the students’ decision-making process and career pathways has yet to be explored. We aimed to evaluate whether doctors gave students gender-specific advice and the extent to which this advice influenced the students. Furthermore, we explored whether students felt their gender affected their career choices. We carried out a cross-sectional national study of British clinical medical students. A standardised questionnaire was completed by 94 students (54.3% female. The response rate was 88.7%. Results showed that 43.6% (n=41 of students received career advice based purely on their gender, and 63.4% (n=26 of these said that this would influence their career choices. Importantly, 82.9% (n=34 of the students who received gender-specific advice were female. Additionally, 41.2% (n=21 of females felt their gender would restrict their career choices compared with only 11.6% (n=5 of males (p=0.00142. 37.3% (n=19 of females thought their gender would unfairly disadvantage their career progression compared to 4.65% (n=2 of males (p=0.00016. Our results highlighted that doctors gave more gender-specific advice to females compared to males, and that this advice significantly impacts students’ decision making process. Furthermore, females disproportionately felt their careers would be disadvantaged and restricted compared with males. This shows an enormous disparity between male and female attitudes towards medical careers. This can have both long and short-term effects on training, career choices and patient interaction. Further research investigating why females feel their gender will
Koren, Gideon; Bozzo, Pina
While the benefits of evidence-based counseling to large numbers of women and physicians are intuitively evident, there is an urgent need to document that teratology counseling, in addition to improving the quality of life of women and families, also leads to cost saving. The objective of the present study was to calculate the cost effectiveness of the Motherisk Program, a large teratology information and counseling service at The Hospital for Sick Children and the University of Toronto. We analyzed data from the Motherisk Program on its 2012 activities in two domains: 1) Calculation of cost-saving in preventing unjustified pregnancy terminations; and 2) prevention of major birth defects. Cost of pregnancy termination and lifelong cost of specific birth defects were identified from primary literature and prorated for cost of living for the year 2013. Prevention of 255 pregnancy terminations per year led to cost savings of $516,630. The total estimated number of major malformations prevented by Motherisk counseling in 2012 was 8.41 cases at a total estimated cost of $9,032,492. With an estimated minimum annual prevention of 8 major malformations, and numerous unnecessary terminations of otherwise- wanted pregnancies, a cost saving of $10 million can be calculated. In 2013 the operating budget of Motherisk counseling totaled $640,000. Even based on the narrow range of activities for which we calculated cost, this service is highly cost- effective. Because most teratology counseling services are operating in a very similar method to Motherisk, it is fair to assume that these results, although dependent on the size of the service, are generalizable to other countries.
Al Awaidy, Salah Thabit; Gebremeskel, Berhanu G; Al Obeidani, Idris; Al Baqlani, Said; Haddadin, Wisam; O'Brien, Megan A
Rotavirus gastroenteritis (RGE) is the leading cause of diarrhea in young children in Oman, incurring substantial healthcare and economic burden. We propose to formally assess the potential cost effectiveness of implementing universal vaccination with a pentavalent rotavirus vaccine (RV5) on reducing the health care burden and costs associated with rotavirus gastroenteritis (RGE) in Oman A Markov model was used to compare two birth cohorts, including children who were administered the RV5 vaccination versus those who were not, in a hypothetical group of 65,500 children followed for their first 5 years of life in Oman. The efficacy of the vaccine in reducing RGE-related hospitalizations, emergency department (ED) and office visits, and days of parental work loss for children receiving the vaccine was based on the results of the Rotavirus Efficacy and Safety Trial (REST). The outcome of interest was cost per quality-adjusted life year (QALY) gained from health care system and societal perspectives. A universal RV5 vaccination program is projected to reduce, hospitalizations, ED visits, outpatient visits and parental work days lost due to rotavirus infections by 89%, 80%, 67% and 74%, respectively. In the absence of RV5 vaccination, RGE-related societal costs are projected to be 2,023,038 Omani Rial (OMR) (5,259,899 United States dollars [USD]), including 1,338,977 OMR (3,481,340 USD) in direct medical costs. However, with the introduction of RV5, direct medical costs are projected to be 216,646 OMR (563,280 USD). Costs per QALY saved would be 1,140 OMR (2,964 USD) from the health care payer perspective. An RV5 vaccination program would be considered cost saving, from the societal perspective. Universal RV5 vaccination in Oman is likely to significantly reduce the health care burden and costs associated with rotavirus gastroenteritis and may be cost-effective from the payer perspective and cost saving from the societal perspective.
Banks, Matthew L; Blough, Bruce E
Preclinical and human laboratory choice procedures have been invaluable in improving our knowledge of the neurobiological mechanisms of drug reinforcement and in the drug development process for candidate medications to treat drug addiction. However, little is known about the neuropharmacological mechanisms of methamphetamine vs food choice. The aims of this study were to develop a methamphetamine vs food choice procedure and determine treatment effects with two clinically relevant compounds: the monoamine uptake inhibitor bupropion and the dopamine antagonist risperidone. Rhesus monkeys (n=6) responded under a concurrent schedule of food delivery (1-g pellets, fixed-ratio (FR) 100 schedule) and intravenous methamphetamine injections (0-0.32 mg/kg/injection, FR10 schedule) during 7-day bupropion (0.32-1.8 mg/kg/h) and risperidone (0.001-0.0056 mg/kg/h) treatment periods. For comparison, effects of removing food pellets or methamphetamine injections and FR response requirement manipulations were also examined. Under saline treatment conditions, food was preferred over no methamphetamine or small unit methamphetamine doses (0.01-0.032 mg/kg/injection). Larger methamphetamine doses resulted in greater methamphetamine preference and 0.32 mg/kg/injection methamphetamine maintained near exclusive preference. Removing food availability increased methamphetamine choice, whereas removing methamphetamine availability decreased methamphetamine choice. Methamphetamine choice was not significantly altered when the FR response requirements for food and drug were the same (FR100:FR100 or FR10:FR10). Risperidone treatment increased methamphetamine choice, whereas bupropion treatment did not alter methamphetamine choice up to doses that decreased rates of operant behavior. Overall, these negative results with bupropion and risperidone are concordant with previous human laboratory and clinical trials and support the potential validity of this preclinical methamphetamine vs food
This study investigated types of career choice in high school students and examined the effects of career paths on time perspective development. The participants were 4,756 third grade students from nine public high schools in Tokyo. The high school questionnaire survey was conducted throughout autumn of 2008, 2009, and 2010. One year later, 962 graduates participated in the follow-up questionnaire survey by post. Distinguishing gender difference among career paths was found. Girls tend to choose significantly shorter learning careers (p time perspective than other groups (p time perspective between "school to school transition" and "school to work transition". It is suggested that the "school to work transition" tends to be more critical for adolescents and has negative effects on time perspective. These results suggest that the goal content in careers may promote or inhibit the formation of time perspectives during the graduation transition.
Derdeyn, C P; Powers, W J
The value of screening for asymptomatic carotid stenosis has become an important issue with the recently reported beneficial effect of endarterectomy. The purpose of this study is to evaluate the cost-effectiveness of using Doppler ultrasound as a screening tool to select subjects for arteriography and subsequent surgery. A computer model was developed to simulate the cost-effectiveness of screening a cohort of 1000 men during a 20-year period. The primary outcome measure was incremental present-value dollar expenditures for screening and treatment per incremental present-value quality-adjusted life-year (QALY) saved. Estimates of disease prevalence and arteriographic and surgical complication rates were obtained from the literature. Probabilities of stroke and death with surgical and medical treatment were obtained from published clinical trials. Doppler ultrasound sensitivity and specificity were obtained through review of local experience. Estimates of costs were obtained from local Medicare reimbursement data. A one-time screening program of a population with a high prevalence (20%) of > or = 60% stenosis cost $35130 per incremental QALY gained. Decreased surgical benefit or increased annual discount rate was detrimental, resulting in lost QALYs. Annual screening cost $457773 per incremental QALY gained. In a low-prevalence (4%) population, one-time screening cost $52588 per QALY gained, while annual screening was detrimental. The cost-effectiveness of a one-time screening program for an asymptomatic population with a high prevalence of carotid stenosis may be cost-effective. Annual screening is detrimental. The most sensitive variables in this simulation model were long-term stroke risk reduction after surgery and annual discount rate for accumulated costs and QALYs.
Kate A Halton
Full Text Available BACKGROUND: A bundled approach to central venous catheter care is currently being promoted as an effective way of preventing catheter-related bloodstream infection (CR-BSI. Consumables used in the bundled approach are relatively inexpensive which may lead to the conclusion that the bundle is cost-effective. However, this fails to consider the nontrivial costs of the monitoring and education activities required to implement the bundle, or that alternative strategies are available to prevent CR-BSI. We evaluated the cost-effectiveness of a bundle to prevent CR-BSI in Australian intensive care patients. METHODS AND FINDINGS: A Markov decision model was used to evaluate the cost-effectiveness of the bundle relative to remaining with current practice (a non-bundled approach to catheter care and uncoated catheters, or use of antimicrobial catheters. We assumed the bundle reduced relative risk of CR-BSI to 0.34. Given uncertainty about the cost of the bundle, threshold analyses were used to determine the maximum cost at which the bundle remained cost-effective relative to the other approaches to infection control. Sensitivity analyses explored how this threshold alters under different assumptions about the economic value placed on bed-days and health benefits gained by preventing infection. If clinicians are prepared to use antimicrobial catheters, the bundle is cost-effective if national 18-month implementation costs are below $1.1 million. If antimicrobial catheters are not an option the bundle must cost less than $4.3 million. If decision makers are only interested in obtaining cash-savings for the unit, and place no economic value on either the bed-days or the health benefits gained through preventing infection, these cost thresholds are reduced by two-thirds. CONCLUSIONS: A catheter care bundle has the potential to be cost-effective in the Australian intensive care setting. Rather than anticipating cash-savings from this intervention, decision
Lamarche, Larkin; Gionfriddo, Alicia M; Cline, Lindsay E; Gammage, Kimberley L; Adkin, Allan L
Verbal persuasion has been shown to influence psychological and behavioral outcomes. The present study had two objectives: (1) to examine the effect of verbal persuasion on task choice in a balance setting and (2) to evaluate the use of verbal persuasion as an approach to experimentally induce mismatches between perceived and actual balance. Healthy young adults (N=68) completed an 8-m tandem walk task without vision and then were randomly assigned to a feedback group (good, control, or poor), regardless of actual balance. Following the feedback, participants chose to perform the task in one of three conditions differing in level of challenge and also were required to perform the task under the same pre-feedback conditions. Balance efficacy and perceived stability were rated before and after each pre- and post-feedback task, respectively. Balance performance measures were also collected. Following the feedback, participants in the good group were more likely to choose the most challenging task while those in the poor group were more likely to choose the least challenging task. Following the feedback, all groups showed improved balance performance. However, balance efficacy and perceived stability increased for the good and control groups but balance efficacy decreased and perceived stability was unchanged for the poor group. Thus, these findings demonstrate that verbal persuasion can influence task choice and may be used as an approach to experimentally create mismatches between perceived and actual balance. Copyright © 2013 Elsevier B.V. All rights reserved.
Helfer, Peter; Shultz, Thomas R
The widespread availability of calorie-dense food is believed to be a contributing cause of an epidemic of obesity and associated diseases throughout the world. One possible countermeasure is to empower consumers to make healthier food choices with useful nutrition labeling. An important part of this endeavor is to determine the usability of existing and proposed labeling schemes. Here, we report an experiment on how four different labeling schemes affect the speed and nutritional value of food choices. We then apply decision field theory, a leading computational model of human decision making, to simulate the experimental results. The psychology experiment shows that quantitative, single-attribute labeling schemes have greater usability than multiattribute and binary ones, and that they remain effective under moderate time pressure. The computational model simulates these psychological results and provides explanatory insights into them. This work shows how experimental psychology and computational modeling can contribute to the evaluation and improvement of nutrition-labeling schemes. © 2014 New York Academy of Sciences.
3. REPORT TYPE AND DATES COVERED Master’s thesis 4. TITLE AND SUBTITLE K-12 SCHOOLS: THE EFFECT OF PUBLIC SCHOOL CHOICES ON MARINE FAMILIES’ CO...be educated ? One theory regarding decision-making in general is the rational choice theory . This approach to explaining the process of making...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS Approved for public release. Distribution is unlimited. K-12 SCHOOLS
Broers, Valérie; De Breucker, Céline; Van den Broucke, Stephan; Luminet, Olivier
BACKGROUND: Nudging refers to interventions that organize the choice architecture in order to alter people's behaviour in a predictable way without forbidding any options or significantly changing their economic incentives. As a strategy to encourage healthy behaviour, nudging can serve as a complement to health education. However, the empirical evidence regarding the effectiveness of nudging as a way to influence food choice remains contradictory. To address this issue, a systematic review a...
Al-Khouja, Lutfi T; Baron, Eli M; Johnson, J Patrick; Kim, Terrence T; Drazin, Doniel
Medical care has been evolving with the increased influence of a value-based health care system. As a result, more emphasis is being placed on ensuring cost-effectiveness and utility in the services provided to patients. This study looks at this development in respect to minimally invasive spine surgery (MISS) costs. A literature review using PubMed, the Cost-Effectiveness Analysis (CEA) Registry, and the National Health Service Economic Evaluation Database (NHS EED) was performed. Papers were included in the study if they reported costs associated with minimally invasive spine surgery (MISS). If there was no mention of cost, CEA, cost-utility analysis (CUA), quality-adjusted life year (QALY), quality, or outcomes mentioned, then the article was excluded. Fourteen studies reporting costs associated with MISS in 12,425 patients (3675 undergoing minimally invasive procedures and 8750 undergoing open procedures) were identified through PubMed, the CEA Registry, and NHS EED. The percent cost difference between minimally invasive and open approaches ranged from 2.54% to 33.68%-all indicating cost saving with a minimally invasive surgical approach. Average length of stay (LOS) for minimally invasive surgery ranged from 0.93 days to 5.1 days compared with 1.53 days to 12 days for an open approach. All studies reporting EBL reported lower volume loss in an MISS approach (range 10-392.5 ml) than in an open approach (range 55-535.5 ml). There are currently an insufficient number of studies published reporting the costs of MISS. Of the studies published, none have followed a standardized method of reporting and analyzing cost data. Preliminary findings analyzing the 14 studies showed both cost saving and better outcomes in MISS compared with an open approach. However, more Level I CEA/CUA studies including cost/QALY evaluations with specifics of the techniques utilized need to be reported in a standardized manner to make more accurate conclusions on the cost effectiveness of
Duke, Joshua M; Dundas, Steven J; Messer, Kent D
Economists advocate that the billions of public dollars spent on conservation be allocated to achieve the largest possible social benefit. This is "cost-effective conservation"-a process that incorporates both monetized benefits and costs. Though controversial, cost-effective conservation is poorly understood and rarely implemented by planners. Drawing from the largest publicly financed conservation programs in the United States, this paper seeks to improve the communication from economists to planners and to overcome resistance to cost-effective conservation. Fifteen practical lessons are distilled, including the negative implications of limiting selection with political constraints, using nonmonetized benefit measures or benefit indices, ignoring development risk, using incomplete cost measures, employing cost measures sequentially, and using benefit indices to capture costs. The paper highlights interrelationships between benefits and complications such as capitalization and intertemporal planning. The paper concludes by identifying the challenges at the research frontier, including incentive problems associated with adverse selection, additionality, and slippage. Copyright © 2013 Elsevier Ltd. All rights reserved.
Colgan, P.A.; Gutierrez, J.
Published information on the distribution of radon levels in Spanish single family dwellings is used to evaluate the cost-effectiveness of three different intervention scenarios: remediation of existing dwellings, radon proofing of all future dwellings and the targetting of areas with higher than average indoor radon concentrations. Analysis is carried out on the basis of a Reference Level of 400 Bq m -3 for the existing housing stock and 200 Bq m -3 for new dwellings. Certain assumptions are made about the effectiveness and durability of the measures applied and annualised costs are used to calculate the costs per lung cancer death averted. The results reveal that targetting future housing is a more cost-effective option than remediation of existing dwellings with radon concentrations above the Reference Level -the costs per lung cancer death averted are typically $145000. In high-risk areas, these costs can be considerably less, depending on the percentage of dwellings expected to exceed the Reference Level and the average savings in exposure as a result of the intervention. The costs of intervention to reduce lung cancer deaths following exposure to radon compare favourably with those of other health programmes in other countries. (Author)
Kasius, Jenneke C; Eijkemans, René J C; Mol, Ben W J; Fauser, Bart C J M; Fatemi, Human M; Broekmans, Frank J M
This study assessed the cost-effectiveness of office hysteroscopy screening prior to IVF. Therefore, the cost-effectiveness of two distinct strategies - hysteroscopy after two failed IVF cycles (Failedhyst) and routine hysteroscopy prior to IVF (Routinehyst) - was compared with the reference strategy of no hysteroscopy (Nohyst). When present, intrauterine pathology was treated during hysteroscopy. Two models were constructed and evaluated in a decision analysis. In model I, all patients had an increase in pregnancy rate after screening hysteroscopy prior to IVF; in model II, only patients with intrauterine pathology would benefit. For each strategy, the total costs and live birth rates after a total of three IVF cycles were assessed. For model I (all patients benefit from hysteroscopy), Routinehyst was always cost-effective compared with Nohyst or Failedhyst. For the Routinehyst strategy, a monetary profit would be obtained in the case where hysteroscopy would increase the live birth rate after IVF by ≥ 2.8%. In model II (only patients with pathology benefit from hysteroscopy), Routinehyst also dominated Failedhyst. However, hysteroscopy performance resulted in considerable costs. In conclusion, the application of a routine hysteroscopy prior to IVF could be cost-effective. However, randomized trials confirming the effectiveness of hysteroscopy are needed. Copyright © 2013 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
Pecenka, Clint; Parashar, Umesh; Tate, Jacqueline E; Khan, Jahangir A M; Groman, Devin; Chacko, Stephen; Shamsuzzaman, Md; Clark, Andrew; Atherly, Deborah
Diarrheal disease is a leading cause of child mortality globally, and rotavirus is responsible for more than a third of those deaths. Despite substantial decreases, the number of rotavirus deaths in children under five was 215,000 per year in 2013. Of these deaths, approximately 41% occurred in Asia and 3% of those in Bangladesh. While Bangladesh has yet to introduce rotavirus vaccination, the country applied for Gavi support and plans to introduce it in 2018. This analysis evaluates the impact and cost-effectiveness of rotavirus vaccination in Bangladesh and provides estimates of the costs of the vaccination program to help inform decision-makers and international partners. This analysis used Pan American Health Organization's TRIVAC model (version 2.0) to examine nationwide introduction of two-dose rotavirus vaccination in 2017, compared to no vaccination. Three mortality scenarios (low, high, and midpoint) were assessed. Benefits and costs were examined from the societal perspective over ten successive birth cohorts with a 3% discount rate. Model inputs were locally acquired and complemented by internationally validated estimates. Over ten years, rotavirus vaccination would prevent 4000 deaths, nearly 500,000 hospitalizations and 3 million outpatient visits in the base scenario. With a Gavi subsidy, cost/disability adjusted life year (DALY) ratios ranged from $58/DALY to $142/DALY averted. Without a Gavi subsidy and a vaccine price of $2.19 per dose, cost/DALY ratios ranged from $615/DALY to $1514/DALY averted. The discounted cost per DALY averted was less than the GDP per capita for nearly all scenarios considered, indicating that a routine rotavirus vaccination program is highly likely to be cost-effective. Even in a low mortality setting with no Gavi subsidy, rotavirus vaccination would be cost-effective. These estimates exclude the herd immunity benefits of vaccination, so represent a conservative estimate of the cost-effectiveness of rotavirus vaccination
Sigei, Charles; Odaga, John; Mvundura, Mercy; Madrid, Yvette; Clark, Andrew David
Rotavirus vaccines have the potential to prevent a substantial amount of life-threatening gastroenteritis in young African children. This paper presents the results of prospective cost-effectiveness analyses for rotavirus vaccine introduction for Kenya and Uganda. In each country, a national consultant worked with a national technical working group to identify appropriate data and validate study results. Secondary data on demographics, disease burden, health utilization, and costs were used to populate the TRIVAC cost-effectiveness model. The baseline analysis assumed an initial vaccine price of $0.20 per dose, corresponding to Gavi, the Vaccine Alliance stipulated copay for low-income countries. The incremental cost-effectiveness of a 2-dose rotavirus vaccination schedule was evaluated for 20 successive birth cohorts from the government perspective in both countries, and from the societal perspective in Uganda. Between 2014 and 2033, rotavirus vaccination can avert approximately 60,935 and 216,454 undiscounted deaths and hospital admissions respectively in children under 5 years in Kenya. In Uganda, the respective number of undiscounted deaths and hospital admission averted is 70,236 and 329,779 between 2016 and 2035. Over the 20-year period, the discounted vaccine program costs are around US$ 80 million in Kenya and US$ 60 million in Uganda. Discounted government health service costs avoided are US$ 30 million in Kenya and US$ 10 million in Uganda (or US$ 18 million including household costs). The cost per disability-adjusted life-year (DALY) averted from a government perspective is US$ 38 in Kenya and US$ 34 in Uganda (US$ 29 from a societal perspective). Rotavirus vaccine introduction is highly cost-effective in both countries in a range of plausible 'what-if' scenarios. The involvement of national experts improves the quality of data used, is likely to increase acceptability of the results in decision-making, and can contribute to strengthened national
Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P
This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems.
van Luijt, P A; Heijnsdijk, E A M; de Koning, H J
The Norwegian Breast Cancer Screening Programme (NBCSP) has a nation-wide coverage since 2005. All women aged 50-69 years are invited biennially for mammography screening. We evaluated breast cancer mortality reduction and performed a cost-effectiveness analysis, using our microsimulation model, calibrated to most recent data. The microsimulation model allows for the comparison of mortality and costs between a (hypothetical) situation without screening and a situation with screening. Breast cancer incidence in Norway had a steep increase in the early 1990s. We calibrated the model to simulate this increase and included recent costs for screening, diagnosis and treatment of breast cancer and travel and productivity loss. We estimate a 16% breast cancer mortality reduction for a cohort of women, invited to screening, followed over their complete lifetime. Cost-effectiveness is estimated at NOK 112,162 per QALY gained, when taking only direct medical costs into account (the cost of the buses, examinations, and invitations). We used a 3.5% annual discount rate. Cost-effectiveness estimates are substantially below the threshold of NOK 1,926,366 as recommended by the WHO guidelines. For the Norwegian population, which has been gradually exposed to screening, breast cancer mortality reduction for women exposed to screening is increasing and is estimated to rise to ∼30% in 2020 for women aged 55-80 years. The NBCSP is a highly cost-effective measure to reduce breast cancer specific mortality. We estimate a breast cancer specific mortality reduction of 16-30%, at the cost of 112,162 NOK per QALY gained. © 2016 UICC.
Full Text Available Abstract Background A quality improvement collaborative (QIC in the Dutch long-term care sector (nursing homes, assisted living facilities, home care used evidence-based prevention methods to reduce the incidence and prevalence of pressure ulcers (PUs. The collaborative consisted of a core team of experts and 25 organizational project teams. Our aim was to determine its cost-effectiveness from a healthcare perspective. Methods We used a non-controlled pre-post design to establish the change in incidence and prevalence of PUs in 88 patients over the course of a year. Staff indexed data and prevention methods (activities, materials. Quality of life (Qol weights were assigned to the PU states. We assessed the costs of activities and materials in the project. A Markov model was built based on effectiveness and cost data, complemented with a probabilistic sensitivity analysis. To illustrate the results of longer term, three scenarios were created in which change in incidence and prevalence measures were (1 not sustained, (2 partially sustained, and (3 completely sustained. Results Incidence of PUs decreased from 15% to 4.5% for the 88 patients. Prevalence decreased from 38.6% to 22.7%. Average Quality of Life (Qol of patients increased by 0.02 Quality Adjusted Life Years (QALYs in two years; healthcare costs increased by €2000 per patient; the Incremental Cost-effectiveness Ratio (ICER was between 78,500 and 131,000 depending on whether the changes in incidence and prevalence of PU were sustained. Conclusions During the QIC PU incidence and prevalence significantly declined. When compared to standard PU care, the QIC was probably more costly and more effective in the short run, but its long-term cost-effectiveness is questionable. The QIC can only be cost-effective if the changes in incidence and prevalence of PU are sustained.
Makai, Peter; Koopmanschap, Marc; Bal, Roland; Nieboer, Anna P
A quality improvement collaborative (QIC) in the Dutch long-term care sector (nursing homes, assisted living facilities, home care) used evidence-based prevention methods to reduce the incidence and prevalence of pressure ulcers (PUs). The collaborative consisted of a core team of experts and 25 organizational project teams. Our aim was to determine its cost-effectiveness from a healthcare perspective. We used a non-controlled pre-post design to establish the change in incidence and prevalence of PUs in 88 patients over the course of a year. Staff indexed data and prevention methods (activities, materials). Quality of life (Qol) weights were assigned to the PU states. We assessed the costs of activities and materials in the project. A Markov model was built based on effectiveness and cost data, complemented with a probabilistic sensitivity analysis. To illustrate the results of longer term, three scenarios were created in which change in incidence and prevalence measures were (1) not sustained, (2) partially sustained, and (3) completely sustained. Incidence of PUs decreased from 15% to 4.5% for the 88 patients. Prevalence decreased from 38.6% to 22.7%. Average Quality of Life (Qol) of patients increased by 0.02 Quality Adjusted Life Years (QALY)s in two years; healthcare costs increased by euro2000 per patient; the Incremental Cost-effectiveness Ratio (ICER) was between 78,500 and 131,000 depending on whether the changes in incidence and prevalence of PU were sustained. During the QIC PU incidence and prevalence significantly declined. When compared to standard PU care, the QIC was probably more costly and more effective in the short run, but its long-term cost-effectiveness is questionable. The QIC can only be cost-effective if the changes in incidence and prevalence of PU are sustained.
John, Denny; Parikh, Rajul
Population-based screening for glaucoma has been demonstrated to be cost-effective if targeted at high-risk groups such as older adults and those with a family history of glaucoma, and through use of a technician for conducting initial assessment rather than a medical specialist. This study attempts to investigate the cost-effectiveness of a hypothetical community screening and subsequent treatment programme for glaucoma in comparison with current practice (i.e. with no screening programme but with some opportunistic case finding) in the urban areas of India. A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in the urban areas of India. Screening and treatment costs were obtained from an administrator of a tertiary eye hospital in India. The probabilities for the screening pathway were derived from published literature and expert opinion. The glaucoma prevalence rates for urban areas were adapted from the Chennai Glaucoma Study findings. A decision-analytical model using TreeAge Pro 2015 was built to model events, costs and treatment pathways. One-way sensitivity analyses were conducted. The introduction of a community screening programme for glaucoma is likely to be cost-effective, the estimated incremental cost-effectiveness ratio (ICER) values being 10,668.68 when compared with no screening programme and would treat an additional 4443 cases and prevent 1790 person-years of blindness over a 10-year period in the urban areas of India. Sensitivity analyses revealed that glaucoma prevalence rates across various age groups, screening uptake rate, follow-up compliance after screening, treatment costs and utility values of health states associated with medical and surgical treatment of glaucoma had an impact on the ICER values of the screening programme. In comparison with current practice (i.e. without a screening programme but with some opportunistic case finding
Whitmore, Robert G; Thawani, Jayesh P; Grady, M Sean; Levine, Joshua M; Sanborn, Matthew R; Stein, Sherman C
The object of this study was to determine whether aggressive treatment of severe traumatic brain injury (TBI), including invasive intracranial monitoring and decompressive craniectomy, is cost-effective. A decision-analytical model was created to compare costs, outcomes, and cost-effectiveness of 3 strategies for treating a patient with severe TBI. The aggressive-care approach is compared with "routine care," in which Brain Trauma Foundation guidelines are not followed. A "comfort care" category, in which a single day in the ICU is followed by routine floor care, is included for comparison only. Probabilities of each treatment resulting in various Glasgow Outcome Scale (GOS) scores were obtained from the literature. The GOS scores were converted to quality-adjusted life years (QALYs), based on expected longevity and calculated quality of life associated with each GOS category. Estimated direct (acute and long-term medical care) and indirect (loss of productivity) costs were calculated from the perspective of society. Sensitivity analyses employed a 2D Monte Carlo simulation of 1000 trials, each with 1000 patients. The model was also used to estimate these values for patients 40, 60, and 80 years of age. For the average 20-year-old, aggressive care yields 11.7 (± 1.6 [SD]) QALYs, compared with routine care (10.0 ± 1.5 QALYs). This difference is highly significant (p care remains significantly better at all ages. When all costs are considered, aggressive care is also significantly less costly than routine care ($1,264,000 ± $118,000 vs $1,361,000 ± $107,000) for the average 20-year-old. Aggressive care remains significantly less costly until age 80, at which age it costs more than routine care. However, even in the 80-year-old, aggressive care is likely the more cost-effective approach. Comfort care is associated with poorer outcomes at all ages and with higher costs for all groups except 80-year-olds. When all the costs of severe TBI are considered, aggressive
Bodden, D.H.M.; Dirksen, C.D.; Bögels, S.M.; Nauta, M.H.; de Haan, E.; Ringrose, J.; Appelboom, C.; Brinkman, A.G.; Appelboom-Geerts, K.C.M.M.J.
The objective of this study was to investigate the cost-effectiveness of family cognitive-behavioral therapy (CBT) compared with individual CBT in children with anxiety disorders. Clinically anxious children (aged 8—18 years) referred for treatment were randomly assigned to family or individual CBT
Adarkwah, Charles Christian; Sadoghi, Amirhossein; Gandjour, Afschin
There has been a debate on whether cost-effectiveness analysis should consider the cost of consumption and leisure time activities when using the quality-adjusted life year as a measure of health outcome under a societal perspective. The purpose of this study was to investigate whether the effects of ill health on consumptive activities are spontaneously considered in a health state valuation exercise and how much this matters. The survey enrolled patients with inflammatory bowel disease in Germany (n = 104). Patients were randomized to explicit and no explicit instruction for the consideration of consumption and leisure effects in a time trade-off (TTO) exercise. Explicit instruction to consider non-health-related utility in TTO exercises did not influence TTO scores. However, spontaneous consideration of non-health-related utility in patients without explicit instruction (60% of respondents) led to significantly lower TTO scores. Results suggest an inclusion of consumption costs in the numerator of the cost-effectiveness ratio, at least for those respondents who spontaneously consider non-health-related utility from treatment. Results also suggest that exercises eliciting health valuations from the general public may include a description of the impact of disease on consumptive activities. Copyright © 2015 John Wiley & Sons, Ltd.
Liverman, D. M.; McConnell, M. C.; Raven, P.
At the request of Congress, the National Academy of Sciences convened a series of coordinated activities to provide advice on actions and strategies that the nation can take to respond to climate change. As part of this suite of activities, this study examines information needs and recommends ways the federal government can better inform responses by enhancing climate change and greenhouse gas information and reporting systems and by improving climate communication and education. Demand for better information to support climate-related decisions has grown rapidly as people, organizations, and governments have moved ahead with plans and actions to reduce greenhouse gas emissions and to adapt to the impacts of climate change. To meet this demand, good information systems and services are needed. Without such systems, decision makers cannot evaluate whether particular policies and actions are achieving their goals or should be modified. Although the many non-federal efforts to reduce emissions and/or adapt to future climate changes carry considerable potential to reduce risks related to climate change, there is currently no comprehensive way to assess the effectiveness of those efforts. In addition, the diverse climate change responses to date have resulted in a patchwork of regional, state, and local policies that has prompted many state and business leaders to call for the development of a more predictable and coherent policy environment at the federal level. This report demonstrates that the nation lacks comprehensive, robust, and credible information and reporting systems to inform climate choices and evaluate their effectiveness. This report also argues that decision makers can benefit from a systematic and iterative framework for responding to climate change, in which decisions and policies can be revised in light of new information and experience and that improved information and reporting systems allow for ongoing evaluation of responses to climate risks. The
Sevick, Laura K; Esmail, Rosmin; Tang, Karen; Lorenzetti, Diane L; Ronksley, Paul; James, Matthew; Santana, Maria; Ghali, William A; Clement, Fiona
The transition between acute care and community care can be a vulnerable period in a patients' treatment due to the potential for postdischarge adverse events. The vulnerability of this period has been attributed to factors related to the miscommunication between hospital-based and community-based physicians. Electronic discharge communication has been proposed as one solution to bridge this communication gap. Prior to widespread implementation of these tools, the costs and benefits should be considered. To establish the cost and cost-effectiveness of electronic discharge communications compared with traditional discharge systems for individuals who have completed care with one provider and are transitioning care to a new provider. We conducted a systematic review of the published literature, using best practices, to identify economic evaluations/cost analyses of electronic discharge communication tools. Inclusion criteria were: (1) economic analysis and (2) electronic discharge communication tool as the intervention. Quality of each article was assessed, and data were summarised using a component-based analysis. One thousand unique abstracts were identified, and 57 full-text articles were assessed for eligibility. Four studies met final inclusion criteria. These studies varied in their primary objectives, methodology, costs reported and outcomes. All of the studies were of low to good quality. Three of the studies reported a cost-effectiveness measure ranging from an incremental daily cost of decreasing average discharge note completion by 1 day of $0.331 (2003 Canadian), a cost per page per discharge letter of €9.51 and a dynamic net present value of €31.1 million for a 5-year implementation of the intervention. None of the identified studies considered clinically meaningful patient or quality outcomes. Economic analyses of electronic discharge communications are scarcely reported, and with inconsistent methodology and outcomes. Further studies are needed
Broughton, Edward I; Gomez, Ivonne; Nuñez, Oscar; Wong, Yudy
To determine the costs and cost-effectiveness of an intervention to improve quality of care for children with diarrhea or pneumonia in 14 hospitals in Nicaragua, based on expenditure data and impact measures. Hospital length of stay (LOS) and deaths were abstracted from a random sample of 1294 clinical records completed at seven of the 14 participating hospitals before the intervention (2003) and 1505 records completed after two years of intervention implementation ("post-intervention"; 2006). Disability-adjusted life years (DALYs) were derived from outcome data. Hospitalization costs were calculated based on hospital and Ministry of Health records and private sector data. Intervention costs came from project accounting records. Decision-tree analysis was used to calculate incremental cost-effectiveness. Average LOS decreased from 3.87 and 4.23 days pre-intervention to 3.55 and 3.94 days post-intervention for diarrhea (P = 0.078) and pneumonia (P = 0.055), respectively. Case fatalities decreased from 45/10 000 and 34/10 000 pre-intervention to 30/10 000 and 27/10 000 post-intervention for diarrhea (P = 0.062) and pneumonia (P = 0.37), respectively. Average total hospitalization and antibiotic costs for both diagnoses were US$ 451 (95% credibility interval [CI]: US$ 419-US$ 482) pre-intervention and US$ 437 (95% CI: US$ 402-US$ 464) post-intervention. The intervention was cost-saving in terms of DALYs (95% CI: -US$ 522- US$ 32 per DALY averted) and cost US$ 21 per hospital day averted (95% CI: -US$ 45- US$ 204). After two years of intervention implementation, LOS and deaths for diarrhea decreased, along with LOS for pneumonia, with no increase in hospitalization costs. If these changes were entirely attributable to the intervention, it would be cost-saving.
Jozaghi, Ehsan; Reid, Andrew A; Andresen, Martin A; Juneau, Alexandre
Supervised injection facilities (SIFs) are venues where people who inject drugs (PWID) have access to a clean and medically supervised environment in which they can safely inject their own illicit drugs. There is currently only one legal SIF in North America: Insite in Vancouver, British Columbia, Canada. The responses and feedback generated by the evaluations of Insite in Vancouver have been overwhelmingly positive. This study assesses whether the above mentioned facility in the Downtown Eastside of Vancouver needs to be expanded to other locations, more specifically that of Canada's capital city, Ottawa. The current study is aimed at contributing to the existing literature on health policy by conducting cost-benefit and cost-effective analyses for the opening of SIFs in Ottawa, Ontario. In particular, the costs of operating numerous SIFs in Ottawa was compared to the savings incurred; this was done after accounting for the prevention of new HIV and Hepatitis C (HCV) infections. To ensure accuracy, two distinct mathematical models and a sensitivity analysis were employed. The sensitivity analyses conducted with the models reveals the potential for SIFs in Ottawa to be a fiscally responsible harm reduction strategy for the prevention of HCV cases--when considered independently. With a baseline sharing rate of 19%, the cumulative annual cost model supported the establishment of two SIFs and the marginal annual cost model supported the establishment of a single SIF. More often, the prevention of HIV or HCV alone were not sufficient to justify the establishment cost-effectiveness; rather, only when both HIV and HCV are considered does sufficient economic support became apparent. Funded supervised injection facilities in Ottawa appear to be an efficient and effective use of financial resources in the public health domain.
Urueña, Analía; Pippo, Tomás; Betelu, María Sol; Virgilio, Federico; Hernández, Laura; Giglio, Norberto; Gentile, Ángela; Diosque, Máximo; Vizzotti, Carla
Rotavirus is a leading cause of severe diarrhea in children under 5. In Argentina, the most affected regions are the Northeast and Northwest, where hospitalizations and deaths are more frequent. This study estimated the cost-effectiveness of adding either of the two licensed rotavirus vaccines to the routine immunization schedule. The integrated TRIVAC vaccine cost-effectiveness model from the Pan American Health Organization's ProVac Initiative (Version 2.0) was used to assess health benefits, costs savings, life-years gained (LYGs), DALYs averted, and cost/DALY averted of vaccinating 10 successive cohorts, from the health care system and societal perspectives. Two doses of monovalent (RV1) rotavirus vaccine and three doses of pentavalent (RV5) rotavirus vaccine were each compared to a scenario assuming no vaccination. The price/dose was US$ 7.50 and US$ 5.15 for RV1 and RV5, respectively. We ran both a national and sub-national analysis, discounting all costs and benefits 3% annually. Our base case results were compared to a range of alternative univariate and multivariate scenarios. The number of LYGs was 5962 and 6440 for RV1 and RV5, respectively. The cost/DALY averted when compared to no vaccination from the health care system and societal perspective was: US$ 3870 and US$ 1802 for RV1, and US$ 2414 and US$ 358 for RV5, respectively. Equivalent figures for the Northeast were US$ 1470 and US$ 636 for RV1, and US$ 913 and US$ 80 for RV5. Therefore, rotavirus vaccination was more cost-effective in the Northeast compared to the whole country; and, in the Northwest, health service's costs saved outweighed the cost of introducing the vaccine. Vaccination with either vaccine compared to no vaccination was highly cost-effective based on WHO guidelines and Argentina's 2011 per capita GDP of US$ 9090. Key variables influencing results were vaccine efficacy, annual loss of efficacy, relative coverage of deaths, vaccine price, and discount rate. Compared to no
Full Text Available Abstract Background A wide range of possible malaria vaccines is being considered and there is a need to identify which vaccines should be prioritized for clinical development. An important element of the information needed for this prioritization is a prediction of the cost-effectiveness of potential vaccines in the transmission settings in which they are likely to be deployed. This analysis needs to consider a range of delivery modalities to ensure that clinical development plans can be aligned with the most appropriate deployment strategies. Methods The simulations are based on a previously published individual-based stochastic model for the natural history and epidemiology of Plasmodium falciparum malaria. Three different vaccine types: pre-erythrocytic vaccines (PEV, blood stage vaccines (BSV, mosquito-stage transmission-blocking vaccines (MSTBV, and combinations of these, are considered each delivered via a range of delivery modalities (Expanded Programme of Immunization – EPI-, EPI with booster, and mass vaccination combined with EPI. The cost-effectiveness ratios presented are calculated for four health outcomes, for assumed vaccine prices of US$ 2 or US$ 10 per dose, projected over a 10-year period. Results The simulations suggest that PEV will be more cost-effective in low transmission settings, while BSV at higher transmission settings. Combinations of BSV and PEV are more efficient than PEV, especially in moderate to high transmission settings, while compared to BSV they are more cost-effective in moderate to low transmission settings. Combinations of MSTBV and PEV or PEV and BSV improve the effectiveness and the cost-effectiveness compared to PEV and BSV alone only when applied with EPI and mass vaccinations. Adding booster doses to the EPI is unlikely to be a cost-effective alternative to delivering vaccines via the EPI for any vaccine, while mass vaccination improves effectiveness, especially in low transmission settings, and is
Hamidi, Vida; Andersen, Marit Helen; Oyen, Ole
, and a consequent potential to increase the pool of kidney donors. However, the cost effectiveness of LLDN remains unknown. The aim of this study was to explore the health and cost consequences of replacing open-donor nephrectomy by LLDN. METHODS: Kidney donors were randomized to laparoscopic (n=63) or open surgery...... (n=59). We obtained data on operating time, personnel costs, length of stay, cost of analgesic, disposable instruments and complications, and indirect costs. Quality of life was captured before the operation and at 1, 6, and 12 months postdonation by means of short form-36. The scores were translated...... into utilities by means of Brazier's 6D algorithm. RESULTS: The cost per patient was U.S. $55,292 with laparoscopic and U.S. $29,886 with open surgery. The greatest cost difference was in costs attributed to complications (U.S. $33,162 vs. U.S. $4,573). The 1-year quality-adjusted life years (QALYs) were 0...
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.
Chung, Shao-Hsi; Cheng, Kuo-Chih
The sunk cost effect is the scenario when individuals are willing to continue to invest capital in a failing project. The purpose of this study was to explain such irrational behavior by exploring how sunk costs affect individuals' willingness to continue investing in an unfavorable project and to understand the role of cognitive dissonance on the sunk cost effect. This study used an experimental questionnaire survey on managers of firms listed on the Taiwan Stock Exchange and Over-The-Counter. The empirical results show that cognitive dissonance does not mediate the relationship between sunk costs and willingness to continue an unfavorable investment project. However, cognitive dissonance has a moderating effect, and only when the level of cognitive dissonance is high does the sunk cost have significantly positive impacts on willingness to continue on with an unfavorable investment. This study offers psychological mechanisms to explain the sunk cost effect based on the theory of cognitive dissonance, and it also provides some recommendations for corporate management.
Brancic, A.B.; Peters, J.S.; Arch, M.
Building Codes are increasingly required to be responsive to social and economic policy concerns. In 1990 the State of Connecticut passes An Act Concerning Global Warming, Public Act 90-219, which mandates the revision of the state building code to require that buildings and building elements be designed to provide optimum cost-effective energy efficiency over the useful life of the building. Further, such revision must meet the American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) Standard 90.1 - 1989. As the largest electric energy supplier in Connecticut, Northeast Utilities (NU) sponsored a pilot study of the cost effectiveness of alternative building code standards for commercial construction. This paper reports on this study which analyzed design and construction means, building elements, incremental construction costs, and energy savings to determine the optimum cost-effective building code standard. Findings are that ASHRAE 90.1 results in 21% energy savings and alternative standards above it result in significant additional savings. Benefit/cost analysis showed that both are cost effective
Vanem, Erik; Endresen, Oyvind; Skjong, Rolf
Oil tanker accidents resulting in large quantities of oil spills and severe pollution have occurred in the past, leading to major public attention and an international focus on finding solutions for minimising the risks related to such events. This paper proposes a novel approach for evaluating measures for prevention and control of marine oil spills, based on considerations of oil spill risk and cost effectiveness. A cost model that incorporates all costs of a shipping accident has been established and oil tanker spill accidents have been further elaborated as a special case of such accidents. Utilising this model, novel implementation criteria, in terms of the Cost of Averting a Tonne of oil Spilt (CATS), for risk control options aiming at mitigating the environmental risk of accidental oil spills, are proposed. The paper presents a review of previous studies on the costs associated with oil spills from shipping, which is a function of many factors such as location of spill, spill amount, type of oil, etc. However, ships are designed for global trade, transporting different oil qualities. Therefore, globally applicable criteria must average over most of these factors, and the spill amount is the remaining factor that will be used to measure cost effectiveness against. A weighted, global average cleanup cost of USD 16,000/tonne of oil spilt has been calculated, considering the distribution of oil tanker traffic densities. Finally, the criteria are compared with some existing regulations for oil spill prevention, response and compensation (OPA 90)
Entingh, D.; Petty, S.
This paper estimates hydrothermal exploration costs and the effects that using slim holes could have on those costs using a computer code developed for the US-DOE. The primary goal of exploration is to generate decision driving information about particular geothermal reservoirs. Compared to today's exploration strategies, the main effect of using slim holes would be to reduce the cost of exploration by about 40 percent. Slim hole exploration does not reduce the overall cost of electricity by much; however, the cost burden is shifted later in the project when outside financing is more likely. The reduced costs of slim holes may also encourage developers to drill more holes that better characterize the reservoir, thus reducing long term reservoir risk. The cost of power could then be cut as much as six percent and project financial risks related to reservoir uncertainties could be reduced by up to one quarter. In order to realize these improvements, the amount of reservoir information recovered from small diameter bore holes needs to be significantly increased
Mortuaire, G; Theis, D; Fackeure, R; Chevalier, D; Gengler, I
To assess the cost-effectiveness of outpatient sinonasal surgery in terms of clinical efficacy and control of expenses. A retrospective study was conducted from January 2014 to January 2016. Patients scheduled for outpatient sinonasal surgery were systematically included. Clinical data were extracted from surgical and anesthesiology computer files. The cost accounting methods applied in our institution were used to evaluate logistic and technical costs. The standardized hospital fees rating system based on hospital stay and severity in diagnosis-related groups (Groupes homogènes de séjours: GHS) was used to estimate institutional revenue. Over 2years, 927 outpatient surgical procedures were performed. The crossover rate to conventional hospital admission was 2.9%. In a day-1 telephone interview, 85% of patients were very satisfied with the procedure. All outpatient cases showed significantly lower costs than estimated for conventional management with overnight admission, while hospital revenue did not differ between the two. This study confirmed the efficacy of outpatient surgery in this indication. Lower costs could allow savings for the health system by readjusting the rating for the procedure. More precise assessment of cost-effectiveness will require more fine-grained studies based on micro costing at hospital level and assessment of impact on conventional surgical activity and post-discharge community care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Sharifi, Mona; Franz, Calvin; Horan, Christine M; Giles, Catherine M; Long, Michael W; Ward, Zachary J; Resch, Stephen C; Marshall, Richard; Gortmaker, Steven L; Taveras, Elsie M
To estimate the cost-effectiveness and population impact of the national implementation of the Study of Technology to Accelerate Research (STAR) intervention for childhood obesity. In the STAR cluster-randomized trial, 6- to 12-year-old children with obesity seen at pediatric practices with electronic health record (EHR)-based decision support for primary care providers and self-guided behavior-change support for parents had significantly smaller increases in BMI than children who received usual care. We used a microsimulation model of a national implementation of STAR from 2015 to 2025 among all pediatric primary care providers in the United States with fully functional EHRs to estimate cost, impact on obesity prevalence, and cost-effectiveness. The expected population reach of a 10-year national implementation is ∼2 million children, with intervention costs of $119 per child and $237 per BMI unit reduced. At 10 years, assuming maintenance of effect, the intervention is expected to avert 43 000 cases and 226 000 life-years with obesity at a net cost of $4085 per case and $774 per life-year with obesity averted. Limiting implementation to large practices and using higher estimates of EHR adoption improved both cost-effectiveness and reach, whereas decreasing the maintenance of the intervention's effect worsened the former. A childhood obesity intervention with electronic decision support for clinicians and self-guided behavior-change support for parents may be more cost-effective than previous clinical interventions. Effective and efficient interventions that target children with obesity are necessary and could work in synergy with population-level prevention strategies to accelerate progress in reducing obesity prevalence. Copyright © 2017 by the American Academy of Pediatrics.
Full Text Available How do prior outcomes affect the risk choice? Research on this can help people to understand investors’ dynamic decisions in financial market. This paper puts forward a new value function. By analyzing the new value function, we find that the prior gains and losses have an impact on the form of value function and the current investors’ risk attitude. Then the paper takes the behavior of the whole stock market as the research object, adopts aggregative index number of 14 representative stocks around the world as samples, and establishes a TVRA-GARCH-M model to investigate the influences of prior gains and losses on the current risk attitude. The empirical study indicates that, at the whole market level, prior gains increase people’s current willingness to take risk assert; that is to say, the house money effect exists in the market, while people are more risk aversion following prior losses.