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Sample records for cost effective large

  1. Cost-effective Sampling Design Applied to Large-scale Monitoring of Boreal Birds

    Directory of Open Access Journals (Sweden)

    Matthew Carlson

    2002-12-01

    Full Text Available Despite their important roles in biodiversity conservation, large-scale ecological monitoring programs are scarce, in large part due to the difficulty of achieving an effective design under fiscal constraints. Using long-term avian monitoring in the boreal forest of Alberta, Canada as an example, we present a methodology that uses power analysis, statistical modeling, and partial derivatives to identify cost-effective sampling strategies for ecological monitoring programs. Empirical parameter estimates were used in simulations that estimated the power of sampling designs to detect trend in a variety of species' populations and community metrics. The ability to detect trend with increased sample effort depended on the monitoring target's variability and how effort was allocated to sampling parameters. Power estimates were used to develop nonlinear models of the relationship between sample effort and power. A cost model was also developed, and partial derivatives of the power and cost models were evaluated to identify two cost-effective avian sampling strategies. For decreasing sample error, sampling multiple plots at a site is preferable to multiple within-year visits to the site, and many sites should be sampled relatively infrequently rather than sampling few sites frequently, although the importance of frequent sampling increases for variable targets. We end by stressing the need for long-term, spatially extensive data for additional taxa, and by introducing optimal design as an alternative to power analysis for the evaluation of ecological monitoring program designs.

  2. A Cost-Effective Planning Graph Approach for Large-Scale Web Service Composition

    Directory of Open Access Journals (Sweden)

    Szu-Yin Lin

    2012-01-01

    Full Text Available Web Service Composition (WSC problems can be considered as a service matching problem, which means that the output parameters of a Web service can be used as inputs of another one. However, when a very large number of Web services are deployed in the environment, the service composition has become sophisticated and complicated process. In this study, we proposed a novel cost-effective Web service composition mechanism. It utilizes planning graph based on backward search algorithm to find multiple feasible solutions and recommends a best composition solution according to the lowest service cost. In other words, the proposed approach is a goal-driven mechanism, which can recommend the approximate solutions, but it consumes fewer amounts of Web services and less nested levels of composite service. Finally, we implement a simulation platform to validate the proposed cost-effective planning graph mechanism in large-scale Web services environment. The simulation results show that our proposed algorithm based on the backward planning graph has reduced by 94% service cost in three different environments of service composition that is compared with other existing service composition approaches which are based on a forward planning graph.

  3. Cost-effective river rehabilitation planning: optimizing for morphological benefits at large spatial scales.

    Science.gov (United States)

    Langhans, Simone D; Hermoso, Virgilio; Linke, Simon; Bunn, Stuart E; Possingham, Hugh P

    2014-01-01

    River rehabilitation aims to protect biodiversity or restore key ecosystem services but the success rate is often low. This is seldom because of insufficient funding for rehabilitation works but because trade-offs between costs and ecological benefits of management actions are rarely incorporated in the planning, and because monitoring is often inadequate for managers to learn by doing. In this study, we demonstrate a new approach to plan cost-effective river rehabilitation at large scales. The framework is based on the use of cost functions (relationship between costs of rehabilitation and the expected ecological benefit) to optimize the spatial allocation of rehabilitation actions needed to achieve given rehabilitation goals (in our case established by the Swiss water act). To demonstrate the approach with a simple example, we link costs of the three types of management actions that are most commonly used in Switzerland (culvert removal, widening of one riverside buffer and widening of both riversides) to the improvement in riparian zone quality. We then use Marxan, a widely applied conservation planning software, to identify priority areas to implement these rehabilitation measures in two neighbouring Swiss cantons (Aargau, AG and Zürich, ZH). The best rehabilitation plans identified for the two cantons met all the targets (i.e. restoring different types of morphological deficits with different actions) rehabilitating 80,786 m (AG) and 106,036 m (ZH) of the river network at a total cost of 106.1 Million CHF (AG) and 129.3 Million CH (ZH). The best rehabilitation plan for the canton of AG consisted of more and better connected sub-catchments that were generally less expensive, compared to its neighbouring canton. The framework developed in this study can be used to inform river managers how and where best to spend their rehabilitation budget for a given set of actions, ensures the cost-effective achievement of desired rehabilitation outcomes, and helps

  4. Assessing cost-effectiveness of specific LID practice designs in response to large storm events

    Science.gov (United States)

    Chui, Ting Fong May; Liu, Xin; Zhan, Wenting

    2016-02-01

    Low impact development (LID) practices have become more important in urban stormwater management worldwide. However, most research on design optimization focuses on relatively large scale, and there is very limited information or guideline regarding individual LID practice designs (i.e., optimal depth, width and length). The objective of this study is to identify the optimal design by assessing the hydrological performance and the cost-effectiveness of different designs of LID practices at a household or business scale, and to analyze the sensitivity of the hydrological performance and the cost of the optimal design to different model and design parameters. First, EPA SWMM, automatically controlled by MATLAB, is used to obtain the peak runoff of different designs of three specific LID practices (i.e., green roof, bioretention and porous pavement) under different design storms (i.e., 2 yr and 50 yr design storms of Hong Kong, China and Seattle, U.S.). Then, life cycle cost is estimated for the different designs, and the optimal design, defined as the design with the lowest cost and at least 20% peak runoff reduction, is identified. Finally, sensitivity of the optimal design to the different design parameters is examined. The optimal design of green roof tends to be larger in area but thinner, while the optimal designs of bioretention and porous pavement tend to be smaller in area. To handle larger storms, however, it is more effective to increase the green roof depth, and to increase the area of the bioretention and porous pavement. Porous pavement is the most cost-effective for peak flow reduction, followed by bioretention and then green roof. The cost-effectiveness, measured as the peak runoff reduction/thousand Dollars of LID practices in Hong Kong (e.g., 0.02 L/103 US s, 0.15 L/103 US s and 0.93 L/103 US s for green roof, bioretention and porous pavement for 2 yr storm) is lower than that in Seattle (e.g., 0.03 L/103 US s, 0.29 L/103 US s and 1.58 L/103 US s for

  5. The cognitive dynamics of computer science cost-effective large scale software development

    CERN Document Server

    De Gyurky, Szabolcs Michael; John Wiley & Sons

    2006-01-01

    This book has three major objectives: To propose an ontology for computer software; To provide a methodology for development of large software systems to cost and schedule that is based on the ontology; To offer an alternative vision regarding the development of truly autonomous systems.

  6. A Cost Effectiveness Analysis of Large and Small Classes in the University.

    Science.gov (United States)

    Maxwell, Nan L.; Lopus, Jane S.

    1995-01-01

    Using university cost data and student data from 176 members of university economics classes, this study finds that substantial monetary savings are realized by offering large classes, although their students have a 38% decreased probability of enrolling in future economics classes. Money savings may translate into enrollment losses. (SLD)

  7. Assessing Cost-effectiveness of Green Infrastructures in response to Large Storm Events at Household Scale

    Science.gov (United States)

    Chui, T. F. M.; Liu, X.; Zhan, W.

    2015-12-01

    Green infrastructures (GI) are becoming more important for urban stormwater control worldwide. However, relatively few studies focus on researching the specific designs of GI at household scale. This study assesses the hydrological performance and cost-effectiveness of different GI designs, namely green roofs, bioretention systems and porous pavements. It aims to generate generic insights by comparing the optimal designs of each GI in 2-year and 50-year storms of Hong Kong, China and Seattle, US. EPA SWMM is first used to simulate the hydrologic performance, in particular, the peak runoff reduction of thousands of GI designs. Then, life cycle costs of the designs are computed and their effectiveness, in terms of peak runoff reduction percentage per thousand dollars, is compared. The peak runoff reduction increases almost linearly with costs for green roofs. However, for bioretention systems and porous pavements, peak runoff reduction only increases significantly with costs in the mid values. For achieving the same peak runoff reduction percentage, the optimal soil depth of green roofs increases with the design storm, while surface area does not change significantly. On the other hand, for bioretention systems and porous pavements, the optimal surface area increases with the design storm, while thickness does not change significantly. In general, the cost effectiveness of porous pavements is highest, followed by bioretention systems and then green roofs. The cost effectiveness is higher for a smaller storm, and is thus higher for 2-year storm than 50-year storm, and is also higher for Seattle when compared to Hong Kong. This study allows us to better understand the hydrological performance and cost-effectiveness of different GI designs. It facilitates the implementation of optimal choice and design of each specific GI for stormwater mitigation.

  8. Large-scale system effectiveness analysis. Sub-problem 3: a conceptual framework for system cost. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Myers, D.R.; Lee, W.C.; Yabroff, I.W.

    1980-06-16

    The effectiveness of a large-scale electric power system can be measured by four factors: system performance, system availability, system cost, and system worth (from the user perspective). In response to the need for synergistic effectiveness measures. A broad, multi-contractor research project is being conducted to integrate those four categories. This report describes system cost at two levels: a conceptual framework for measuring the total cost of producing electricity under diverse system effectiveness measures, and a set of general cost inputs that relate the framework to specific utility types. In this report, Chapter II describes the general-level conceptual framework for assessing the cost of system effectivenss attributes. Chapter III shows how the actual costs of a power system can be disaggregated and then integrated into the broad-level conceptual framework. Chapter IV utilizes the conceptual framework and the concepts underlying its development to produce some concrete examples of measures of cost of system effectiveness. Appendix A is a more in-depth look at the cost of fuel, and illustrates the level of analytical detail necessary for putting the framework into practice.

  9. Integrated, long term, sustainable, cost effective biosolids management at a large Canadian wastewater treatment facility

    Energy Technology Data Exchange (ETDEWEB)

    LeBlance, R.J.; Allain, C.J.; Laughton, P.J.; Henry, J.G.

    2003-07-01

    The Greater Moncton Sewerage Commission's 115 000 m{sup 3}/d advanced, chemically assisted primary wastewater treatment facility located in New Brunswick, Canada, has developed an integrated, long term, sustainable, cost effective programme for the management and beneficial utilization of biosolids from lime stabilized raw sludge. The paper overviews biosolids production, lime stabilization, conveyance, and odour control followed by an indepth discussion of the wastewater sludge as a resource programme, namely: composting, mine site reclamation, landfill cover, land application for agricultural use, tree farming, sod farm base as a soil enrichment, topsoil manufacturing. The paper also addresses the issues of metals, pathogens, organic compounds, the quality control program along with the regulatory requirements. Biosolids capital and operating costs are presented. Research results on removal of metals from primary sludge using a unique biological process known as BIOSOL as developed by the University of Toronto, Canada to remove metals and destroy pathogens are presented. The paper also discusses an ongoing cooperative research project with the Universite de Moncton where various mixtures of plant biosolids are composted with low quality soil. Integration, approach to sustainability and ''cumulative effects'' as part of the overall biosolids management strategy is also discussed. (author)

  10. An improved method for the cost-effective expression and purification of large quantities of KcsA.

    Science.gov (United States)

    Tilegenova, Cholpon; Vemulapally, Spandana; Cortes, Doris M; Cuello, Luis G

    2016-11-01

    KcsA, the bacterial K(+) channel from Streptomyces lividans, is the prototypical model system to study the functional and structural correlations of the pore domain of eukaryotic voltage-gated K(+) channels (Kv channels). It contains all the molecular elements responsible for ion conduction, activation, deactivation and inactivation gating [1]. KcsA's structural simplicity makes it highly amenable for structural studies. Therefore, it is methodological advantageous to produce large amounts of functional and properly folded KcsA in a cost-effective manner. In the present study, we show an optimized protocol for the over-expression and purification of large amounts of high-quality, fully functional and crystallizable KcsA using inexpensive detergents, which significantly lowered the cost of the purification process. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Cost effective flip chip assembly and interconnection technologies for large area pixel sensor applications

    Energy Technology Data Exchange (ETDEWEB)

    Fritzsch, T., E-mail: thomas.fritzsch@izm.fraunhofer.de [Fraunhofer IZM, Gustav-Meyer-Allee 25, Berlin 13355 (Germany); Jordan, R.; Oppermann, H. [Fraunhofer IZM, Gustav-Meyer-Allee 25, Berlin 13355 (Germany); Ehrmann, O. [Berlin Institute of Technology (TUB), Berlin 10623 (Germany); Toepper, M.; Baumgartner, T.; Lang, K.-D. [Fraunhofer IZM, Gustav-Meyer-Allee 25, Berlin 13355 (Germany)

    2011-09-11

    Much of the cost of manufacturing pixel detectors is due to bumping and flip chip assembly of the readout chips onto sensor tiles, even if it is done on wafer level. To address this issue, Fraunhofer IZM investigated two new technological approaches, namely screen printing using dry film resist and chip-to-wafer assembly. In the first approach, solder bumps with diameters of 80 and 25 {mu}m in pitches of 110 and 60 {mu}m, respectively, were produced by screen-printing solder paste using a photo-structured dry film resist. Results indicated that the technology is a viable high yield and low cost bumping process. The second approach was developed to decrease the number of manual handling steps in pixel module manufacturing, which is critical for reducing processing time and cost. Here, chip designs on 200 mm readout chip (ROC) wafers and 150 mm sensor wafers were especially adapted for chip-to-wafer assembly and to ensure that the interconnection yield and reliability could be tested. After bumping and dicing of the readout chip wafer and UBM plating on the sensor wafer, individual dice were flip chip mounted on the pre-diced sensor wafer. This paper describes the technological steps, key processing parameters and first results for both technologies.

  12. A Cost-Effective Peer-to-Peer Architecture for Large-Scale On-Demand Media Streaming

    Directory of Open Access Journals (Sweden)

    Xin Liu

    2006-05-01

    Full Text Available This paper presents a cost-effective peer-to-peer (P2P architecture for large-scale on-demand media streaming, named BitVampire. BitVampire’s primary design goal is to aggregate peers’ storage and upstream bandwidth to facilitate on-demand media streaming. To achieve this goal, BitVampire splits published videos into segments and distributes them to different peers. When a peer (or a receiver wants to watch a video, it (i searches the corresponding segments, then (ii selfishly determines the best subset of supplying peers and (iii aggregates bandwidth from these peers to stream the media content. In BitVampire, participating peers help each other to get the desired media content, thus powerful servers/proxies are not necessary, which makes it a cost- effective approach. To demonstrate the effectiveness of BitVampire, we conducted extensive simulation on large, hierarchical, Internet-like topologies. We also implemented a functional prototype using Java and Java Media Framework (JMF to demonstrate the feasibility of BitVampire.

  13. Costs and cost-effectiveness of a large-scale mass testing and treatment intervention for malaria in Southern Province, Zambia.

    Science.gov (United States)

    Silumbe, Kafula; Yukich, Joshua O; Hamainza, Busiku; Bennett, Adam; Earle, Duncan; Kamuliwo, Mulakwa; Steketee, Richard W; Eisele, Thomas P; Miller, John M

    2015-05-20

    A cluster, randomized, control trial of three dry-season rounds of a mass testing and treatment intervention (MTAT) using rapid diagnostic tests (RDTs) and artemether-lumefantrine (AL) was conducted in four districts in Southern Province, Zambia. Data were collected on the costs and logistics of the intervention and paired with effectiveness estimated from a community randomized control trial for the purpose of conducting a provider perspective cost-effectiveness analysis of MTAT vs no MTAT (Standard of Care). Dry-season MTAT in this setting did not reduce malaria transmission sufficiently to permit transition to a case-investigation strategy to then pursue malaria elimination, however, the intervention did substantially reduce malaria illness and was a highly cost-effective intervention for malaria burden reduction in this moderate transmission area. The cost per RDT administered was estimated to be USD4.39 (range: USD1.62-13.96) while the cost per AL treatment administered was estimated to be USD34.74 (range: USD3.87-3,835). The net cost per disability adjusted life year averted (incremental cost-effectiveness ratio) was estimated to be USD804. The intervention appears to be highly cost-effective relative to World Health Organization thresholds for malaria burden reduction in Zambia as compared to no MTAT. However, it was estimated that population-wide mass drug administration is likely to be more cost-effective for burden reduction and for transmission reduction compared to MTAT.

  14. Study of Cost Effective Large Advanced Pressurized Water Reactors that Employ Passive Safety Features

    Energy Technology Data Exchange (ETDEWEB)

    Winters, J. W.; Corletti, M. M.; Hayashi, Y.

    2003-11-12

    A report of DOE sponsored portions of AP1000 Design Certification effort. On December 16, 1999, The United States Nuclear Regulatory Commission issued Design Certification of the AP600 standard nuclear reactor design. This culminated an 8-year review of the AP600 design, safety analysis and probabilistic risk assessment. The AP600 is a 600 MWe reactor that utilizes passive safety features that, once actuated, depend only on natural forces such as gravity and natural circulation to perform all required safety functions. These passive safety systems result in increased plant safety and have also significantly simplified plant systems and equipment, resulting in simplified plant operation and maintenance. The AP600 meets NRC deterministic safety criteria and probabilistic risk criteria with large margins. A summary comparison of key passive safety system design features is provided in Table 1. These key features are discussed due to their importance in affecting the key thermal-hydraulic phenomenon exhibited by the passive safety systems in critical areas. The scope of some of the design changes to the AP600 is described. These changes are the ones that are important in evaluating the passive plant design features embodied in the certified AP600 standard plant design. These design changes are incorporated into the AP1000 standard plant design that Westinghouse is certifying under 10 CFR Part 52. In conclusion, this report describes the results of the representative design certification activities that were partially supported by the Nuclear Energy Research Initiative. These activities are unique to AP1000, but are representative of research activities that must be driven to conclusion to realize successful licensing of the next generation of nuclear power plants in the United States.

  15. The Navy Needs More Comprehensive Guidance for Evaluating and Supporting CostEffectiveness of LargeScale Renewable Energy Projects (REDACTED)

    Science.gov (United States)

    2016-08-25

    project cost to current dollar value. 15 According to REPO personnel, the minimum kilowatt-hours represents less than 5 percent of the Navy’s total...No. DODIG-2016-130 The Navy Needs More Comprehensive Guidance for Evaluating and Supporting Cost -Effectiveness of Large-Scale Renewable Energy...Defense that supports the warfighter; promotes accountability , integrity, and efficiency; advises the Secretary of Defense and Congress; and informs

  16. Financial costs of large carnivore translocations--accounting for conservation.

    Directory of Open Access Journals (Sweden)

    Florian J Weise

    Full Text Available Human-carnivore conflict continues to present a major conservation challenge around the world. Translocation of large carnivores is widely implemented but remains strongly debated, in part because of a lack of cost transparency. We report detailed translocation costs for three large carnivore species in Namibia and across different translocation scenarios. We consider the effect of various parameters and factors on costs and translocation success. Total translocation cost for 30 individuals in 22 events was $80,681 (US Dollars. Median translocation cost per individual was $2,393, and $2,669 per event. Median cost per cheetah was $2,760 (n = 23, and $2,108 per leopard (n = 6. One hyaena was translocated at a cost of $1,672. Tracking technology was the single biggest cost element (56%, followed by captive holding and feeding. Soft releases, prolonged captivity and orphaned individuals also increased case-specific costs. A substantial proportion (65.4% of the total translocation cost was successfully recovered from public interest groups. Less than half the translocations were confirmed successes (44.4%, 3 unknown with a strong species bias. Four leopards (66.7% were successfully translocated but only eight of the 20 cheetahs (40.0% with known outcome met these strict criteria. None of the five habituated cheetahs was translocated successfully, nor was the hyaena. We introduce the concept of Individual Conservation Cost (ICC and define it as the cost of one successfully translocated individual adjusted by costs of unsuccessful events of the same species. The median ICC for cheetah was $6,898 and $3,140 for leopard. Translocations are costly, but we demonstrate that they are not inherently more expensive than other strategies currently employed in non-lethal carnivore conflict management. We conclude that translocation should be one available option for conserving large carnivores, but needs to be critically evaluated on a case-by-case basis.

  17. Financial costs of large carnivore translocations--accounting for conservation.

    Science.gov (United States)

    Weise, Florian J; Stratford, Ken J; van Vuuren, Rudolf J

    2014-01-01

    Human-carnivore conflict continues to present a major conservation challenge around the world. Translocation of large carnivores is widely implemented but remains strongly debated, in part because of a lack of cost transparency. We report detailed translocation costs for three large carnivore species in Namibia and across different translocation scenarios. We consider the effect of various parameters and factors on costs and translocation success. Total translocation cost for 30 individuals in 22 events was $80,681 (US Dollars). Median translocation cost per individual was $2,393, and $2,669 per event. Median cost per cheetah was $2,760 (n = 23), and $2,108 per leopard (n = 6). One hyaena was translocated at a cost of $1,672. Tracking technology was the single biggest cost element (56%), followed by captive holding and feeding. Soft releases, prolonged captivity and orphaned individuals also increased case-specific costs. A substantial proportion (65.4%) of the total translocation cost was successfully recovered from public interest groups. Less than half the translocations were confirmed successes (44.4%, 3 unknown) with a strong species bias. Four leopards (66.7%) were successfully translocated but only eight of the 20 cheetahs (40.0%) with known outcome met these strict criteria. None of the five habituated cheetahs was translocated successfully, nor was the hyaena. We introduce the concept of Individual Conservation Cost (ICC) and define it as the cost of one successfully translocated individual adjusted by costs of unsuccessful events of the same species. The median ICC for cheetah was $6,898 and $3,140 for leopard. Translocations are costly, but we demonstrate that they are not inherently more expensive than other strategies currently employed in non-lethal carnivore conflict management. We conclude that translocation should be one available option for conserving large carnivores, but needs to be critically evaluated on a case-by-case basis.

  18. Menu Costs, Aggregate Fluctuations and Large Shocks

    OpenAIRE

    Karadi, Peter; Reiff, Adam

    2014-01-01

    In menu cost models, real effects of aggregate nominal shocks are sensitive to unobserved characteristics of price setting. The standard way to calibrate key pricing parameters is to match the cross-sectional distribution of price changes. We argue that this unconditional distribution contains insufficient information for a clean identification. In particular, it is consistent with parameterizations with contradictory aggregate implications: one generating sizeable real effects, the other eff...

  19. Cost-Effectiveness Comparison of Response Strategies to a Large-Scale Anthrax Attack on the Chicago Metropolitan Area: Impact of Timing and Surge Capacity

    Science.gov (United States)

    Dobrez, Debra; Parada, Jorge P.; Steinberg, Justin M.; Kahn, Adam; Bennett, Charles L.; Schmitt, Brian P.

    2012-01-01

    Rapid public health response to a large-scale anthrax attack would reduce overall morbidity and mortality. However, there is uncertainty about the optimal cost-effective response strategy based on timing of intervention, public health resources, and critical care facilities. We conducted a decision analytic study to compare response strategies to a theoretical large-scale anthrax attack on the Chicago metropolitan area beginning either Day 2 or Day 5 after the attack. These strategies correspond to the policy options set forth by the Anthrax Modeling Working Group for population-wide responses to a large-scale anthrax attack: (1) postattack antibiotic prophylaxis, (2) postattack antibiotic prophylaxis and vaccination, (3) preattack vaccination with postattack antibiotic prophylaxis, and (4) preattack vaccination with postattack antibiotic prophylaxis and vaccination. Outcomes were measured in costs, lives saved, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). We estimated that postattack antibiotic prophylaxis of all 1,390,000 anthrax-exposed people beginning on Day 2 after attack would result in 205,835 infected victims, 35,049 fulminant victims, and 28,612 deaths. Only 6,437 (18.5%) of the fulminant victims could be saved with the existing critical care facilities in the Chicago metropolitan area. Mortality would increase to 69,136 if the response strategy began on Day 5. Including postattack vaccination with antibiotic prophylaxis of all exposed people reduces mortality and is cost-effective for both Day 2 (ICER=$182/QALY) and Day 5 (ICER=$1,088/QALY) response strategies. Increasing ICU bed availability significantly reduces mortality for all response strategies. We conclude that postattack antibiotic prophylaxis and vaccination of all exposed people is the optimal cost-effective response strategy for a large-scale anthrax attack. Our findings support the US government's plan to provide antibiotic prophylaxis and

  20. COST MODEL FOR LARGE URBAN SCHOOLS.

    Science.gov (United States)

    O'BRIEN, RICHARD J.

    THIS DOCUMENT CONTAINS A COST SUBMODEL OF AN URBAN EDUCATIONAL SYSTEM. THIS MODEL REQUIRES THAT PUPIL POPULATION AND PROPOSED SCHOOL BUILDING ARE KNOWN. THE COST ELEMENTS ARE--(1) CONSTRUCTION COSTS OF NEW PLANTS, (2) ACQUISITION AND DEVELOPMENT COSTS OF BUILDING SITES, (3) CURRENT OPERATING EXPENSES OF THE PROPOSED SCHOOL, (4) PUPIL…

  1. Cost-Effective Large-Scale Occupancy-Abundance Monitoring of Invasive Brushtail Possums (Trichosurus Vulpecula on New Zealand's Public Conservation Land.

    Directory of Open Access Journals (Sweden)

    Andrew M Gormley

    Full Text Available There is interest in large-scale and unbiased monitoring of biodiversity status and trend, but there are few published examples of such monitoring being implemented. The New Zealand Department of Conservation is implementing a monitoring program that involves sampling selected biota at the vertices of an 8-km grid superimposed over the 8.6 million hectares of public conservation land that it manages. The introduced brushtail possum (Trichosurus Vulpecula is a major threat to some biota and is one taxon that they wish to monitor and report on. A pilot study revealed that the traditional method of monitoring possums using leg-hold traps set for two nights, termed the Trap Catch Index, was a constraint on the cost and logistical feasibility of the monitoring program. A phased implementation of the monitoring program was therefore conducted to collect data for evaluating the trade-off between possum occupancy-abundance estimates and the costs of sampling for one night rather than two nights. Reducing trapping effort from two nights to one night along four trap-lines reduced the estimated costs of monitoring by 5.8% due to savings in labour, food and allowances; it had a negligible effect on estimated national possum occupancy but resulted in slightly higher and less precise estimates of relative possum abundance. Monitoring possums for one night rather than two nights would provide an annual saving of NZ$72,400, with 271 fewer field days required for sampling. Possums occupied 60% (95% credible interval; 53-68 of sampling locations on New Zealand's public conservation land, with a mean relative abundance (Trap Catch Index of 2.7% (2.0-3.5. Possum occupancy and abundance were higher in forest than in non-forest habitats. Our case study illustrates the need to evaluate relationships between sampling design, cost, and occupancy-abundance estimates when designing and implementing large-scale occupancy-abundance monitoring programs.

  2. The cost of a large-scale hollow fibre MBR.

    Science.gov (United States)

    Verrecht, Bart; Maere, Thomas; Nopens, Ingmar; Brepols, Christoph; Judd, Simon

    2010-10-01

    A cost sensitivity analysis was carried out for a full-scale hollow fibre membrane bioreactor to quantify the effect of design choices and operational parameters on cost. Different options were subjected to a long term dynamic influent profile and evaluated using ASM1 for effluent quality, aeration requirements and sludge production. The results were used to calculate a net present value (NPV), incorporating both capital expenditure (capex), based on costs obtained from equipment manufacturers and full-scale plants, and operating expenditure (opex), accounting for energy demand, sludge production and chemical cleaning costs. Results show that the amount of contingency built in to cope with changes in feedwater flow has a large impact on NPV. Deviation from a constant daily flow increases NPV as mean plant utilisation decreases. Conversely, adding a buffer tank reduces NPV, since less membrane surface is required when average plant utilisation increases. Membrane cost and lifetime is decisive in determining NPV: an increased membrane replacement interval from 5 to 10 years reduces NPV by 19%. Operation at higher SRT increases the NPV, since the reduced costs for sludge treatment are offset by correspondingly higher aeration costs at higher MLSS levels, though the analysis is very sensitive to sludge treatment costs. A higher sustainable flux demands greater membrane aeration, but the subsequent opex increase is offset by the reduced membrane area and the corresponding lower capex.

  3. Emergency vaccination for classical swine fever will not be cost-effective for countries with a large export

    DEFF Research Database (Denmark)

    Boklund, Anette; Toft, Nils; Alban, Lis;

    2009-01-01

    the epidemiological and economic consequences of such control strategies under Danish conditions with respect to herd demographics and geography as well as to investigate the effect of extra biosecurity on farms. We used InterSpread Plus to model the effect of nine different control strategies: the minimum measures...... required by the EU plus depopulation of contact herds (EUplus), extra depopulation of neighbouring herds, extra surveillance of neighbouring herds, extra surveil-lance within the protection and surveillance zones, extra biosecurity in SPF herds – or in all herds, vaccination of all pigs in the 1 or 2 km......, the vaccination-to-live strategy appeared to be more effective. Epidemics become larger and longer if the index case is a nucleus herd. This implies that biosecurity in nucleus herds is extremely important to avoid transmission of CSF to these herds. In the Netherlands in 1997-98, many herds were involved...

  4. Cost Overruns in Large-scale Transportation Infrastructure Projects

    DEFF Research Database (Denmark)

    Cantarelli, Chantal C; Flyvbjerg, Bent; Molin, Eric J. E

    2010-01-01

    Managing large-scale transportation infrastructure projects is difficult due to frequent misinformation about the costs which results in large cost overruns that often threaten the overall project viability. This paper investigates the explanations for cost overruns that are given in the literature...

  5. The challenge of monitoring elusive large carnivores: An accurate and cost-effective tool to identify and sex pumas (Puma concolor) from footprints

    Science.gov (United States)

    2017-01-01

    Acquiring reliable data on large felid populations is crucial for effective conservation and management. However, large felids, typically solitary, elusive and nocturnal, are difficult to survey. Tagging and following individuals with VHF or GPS technology is the standard approach, but costs are high and these methodologies can compromise animal welfare. Such limitations can restrict the use of these techniques at population or landscape levels. In this paper we describe a robust technique to identify and sex individual pumas from footprints. We used a standardized image collection protocol to collect a reference database of 535 footprints from 35 captive pumas over 10 facilities; 19 females (300 footprints) and 16 males (235 footprints), ranging in age from 1–20 yrs. Images were processed in JMP data visualization software, generating one hundred and twenty three measurements from each footprint. Data were analyzed using a customized model based on a pairwise trail comparison using robust cross-validated discriminant analysis with a Ward’s clustering method. Classification accuracy was consistently > 90% for individuals, and for the correct classification of footprints within trails, and > 99% for sex classification. The technique has the potential to greatly augment the methods available for studying puma and other elusive felids, and is amenable to both citizen-science and opportunistic/local community data collection efforts, particularly as the data collection protocol is inexpensive and intuitive. PMID:28273159

  6. Cost effective solar Inverter

    Directory of Open Access Journals (Sweden)

    Nagarathna M

    2015-06-01

    Full Text Available Solar energy the most efficient, eco-friendly and abundantly available energy source in the nature. It can be converted into electrical energy in cost effective manner. In recent years, the interest in solar energy has risen due to surging oil prices and environmental concern. In many remote or underdeveloped areas, direct access to an electric grid is impossible and a photovoltaic inverter system would make life much simpler and more convenient. With this in mind, it is aimed to design, build, and test a solar panel inverter. This inverter system could be used as backup power during outages, battery charging, or for typical household applications. The main components of this solar system are solar cell, dc to dc boost converters, and inverter. Sine wave push pull inverter topology is used for inverter. In this topology only two MOSFETs are used and isolation requirement between control circuit and power circuit is also less which helps to decrease the cost of solar inverter.

  7. Cost Overruns in Large-scale Transportation Infrastructure Projects

    DEFF Research Database (Denmark)

    Cantarelli, Chantal C; Flyvbjerg, Bent; Molin, Eric J. E

    2010-01-01

    Managing large-scale transportation infrastructure projects is difficult due to frequent misinformation about the costs which results in large cost overruns that often threaten the overall project viability. This paper investigates the explanations for cost overruns that are given in the literature....... Overall, four categories of explanations can be distinguished: technical, economic, psychological, and political. Political explanations have been seen to be the most dominant explanations for cost overruns. Agency theory is considered the most interesting for political explanations and an eclectic theory...

  8. The Nonmydriatic Fundus Camera in Diabetic Retinopathy Screening: A Cost-Effective Study with Evaluation for Future Large-Scale Application

    Science.gov (United States)

    Scarpa, Giuseppe; Urban, Francesca; Tessarin, Michele; Gallo, Giovanni; Midena, Edoardo

    2016-01-01

    Aims. The study aimed to present the experience of a screening programme for early detection of diabetic retinopathy (DR) using a nonmydriatic fundus camera, evaluating the feasibility in terms of validity, resources absorption, and future advantages of a potential application, in an Italian local health authority. Methods. Diabetic patients living in the town of Ponzano, Veneto Region (Northern Italy), were invited to be enrolled in the screening programme. The “no prevention strategy” with the inclusion of the estimation of blindness related costs was compared with screening costs in order to evaluate a future extensive and feasible implementation of the procedure, through a budget impact approach. Results. Out of 498 diabetic patients eligible, 80% was enrolled in the screening programme. 115 patients (34%) were referred to an ophthalmologist and 9 cases required prompt treatment for either proliferative DR or macular edema. Based on the pilot data, it emerged that an extensive use of the investigated screening programme, within the Greater Treviso area, could prevent 6 cases of blindness every year, resulting in a saving of €271,543.32 (−13.71%). Conclusions. Fundus images obtained with a nonmydriatic fundus camera could be considered an effective, cost-sparing, and feasible screening tool for the early detection of DR, preventing blindness as a result of diabetes. PMID:27885337

  9. Robin Hood: A cost-efficient two-stage approach to large-scale simultaneous inference with non-homogeneous sparse effects.

    Science.gov (United States)

    Pecanka, Jakub; Goeman, Jelle

    2017-04-25

    A classical approach to experimental design in many scientific fields is to first gather all of the data and then analyze it in a single analysis. It has been recognized that in many areas such practice leaves substantial room for improvement in terms of the researcher's ability to identify relevant effects, in terms of cost efficiency, or both. Considerable attention has been paid in recent years to multi-stage designs, in which the user alternates between data collection and analysis and thereby sequentially reduces the size of the problem. However, the focus has generally been towards designs that require a hypothesis be tested in every single stage before it can be declared as rejected by the procedure. Such procedures are well-suited for homogeneous effects, i.e. effects of (almost) equal sizes, however, with effects of varying size a procedure that permits rejection at interim stages is much more suitable. Here we present precisely such multi-stage testing procedure called Robin Hood. We show that with heterogeneous effects our method substantially improves on the existing multi-stage procedures with an essentially zero efficiency trade-off in the homogeneous effect realm, which makes it especially useful in areas such as genetics, where heterogeneous effects are common. Our method improves on existing approaches in a number of ways including a novel way of performing two-sided testing in a multi-stage procedure with increased power for detecting small effects.

  10. Enhancing Social Surveys Through the Postal Collection of Shed Milk Teeth: an Example of a Large-Scale Cost-Effective Collection on a Longitudinal Study

    Directory of Open Access Journals (Sweden)

    Samantha Jayne Parsons

    2016-04-01

    Full Text Available Social scientists and health researchers often need valid and reliable health measures from survey respondents to address key research questions, whether on environmental risks, weight and nutrition, physical activity or health / risky behaviours. There are long-standing debates on the validity of self-reported measures of health status and health behaviours in representative sample surveys. Such problems are particularly acute when the health status or behaviour occurred in the past and depends on retrospective recall. Increasingly social surveys are collecting direct biomarkers to provide more precise information on health status and behaviours. While much of this biomarker collection requires clinic visits or in-home nurse visits, some biomarkers are amenable to less costly and intrusive collection. Shed milk teeth are a good example of a stable biomarker that can provide extensive information on early (including in utero child environmental and family contexts that may shed valuable light on childhood and adult health and social outcomes. Shed milk teeth are also potentially cheap (and non-intrusive to collect as well as to store. In this paper we report on the collection of shed milk teeth in a nationally representative sample in the UK using postal methods. We conclude that for surveys involving children and with broad geographical coverage, incorporating the collection of shed milk teeth could prove a cost-effective enhancement, providing valuable environmental, nutritional and health information.

  11. Large-scale development of cost-effective SNP marker assays for diversity assessment and genetic mapping in chickpea and comparative mapping in legumes

    Science.gov (United States)

    Hiremath, Pavana J; Kumar, Ashish; Penmetsa, Ramachandra Varma; Farmer, Andrew; Schlueter, Jessica A; Chamarthi, Siva K; Whaley, Adam M; Carrasquilla-Garcia, Noelia; Gaur, Pooran M; Upadhyaya, Hari D; Kavi Kishor, Polavarapu B; Shah, Trushar M; Cook, Douglas R; Varshney, Rajeev K

    2012-01-01

    A set of 2486 single nucleotide polymorphisms (SNPs) were compiled in chickpea using four approaches, namely (i) Solexa/Illumina sequencing (1409), (ii) amplicon sequencing of tentative orthologous genes (TOGs) (604), (iii) mining of expressed sequence tags (ESTs) (286) and (iv) sequencing of candidate genes (187). Conversion of these SNPs to the cost-effective and flexible throughput Competitive Allele Specific PCR (KASPar) assays generated successful assays for 2005 SNPs. These marker assays have been designated as Chickpea KASPar Assay Markers (CKAMs). Screening of 70 genotypes including 58 diverse chickpea accessions and 12 BC3F2 lines showed 1341 CKAMs as being polymorphic. Genetic analysis of these data clustered chickpea accessions based on geographical origin. Genotyping data generated for 671 CKAMs on the reference mapping population (Cicer arietinum ICC 4958 × Cicer reticulatum PI 489777) were compiled with 317 unpublished TOG-SNPs and 396 published markers for developing the genetic map. As a result, a second-generation genetic map comprising 1328 marker loci including novel 625 CKAMs, 314 TOG-SNPs and 389 published marker loci with an average inter-marker distance of 0.59 cM was constructed. Detailed analyses of 1064 mapped loci of this second-generation chickpea genetic map showed a higher degree of synteny with genome of Medicago truncatula, followed by Glycine max, Lotus japonicus and least with Vigna unguiculata. Development of these cost-effective CKAMs for SNP genotyping will be useful not only for genetics research and breeding applications in chickpea, but also for utilizing genome information from other sequenced or model legumes. PMID:22703242

  12. Cost-Effective Clustering

    CERN Document Server

    Gottlieb, S

    2001-01-01

    Small Beowulf clusters can effectively serve as personal or group supercomputers. In such an environment, a cluster can be optimally designed for a specific problem (or a small set of codes). We discuss how theoretical analysis of the code and benchmarking on similar hardware lead to optimal systems.

  13. Characterization of a Large, Low-Cost 3D Scanner

    Directory of Open Access Journals (Sweden)

    Jeremy Straub

    2015-01-01

    Full Text Available Imagery-based 3D scanning can be performed by scanners with multiple form factors, ranging from small and inexpensive scanners requiring manual movement around a stationary object to large freestanding (nearly instantaneous units. Small mobile units are problematic for use in scanning living creatures, which may be unwilling or unable to (or for the very young and animals, unaware of the need to hold a fixed position for an extended period of time. Alternately, very high cost scanners that can capture a complete scan within a few seconds are available, but they are cost prohibitive for some applications. This paper seeks to assess the performance of a large, low-cost 3D scanner, presented in prior work, which is able to concurrently capture imagery from all around an object. It provides the capabilities of the large, freestanding units at a price point akin to the smaller, mobile ones. This allows access to 3D scanning technology (particularly for applications requiring instantaneous imaging at a lower cost. Problematically, prior analysis of the scanner’s performance was extremely limited. This paper characterizes the efficacy of the scanner for scanning both inanimate objects and humans. Given the importance of lighting to visible light scanning systems, the scanner’s performance under multiple lighting configurations is evaluated, characterizing its sensitivity to lighting design.

  14. Prenatal screening costs at a large military treatment facility.

    Science.gov (United States)

    Shiv, Erin; Sale, Taylor J; Simsiman, Amanda; Leininger, William M; Lutgendorf, Monica A

    2017-07-01

    Prenatal screening with cell-free DNA (cfDNA) offers improved detection of Down syndrome (T21) compared to conventional screening. These tests are expensive and have fewer detectable anomalies. Our objective was to investigate potential costs and test performance of screening algorithms when accounting for detectable aneuploidies. This is a cost analysis for a large military treatment facility. Using a theoretical delivery cohort and published performance data, universal screening with cfDNA was compared to sequential screening, comparing T21 to all detectable aneuploidies. Predicted test performance and costs were calculated. A cohort of 3000 deliveries was used. For T21, universal cfDNA is more expensive ($1,346,064) than sequential screening ($244,885), but has a lower false positive rate and avoids 101 invasive diagnostic tests. An additional case of T21 is detected with a marginal cost of $1,101,179. For all detectable aneuploidies, cfDNA is more expensive ($1,353,660) than sequential screening ($239,189), and 59 invasive diagnostic tests are avoided. Sequential screening detects an additional case of aneuploidy, with a cost savings of $1,114,471. Although cfDNA is superior in detecting T21 cases, sequential screening is superior when considering all aneuploidies detectable. The cost increase with universal cfDNA is significant, and is not justified with small improvements in the performance.

  15. Costs and cost-effectiveness of alternative tuberculosis ...

    African Journals Online (AJOL)

    Costs and cost-effectiveness of alternative tuberculosis management strategies in South ... important national implications, supporting the goals of the new tuberculosis control programme. ... DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT ...

  16. Designing a low-cost effective network for monitoring large scale regional seismicity in a soft-soil region (Alsace, France)

    Science.gov (United States)

    Bès de Berc, M.; Doubre, C.; Wodling, H.; Jund, H.; Hernandez, A.; Blumentritt, H.

    2015-12-01

    The Seismological Observatory of the North-East of France (ObSNEF) is developing its monitoring network within the framework of several projects. Among these project, RESIF (Réseau sismologique et géodésique français) allows the instrumentation of broad-band seismic stations, separated by 50-100 km. With the recent and future development of geothermal industrial projects in the Alsace region, the ObSNEF is responsible for designing, building and operating a dense regional seismic network in order to detect and localize earthquakes with both a completeness magnitude of 1.5 and no clipping for M6.0. The realization of the project has to be done prior to the summer 2016Several complex technical and financial constraints constitute such a projet. First, most of the Alsace Région (150x150 km2), particularly the whole Upper Rhine Graben, is a soft-soil plain where seismic signals are dominated by a high frequency noise level. Second, all the signals have to be transmitted in near real-time. And finally, the total cost of the project must not exceed $450,000.Regarding the noise level in Alsace, in order to make a reduction of 40 dB for frequencies above 1Hz, we program to instrument into 50m deep well with post-hole sensor for 5 stations out of 8 plane new stations. The 3 remaining would be located on bedrock along the Vosges piedmont. In order to be sensitive to low-magnitude regional events, we plan to install a low-noise short-period post-hole velocimeter. In order to avoid saturation for high potentiel local events (M6.0 at 10km), this velocimeter will be coupled with a surface strong-motion sensor. Regarding the connectivity, these stations will have no wired network, which reduces linking costs and delays. We will therefore use solar panels and a 3G/GPRS network. The infrastructure will be minimal and reduced to an outdoor box on a secured parcel of land. In addition to the data-logger, we will use a 12V ruggedized computer, hosting a seed-link server for near

  17. Cost-effective nursing practice: cost-awareness and empowerment.

    Science.gov (United States)

    Fisher, P

    1993-12-01

    Cost-effective nursing practice is essential to succeed today as resources allocated to health care are declining. Realizing that any change poses a threat to our security, it is imperative that stakeholders be permitted to participate in decision-making processes affecting their work. An honest, open exchange of ideas towards cost-effective practices should be encouraged. Cost-effective behaviours are influenced significantly by negative attitudes with regard to loss of human resources, increased workload, and potential pay cuts. This article describes innovative strategies which could promote successful cost-effective nursing practice, including working smarter, not working harder. Topics addressed are attitude, awareness and empowerment.

  18. A Departmental Cost-Effectiveness Model.

    Science.gov (United States)

    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…

  19. Cost effectiveness in trauma care.

    Science.gov (United States)

    Elliott, D C; Rodriguez, A

    1996-02-01

    The above discussion brings together a vast body of data that together proclaim with fervent clarity: Traumatic injuries are expensive. The expense is paid in productive lives lost, in permanent disability, in pain and suffering, and in health care resources consumed. As local and regional trauma systems struggle for development and survival, competition for the health care dollar casts in the additional necessity of providing the service of trauma care with maximum efficiency. Despite the variety of cost-efficiency measures described above, a majority of trauma centers continue to operate "in the red." Such cannot continue indefinitely. Fiscal responsibility dictates that health care institutions must balance budgets in order to maintain operations. Four primary strategies for cost containment appear from the above discussion: 1. Improve reimbursement rates from trauma patients. 2. Increase outside funding from government sources. 3. Improve cost efficiency of diagnostic and therapeutic procedures used in trauma patient management. 4. Increase efforts aimed at primary prevention of intentional and unintentional injuries. In the final analysis, most authors agree that the last strategy offers the best hope. As stated in their article, "The Economic Impact of Injuries," Harlan and colleagues conclude that "the most effective medical and cost reduction strategy would be prevention." The same article goes on to detail how greater funding for research into optimal prevention modalities could reap societal and economic benefits far beyond the value of the initial outlay. Yet such research funding continues to be inadequate. For every dollar spent on medical care of cancer patients, nine cents is directed to research. For every dollar spent on trauma care, less than a penny is spent on research. Until the public recognizes the terrible toll trauma extracts in lives, livelihood, and money wasted and until it realizes the pre-eminent importance of prevention, care of the

  20. Pursuing Photovoltaic Cost-Effectiveness

    DEFF Research Database (Denmark)

    Yang, Yongheng; Koutroulis, Eftichios; Sangwongwanich, Ariya

    2017-01-01

    Countries with considerable PhotoVoltaic (PV) installations are facing a challenge of overloading their power grid during peak-power production hours if the power infrastructure remains the same. To address this, regulations have been imposed on PV systems, where more active power control should...... 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...... 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...

  1. Cost-Effective Fuel Treatment Planning

    Science.gov (United States)

    Kreitler, J.; Thompson, M.; Vaillant, N.

    2014-12-01

    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

  2. Cost-effectiveness analysis and innovation.

    Science.gov (United States)

    Jena, Anupam B; Philipson, Tomas J

    2008-09-01

    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.

  3. Cost-effectiveness analysis in markets with high fixed costs.

    Science.gov (United States)

    Cutler, David M; Ericson, Keith M Marzilli

    2010-01-01

    We consider how to conduct cost-effectiveness analysis when the social cost of a resource differs from the posted price. From the social perspective, the true cost of a medical intervention is the marginal cost of delivering another unit of a treatment, plus the social cost (deadweight loss) of raising the revenue to fund the treatment. We focus on pharmaceutical prices, which have high markups over marginal cost due to the monopoly power granted to pharmaceutical companies when drugs are under patent. We find that the social cost of a branded drug is approximately one-half the market price when the treatment is paid for by a public insurance plan and one-third the market price for mandated coverage by private insurance. We illustrate the importance of correctly accounting for social costs using two examples: coverage for statin drugs and approval for a drug to treat kidney cancer (sorafenib). In each case, we show that the correct social perspective for cost-effectiveness analysis would be more lenient than researcher recommendations.

  4. Non-fragile guaranteed cost control for uncertain neutral large-scale interconnected systems

    Institute of Scientific and Technical Information of China (English)

    Dan Zhao; Qingling Zhang; Heli Hu; Chunyuan Zhao

    2010-01-01

    This paper focuses on the problem of non-fragile decentralized guaranteed cost control for uncertain neutral large-scale interconnected systems with time-varying delays in state,control input and interconnections.A novel scheme,viewing the interconnections with time-varying delays as effective information but not disturbances,is developed.Based on Lyapunov stability theory,using various techniques of decomposing and magnifying matrices,a design method of the non-fragile decentralized guaranteed cost controller for unperturbed neutral large-scale interconnected systems is proposed and the guaranteed cost is presented.The further results are derived for the uncertain case from the criterion of unperturbed neutral large-scale interconnected systems.Finally,an illustrative example shows that the results are significantly better than the existing results in the literatures.

  5. Costs, health effects and cost-effectiveness of alcohol and tobacco control strategies in Estonia.

    NARCIS (Netherlands)

    Lai, T.; Habicht, J.; Reinap, M.; Chisholm, D.; Baltussen, R.M.P.M.

    2007-01-01

    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 Kroo

  6. Hip Fracture Prevention: Cost-Effective Strategies

    OpenAIRE

    Peter Vestergaard; Lars Rejnmark; Leif Mosekilde

    2001-01-01

    The available literature on cost benefit, cost effectiveness and cost utility of different drug and non-drug regimens in preventing hip fractures was reviewed. The cost of a hip fracture and of the different treatment regimens varied considerably from one country to another. In primary prevention, potential savings only exceeded costs in women over the age of 70 years treated with hormonal replacement therapy (HRT). In the case of HRT, treating those with low bone mineral density levels (seco...

  7. Large Hadron Collider in crisis as magnet costs spiral upwards

    CERN Multimedia

    Adam, D

    2001-01-01

    Managers of the LHC project admitted this week that it faces cost overruns of several hundred million dollars. CERN will face years of budget cuts but this will cover only a fraction of the extra costs - the 20 member states will be asked to cover the rest (1 page).

  8. Costs and effects in lumbar spinal fusion

    DEFF Research Database (Denmark)

    Soegaard, Rikke; Christensen, Finn Bjarke; Christiansen, Terkel

    2007-01-01

    ) instrumented posterolateral lumbar spinal fusion, or (3) instrumented posterolateral lumbar spinal fusion + anterior intervertebral support. Analysis of costs was performed at the patient-level, from an administrator's perspective, by means of Activity-Based-Costing. Clinical effects were measured by means...... 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...... of the present investigation is a recommendation to focus further on determinants of cost-effectiveness. For example, patient characteristics that are modifiable at a relatively low expense may have greater influence on cost-effectiveness than the surgical technique itself--at least from an administrator...

  9. Evidence-based practice: cost-benefit of large system implementation.

    Science.gov (United States)

    Schifalacqua, Marita Mackinnon; Shepard, Ann; Kelley, Wanda

    2012-01-01

    The key points for designing and implementing an evidence-based practice (EBP) model in a large health care system are discussed. This implementation created strategies for practice changes for organizational change. The quality management methods included structured EBP toolkits that are described as part of the deliverable of each toolkit's Design Team. The cost-benefit evaluation process of staff time in the development stage of an EBP is explained. The conclusion is that a representative group of clinicians can be leveraged to create the standard and materials for system implementation, thereby providing improved patient care that is evidence-based and cost-effective.Many hands make light work....

  10. Electrochemical Journals, AIP's Scitation, Cost-Effectiveness

    OpenAIRE

    Roth, Dana L

    2004-01-01

    A review of the relative subscription costs, page & article counts of Electrochemical Society journals compared with commercial counterparts. A description of the AIP's Scitation database. The relative cost-effectiveness (normalized cost/article/Impact Factor) of society and commercial journals related to electrochemistry.

  11. CT colonography and cost-effectiveness

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2008-11-15

    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.)

  12. Cost Distribution of Environmental Flow Demands in a Large Scale Multi-Reservoir System

    Science.gov (United States)

    Marques, G.; Tilmant, A.

    2014-12-01

    This paper investigates the recovery of a prescribed flow regime through reservoir system reoperation, focusing on the associated costs and losses imposed on different power plants depending on flows, power plant and reservoir characteristics and systems topology. In large-scale reservoir systems such cost distribution is not trivial, and it should be properly evaluated to identify coordinated operating solutions that avoid penalizing a single reservoir. The methods combine an efficient stochastic dual dynamic programming algorithm for reservoir optimization subject to environmental flow targets with specific magnitude, duration and return period, which effects on fish recruitment are already known. Results indicate that the distribution of the effect of meeting the environmental flow demands throughout the reservoir cascade differs largely, and in some reservoirs power production and revenue are increased, while in others it is reduced. Most importantly, for the example system modeled here (10 reservoirs in the Parana River basin, Brazil) meeting the target environmental flows was possible without reducing the total energy produced in the year, at a cost of $25 Million/year in foregone hydropower revenues (3% reduction). Finally, the results and methods are useful in (a) quantifying the foregone hydropower and revenues resulting from meeting a specific environmental flow demand, (b) identifying the distribution and reallocation of the foregone hydropower and revenue across a large scale system, and (c) identifying optimal reservoir operating strategies to meet environmental flow demands in a large scale multi-reservoir system.

  13. Biosimilar medicines and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Steven Simoens

    2011-02-01

    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

  14. Cost-effectiveness thresholds: pros and cons.

    Science.gov (United States)

    Bertram, Melanie Y; Lauer, Jeremy A; De Joncheere, Kees; Edejer, Tessa; Hutubessy, Raymond; Kieny, Marie-Paule; Hill, Suzanne R

    2016-12-01

    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.

  15. How cost effective is CHP

    Energy Technology Data Exchange (ETDEWEB)

    Bakker, D.; Huizinga, J.

    1989-04-01

    A critical review of the calculations and conclusions of the CHP (combined heat and power generation) Preconditions Working Group, on which an article was published in the November 1988 issue of this magazine. According to the review a correct assignment of costs avoided in the power generating area is more important than gas price reduction. In a postscript to the review the authors of the November article oppose this view. 2 figs., 1 tab.

  16. Inflating with large effective fields

    Science.gov (United States)

    Burgess, C. P.; Cicoli, M.; Quevedo, F.; Williams, M.

    2014-11-01

    We re-examine large scalar fields within effective field theory, in particular focussing on the issues raised by their use in inflationary models (as suggested by BICEP2 to obtain primordial tensor modes). We argue that when the large-field and low-energy regimes coincide the scalar dynamics is most effectively described in terms of an asymptotic large-field expansion whose form can be dictated by approximate symmetries, which also help control the size of quantum corrections. We discuss several possible symmetries that can achieve this, including pseudo-Goldstone inflatons characterized by a coset G/H (based on abelian and non-abelian, compact and non-compact symmetries), as well as symmetries that are intrinsically higher dimensional. Besides the usual trigonometric potentials of Natural Inflation we also find in this way simple large-field power laws (like V propto phi2) and exponential potentials, V(phi) = ∑kVxe-kphi/M. Both of these can describe the data well and give slow-roll inflation for large fields without the need for a precise balancing of terms in the potential. The exponential potentials achieve large r through the limit |η| ll epsilon and so predict r simeq (8/3)(1-ns) consequently ns simeq 0.96 gives r simeq 0.11 but not much larger (and so could be ruled out as measurements on r and ns improve). We examine the naturalness issues for these models and give simple examples where symmetries protect these forms, using both pseudo-Goldstone inflatons (with non-abelian non-compact shift symmetries following familiar techniques from chiral perturbation theory) and extra-dimensional models.

  17. Inflating with large effective fields

    Energy Technology Data Exchange (ETDEWEB)

    Burgess, C.P. [PH-TH Division, CERN, CH-1211, Genève 23 (Switzerland); Cicoli, M. [Dipartimento di Fisica e Astronomia, Università di Bologna, Via Irnerio 46, 40126 Bologna (Italy); Quevedo, F. [Abdus Salam ICTP, Strada Costiera 11, Trieste 34014 (Italy); Williams, M., E-mail: cburgess@perimeterinstitute.ca, E-mail: mcicoli@ictp.it, E-mail: f.quevedo@damtp.cam.ac.uk, E-mail: mwilliams@perimeterinsititute.ca [Department of Physics and Astronomy, McMaster University, 1280 Main Street West, Hamilton ON (Canada)

    2014-11-01

    We re-examine large scalar fields within effective field theory, in particular focussing on the issues raised by their use in inflationary models (as suggested by BICEP2 to obtain primordial tensor modes). We argue that when the large-field and low-energy regimes coincide the scalar dynamics is most effectively described in terms of an asymptotic large-field expansion whose form can be dictated by approximate symmetries, which also help control the size of quantum corrections. We discuss several possible symmetries that can achieve this, including pseudo-Goldstone inflatons characterized by a coset G/H (based on abelian and non-abelian, compact and non-compact symmetries), as well as symmetries that are intrinsically higher dimensional. Besides the usual trigonometric potentials of Natural Inflation we also find in this way simple large-field power laws (like V ∝ φ{sup 2}) and exponential potentials, V(φ) = ∑{sub k}V{sub x}e{sup −kφ/M}. Both of these can describe the data well and give slow-roll inflation for large fields without the need for a precise balancing of terms in the potential. The exponential potentials achieve large r through the limit |η| || ε and so predict r ≅ (8/3)(1-n{sub s}); consequently n{sub s} ≅ 0.96 gives r ≅ 0.11 but not much larger (and so could be ruled out as measurements on r and n{sub s} improve). We examine the naturalness issues for these models and give simple examples where symmetries protect these forms, using both pseudo-Goldstone inflatons (with non-abelian non-compact shift symmetries following familiar techniques from chiral perturbation theory) and extra-dimensional models.

  18. A Low Cost Approach to Large Smart Shelf Setups

    Directory of Open Access Journals (Sweden)

    MOGA, D.

    2011-11-01

    Full Text Available Recent years showed a growing interest in the use of RFID technology in applications like distribution and storage of goods, supply chain and inventory. This paper analyses the current smart shelf solutions and presents the experience of developing an automatic reading system for smart shelves. The proposed system addresses the problem of reading RFID tags from items placed on multiple shelves. It allows the use of standard low cost readers and tags and uses a single antenna that can be positioned in specific locations at repeatable positions. The system proposes an alternative to the approaches with multiple antennas placed in fixed position inside the shelf or around the shelves, offering a lower cost solution by means of dedicated electromechanical devices able to carry the antenna and the reader to the locations of interest along a rail system. Moreover, antenna position can be controlled for three axis of movement allowing for extra flexibility and complete coverage of the shelves. The proposed setup is a fully wireless one. It contains a standard reader, electromechanical positioning actuators and wireless communication and control hardware offering power from integrated batteries.

  19. Inflating with Large Effective Fields

    CERN Document Server

    Burgess, C P; Quevedo, F; Williams, M

    2014-01-01

    We re-examine large scalar fields within effective field theory, in particular focussing on the issues raised by their use in inflationary models (as suggested by BICEP2 to obtain primordial tensor modes). We argue that when the large-field and low-energy regimes coincide the scalar dynamics is most effectively described in terms of an asymptotic large-field expansion whose form can be dictated by approximate symmetries, which also help control the size of quantum corrections. We discuss several possible symmetries that can achieve this, including pseudo-Goldstone inflatons characterized by a coset $G/H$ (based on abelian and non-abelian, compact and non-compact symmetries), as well as symmetries that are intrinsically higher dimensional. Besides the usual trigonometric potentials of Natural Inflation we also find in this way simple {\\em large-field} power laws (like $V \\propto \\phi^2$) and exponential potentials, $V(\\phi) = \\sum_{k} V_k \\; e^{-k \\phi/M}$. Both of these can describe the data well and give slo...

  20. Cost-Effective Stress Management Training.

    Science.gov (United States)

    Shea, Gordon F.

    1980-01-01

    Stress management training can be a cost effective way to improve productivity and job performance. Among many relaxation techniques, the most effective in terms of teachability, participant motivation, and profitability are self-hypnosis, progressive relaxation, and transcendental meditation. (SK)

  1. Low-cost carriers fare competition effect

    NARCIS (Netherlands)

    Carmona Benitez, R.B.; Lodewijks, G.

    2010-01-01

    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 b

  2. Sampling: Making Electronic Discovery More Cost Effective

    Directory of Open Access Journals (Sweden)

    Milton Luoma

    2011-06-01

    Full Text Available With the huge volumes of electronic data subject to discovery in virtually every instance of litigation, time and costs of conducting discovery have become exceedingly important when litigants plan their discovery strategies.  Rather than incurring the costs of having lawyers review every document produced in response to a discovery request in search of relevant evidence, a cost effective strategy for document review planning is to use statistical sampling of the database of documents to determine the likelihood of finding relevant evidence by reviewing additional documents.  This paper reviews and discusses how sampling can be used to make document review more cost effective by considering issues such as an appropriate sample size, how to develop a sampling strategy, and taking into account the potential value of the litigation in relation to the costs of additional discovery efforts. 

  3. Green Infrastructure Siting and Cost Effectiveness Analysis

    Data.gov (United States)

    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.

  4. Assessing Programming Costs of Explicit Memory Localization on a Large Scale Shared Memory Multiprocessor

    Directory of Open Access Journals (Sweden)

    Silvio Picano

    1992-01-01

    Full Text Available We present detailed experimental work involving a commercially available large scale shared memory multiple instruction stream-multiple data stream (MIMD parallel computer having a software controlled cache coherence mechanism. To make effective use of such an architecture, the programmer is responsible for designing the program's structure to match the underlying multiprocessors capabilities. We describe the techniques used to exploit our multiprocessor (the BBN TC2000 on a network simulation program, showing the resulting performance gains and the associated programming costs. We show that an efficient implementation relies heavily on the user's ability to explicitly manage the memory system.

  5. A Systematic Review of Cost-Effectiveness Studies Reporting Cost-per-DALY Averted

    Science.gov (United States)

    Neumann, Peter J.; Thorat, Teja; Zhong, Yue; Anderson, Jordan; Farquhar, Megan; Salem, Mark; Sandberg, Eileen; Saret, Cayla J.; Wilkinson, Colby; Cohen, Joshua T.

    2016-01-01

    considerably. Studies mainly included formal healthcare sector costs. A large number of the studies in Sub-Saharan Africa addressed high-burden conditions such as HIV/AIDS, tuberculosis, neglected tropical diseases and malaria, and diarrhea, lower respiratory infections, meningitis, and other common infectious diseases. Conclusion The Global Health Cost-Effectiveness Analysis Registry reveals a growing and diverse field of cost-per-DALY averted studies. However, study methods and reporting practices have varied substantially. PMID:28005986

  6. Low-cost carriers fare competition effect

    OpenAIRE

    Carmona Benitez, R.B.; Lodewijks, G.

    2010-01-01

    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 be operated by a low-cost carrier with better possibilities to subsist. The proposed model in this paper was set up by analyzing The United States domestic air transport market 2005 year database fr...

  7. Cost effectiveness of a medical digital library.

    Science.gov (United States)

    Roussel, F; Darmoni, S J; Thirion, B

    2001-01-01

    The rapid increase in the price of electronic journals has made the optimization of collection management an urgent task. As there is currently no standard procedure for the evaluation of this problem, we applied the Reading Factor (RF), an electronically computed indicator used for consultation of individual articles. The aim of our study was to assess the cost effective impact of modifications in our digital library (i.e. change of access from the Intranet to the Internet or change in editorial policy). The digital OVID library at Rouen University Hospital continues to be cost-effective in comparison with the interlibrary loan costs. Moreover, when electronic versions are offered alongside a limited amount of interlibrary loans, a reduction in library costs was observed.

  8. 大规模合成长链RNA的简易低成本工艺%A Simple and Cost Effective Process for Large-scale Production of Long Oligoribonucleotides

    Institute of Scientific and Technical Information of China (English)

    张平静; 李铁军; 周宋峰; 朱远源; 陈建新; 陆毅祥; 文锋

    2013-01-01

    由于现有技术所限,RNA分子长度和二级结构往往成为RNA合成困难的主要原因.提供了一种简单低成本大规模制备和纯化长链RNA药物的新工艺,尤其针对具有稳定二级结构的长链RNA药物.采用引物延伸方法替代PCR和线性质粒DNA方法制备线性DNA模板可减少步骤及降低污染,然后用T7 RNA聚合酶转录制备的甲氧基修饰的线性DNA模板获得高均一度的长链RNA,转录粗产物直接用source 15Q阴离子HPLC分离T7 RNA聚合酶、rNTP、转录中断产物、内毒素和模板DNA等,从而获得高纯度RNA终产物.该工艺无需繁琐的酚/氯仿抽提和RNA变性,尤其适用于RNA的大量制备.%The length and stable secondary structure of RNA molecule are general obstacles in RNA synthesis because of current technological bottlenecks. A simple and cost effective process for large-scale preparation and purification of long oligoribonucleotides with stable secondary structure was presented. High homogeneous RNAs are transcribed in vitro with T7 RNA polymerase using linear 2'-0me modified DNA templates, which were prepared by primer extension instead of PCR amplification or linearized plasmid DNA transcription to reduce contamination. The crude transcripts are then directly subjected to an anion-exchange HPLC using source 15Q to separate T7 RNA polymerase, unincorporated rNTPs, small abortive transcripts, endotoxin and DNA templates from pure RNA products. The novel process does neither require tedious phenol/ chloroform extraction nor denaturation of RNA, which is especially useful for larger RNAs preparations.

  9. Optimal control of a large dam, taking into account the water costs [New Edition

    CERN Document Server

    Abramov, Vyacheslav M

    2009-01-01

    This paper studies large dam models where the difference between lower and upper levels $L$ is assumed to be large. Passage across the levels leads to damage, and the damage costs of crossing the lower or upper level are proportional to the large parameter $L$. Input stream of water is described by compound Poisson process, and the water cost depends upon current level of water in the dam. The aim of the paper is to choose the parameters of output stream (specifically defined in the paper) minimizing the long-run expenses. The particular problem, where input stream is Poisson and water costs are not taken into account has been studied in [Abramov, \\emph{J. Appl. Prob.}, 44 (2007), 249-258]. The present paper partially answers the question \\textit{How does the structure of water costs affect the optimal solution?} In particular the case of linear costs is studied.

  10. Cost-effectiveness of automated external defibrillators on airlines.

    Science.gov (United States)

    Groeneveld, P W; Kwong, J L; Liu, Y; Rodriguez, A J; Jones, M P; Sanders, G D; Garber, A M

    2001-09-26

    Installation of automated external defibrillators (AEDs) on passenger aircraft has been shown to improve survival of cardiac arrest in that setting, but the cost-effectiveness of such measures has not been proven. To examine the costs and effectiveness of several different options for AED deployment in the US commercial air transportation system. Decision and cost-effectiveness analysis of a strategy of full deployment on all aircraft as well as several strategies of partial deployment only on larger aircraft, compared with a baseline strategy of no AEDs on aircraft (but training flight attendants in basic life support) for a hypothetical cohort of persons experiencing cardiac arrest aboard US commercial aircraft. Estimates for costs and outcomes were obtained from the medical literature, the Federal Aviation Administration, the Air Transport Association of America, a population-based cohort of Medicare patients, AED manufacturers, and the Bureau of Labor Statistics. Quality-adjusted survival after cardiac arrest; costs of AED deployment on aircraft and of medical care for cardiac arrest survivors. Adding AEDs on passenger aircraft with more than 200 passengers would cost $35 300 per quality-adjusted life-year (QALY) gained. Additional AEDs on aircraft with capacities between 100 and 200 persons would cost an additional $40 800 per added QALY compared with deployment on large-capacity aircraft only, and full deployment on all passenger aircraft would cost an additional $94 700 per QALY gained compared with limited deployment on aircraft with capacity greater than 100. Sensitivity analyses indicated that the quality of life, annual mortality rate, and the effectiveness of AEDs in improving survival were the most influential factors in the model. In 85% of Monte Carlo simulations, AED placement on large-capacity aircraft produced cost-effectiveness ratios of less than $50 000 per QALY. The cost-effectiveness of placing AEDs on commercial aircraft compares favorably

  11. Cost effectiveness of new roadway lighting systems

    Directory of Open Access Journals (Sweden)

    Yi Jiang

    2015-06-01

    Full Text Available Appropriate and adequate lighting at select locations on roadways is essential for roadway safety. As the lighting technologies advance, many types of new lighting devices have been developed for roadway lightings. The most promising new lighting technologies for roadway lighting include light emitting diode, induction, plasma, and metal halide lighting systems. A study was conducted to compare the new systems with the conventional high pressure sodium systems that are currently used on the Indiana roadway systems. In this study, the engineering issues, were analyzed such as illuminance, color rendering, power usage, cost effectiveness, and approval procedures for new roadway lighting systems. This paper, however, presents only the study findings related to cost effectiveness of the evaluated roadway lighting systems. Illustrated in this paper are the main features of the roadway lighting systems under evaluations, installations of the new lighting systems, measurements of power consumptions, and life cycle cost analyses of the lighting systems. Through this study, experience and knowledge have been obtained on the installations, power measurements, and cost effectiveness of the new types of the roadway lighting devices. The actual power values of various luminaires were obtained by measuring the electric current with a multi-meter. It was found that the differences between the rated and measured power values could be significant. The results of the life cycle cost analysis indicate that the lower life cycle costs of some of the alternative lighting devices are attributed to their relatively lower electricity usages and longer lamp/emitter replacement cycles.

  12. A Novel Low-Cost, Large Curvature Bend Sensor Based on a Bowden-Cable.

    Science.gov (United States)

    Jeong, Useok; Cho, Kyu-Jin

    2016-06-24

    Bend sensors have been developed based on conductive ink, optical fiber, and electronic textiles. Each type has advantages and disadvantages in terms of performance, ease of use, and cost. This study proposes a new and low-cost bend sensor that can measure a wide range of accumulated bend angles with large curvatures. This bend sensor utilizes a Bowden-cable, which consists of a coil sheath and an inner wire. Displacement changes of the Bowden-cable's inner wire, when the shape of the sheath changes, have been considered to be a position error in previous studies. However, this study takes advantage of this position error to detect the bend angle of the sheath. The bend angle of the sensor can be calculated from the displacement measurement of the sensing wire using a Hall-effect sensor or a potentiometer. Simulations and experiments have shown that the accumulated bend angle of the sensor is linearly related to the sensor signal, with an R-square value up to 0.9969 and a root mean square error of 2% of the full sensing range. The proposed sensor is not affected by a bend curvature of up to 80.0 m(-1), unlike previous bend sensors. The proposed sensor is expected to be useful for various applications, including motion capture devices, wearable robots, surgical devices, or generally any device that requires an affordable and low-cost bend sensor.

  13. Selecting cost-effective areas for restoration of ecosystem services.

    Science.gov (United States)

    Adame, M F; Hermoso, V; Perhans, K; Lovelock, C E; Herrera-Silveira, J A

    2015-04-01

    Selection of areas for restoration should be based on cost-effectiveness analysis to attain the maximum benefit with a limited budget and overcome the traditional ad hoc allocation of funds for restoration projects. Restoration projects need to be planned on the basis of ecological knowledge and economic and social constraints. We devised a novel approach for selecting cost-effective areas for restoration on the basis of biodiversity and potential provision of 3 ecosystem services: carbon storage, water depuration, and coastal protection. We used Marxan, a spatial prioritization tool, to balance the provision of ecosystem services against the cost of restoration. We tested this approach in a mangrove ecosystem in the Caribbean. Our approach efficiently selected restoration areas that at low cost were compatible with biodiversity targets and that maximized the provision of one or more ecosystem services. Choosing areas for restoration of mangroves on the basis carbon storage potential, largely guaranteed the restoration of biodiversity and other ecosystem services.

  14. [Intensified insulin treatment is cost-effective].

    Science.gov (United States)

    Reichard, P; Alm, C; Andersson, E; Wärn, I; Rosenqvist, U

    1999-01-20

    Both the Diabetes Control and Complications Trial (DCCT) in USA/Canada, and Stockholm Diabetes Intervention Study (SDIS) showed intensified insulin treatment and reduced glycaemia to prevent complications in patients with insulin-dependent (type I) diabetes mellitus. In the DCCT, the intensified treatment was considered cost-effective. In the SDIS, investigation of the direct increase in costs due to the intensified insulin treatment showed the saving in direct costs due to the reduction in photocoagulation requirements, and in the prevalence of renal insufficiency and of amputation, to correspond to 10 years' intensive insulin treatment. Thus, as intensified insulin treatment in type I diabetes reduces direct suffering at a low cost, it may be regarded as 'evidence-based' and mandatory.

  15. Cost optimizing of large-scale offshore wind farms. Appendix K to Q. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-07-01

    This Volume 4 contains reports prepared by SEAS Distribution A.m.b.A., Risoe National Laboratory, Nellemann, Nielsen and Rauschenberger A/S (NNR), Universidad Politecnica de Madrid, National Wind Power Ltd. and Stadtwerke Rostock AG. Appendix K - Wind and wave measurements; Appendix L - Establishment of design basis (wind, wave and ice loads). Appendix M - Wake effects and wind farm modelling. Appendix N - Functional requirements and optimisation of wind turbines. Appendix O - Operation and maintenance system. Appendix O.1 - Helicopter Service (alternative). Appendix P - Cost optimising of large scale offshore wind farms in UK waters. Appendix Q - Cost optimising of large scale offshore wind farms in German waters. Appendix K, L and N have been prepared by Risoe National Laboratory. Appendix M has been prepared by Universidad Politecnica de Madrid. Appendix 0 has been prepared by SEAS Distribution A.m.b.A.. Appendix O.1 has been prepared by Nellemann, Nielsen and Rauschenberger A/S. Appendix P has been prepared by National Wind Power Ltd.. Appendix Q has been prepared by Stadtwerke Rostock AG. (au)

  16. Decentralization for cost-effective conservation

    Science.gov (United States)

    Somanathan, E.; Prabhakar, R.; Mehta, Bhupendra Singh

    2009-01-01

    Since 1930, areas of state-managed forest in the central Himalayas of India have increasingly been devolved to management by local communities. This article studies the long-run effects of the devolution on the cost of forest management and on forest conservation. Village council-management costs an order of magnitude less per unit area and does no worse, and possibly better, at conservation than state management. Geographic proximity and historical and ecological information are used to separate the effects of management from those of possible confounding factors. PMID:19255440

  17. Making choices in health: WHO guide to cost effectiveness analysis

    National Research Council Canada - National Science Library

    Tan Torres Edejer, Tessa

    2003-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . XXI PART ONE: METHODS COST-EFFECTIVENESS FOR GENERALIZED ANALYSIS 1. 2. What is Generalized Cost-Effectiveness Analysis? . . . . . . . . . . . . 3 Undertaking...

  18. Cost effectiveness of robotic mitral valve surgery

    Science.gov (United States)

    2017-01-01

    Significant technological advances have led to an impressive evolution in mitral valve surgery over the last two decades, allowing surgeons to safely perform less invasive operations through the right chest. Most new technology comes with an increased upfront cost that must be measured against postoperative savings and other advantages such as decreased perioperative complications, faster recovery, and earlier return to preoperative level of functioning. The Da Vinci robot is an example of such a technology, combining the significant benefits of minimally invasive surgery with a “gold standard” valve repair. Although some have reported that robotic surgery is associated with increased overall costs, there is literature suggesting that efficient perioperative care and shorter lengths of stay can offset the increased capital and intraoperative expenses. While data on current cost is important to consider, one must also take into account future potential value resulting from technological advancement when evaluating cost-effectiveness. Future refinements that will facilitate more effective surgery, coupled with declining cost of technology will further increase the value of robotic surgery compared to traditional approaches. PMID:28203539

  19. Cost-effectiveness in reproductive medicine

    NARCIS (Netherlands)

    L.M. Moolenaar

    2013-01-01

    This thesis reports on cost-effectiveness in reproductive medicine. Firstly, we evaluated the methodologic quality of studies in reproductive medicine. Insight into the quality of economical analysis in reproductive medicine is important for valuing the performed studies and to assess whether these

  20. Utilization of information on costs and effects.

    NARCIS (Netherlands)

    2006-01-01

    In decision making, information about the costs and effects of road safety measures is only used to a limited extent. European research shows that about 35% of civil servants and politicians use this type of information. Furthermore, there are great differences between northern countries (58%) and c

  1. The scaling relationship between telescope cost and aperture size for very large telescopes

    Science.gov (United States)

    van Belle, Gerard T.; Meinel, Aden Baker; Meinel, Marjorie Pettit

    2004-01-01

    Cost data for ground-based telescopes of the last century are analyzed for trends in the relationship between aperture size and cost. We find that for apertures built prior to 1980, costs scaled as aperture size to the 2.8 power, which is consistent with the precious finding of Meinel (1978). After 1980, 'traditional' monolithic mirror telescope costs have scaled as aperture to the 2.5 power. The large multiple mirror telescopes built or in construction during this time period (Keck, LBT, GTC) appear to deviate from this relationship with significant cost savings as a result, although it is unclear what power law such structures follow. We discuss the implications of the current cost-aperture size data on the proposed large telescope projects of the next ten to twenty years. Structures that naturally tend towards the 2.0 power in the cost-aperture relationship will be the favorable choice for future extremely large apertures; out expectation is that space-based structures will ultimately gain economic advantage over ground-based ones.

  2. Cost-Benefit Analysis of the Large Hadron Collider to 2025 and beyond

    CERN Document Server

    Florio, Massimo; Sirtori, Emanuela

    2015-01-01

    Social cost-benefit analysis (CBA) of projects has been successfully applied in different fields such as transport, energy, health, education, and environment, including climate change. It is often argued that it is impossible to extend the CBA approach to the evaluation of the social impact of research infrastructures, because the final benefit to society of scientific discovery is generally unpredictable. Here, we propose a quantitative approach to this problem, we use it to design an empirically testable CBA model, and we apply it to the the Large Hadron Collider (LHC), the highest-energy accelerator in the world, currently operating at CERN. We show that the evaluation of benefits can be made quantitative by determining their value to users (scientists, early-stage researchers, firms, visitors) and non-users (the general public). Four classes of contributions to users are identified: knowledge output, human capital development, technological spillovers, and cultural effects. Benefits for non-users can be ...

  3. A cost effective CO2 strategy

    DEFF Research Database (Denmark)

    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...... 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......, 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...

  4. [Cost effectiveness and health sector reform].

    Science.gov (United States)

    Musgrove, P

    1995-01-01

    The cost-effectiveness of a health intervention is an estimate of the relation between what it costs to be provided, and the improvement in health which results from such intervention. Health may improve because the incidence of illness or injury is reduced, because death is avoided or delayed, or because the duration or severity of disability is limited. The calculation of this health benefit combines objective factors, such as the age at incidence and whether or not the outcome is death, with subjective factors such as the severity of disability, the judgement as to the value of life lived at different ages, and the rate at which the future is discounted. The construction and interpretation of the estimate are explained. Also, the paper examines whether the concept of cost-effectiveness is consistent with ethical norms such as equity, and concludes that they are not in conflict. Finally, it addresses the question of how to incorporate cost-effectiveness into a health sector reform, and possible ways to implement it.

  5. Cost-effective ultrasound PACS solution

    Science.gov (United States)

    Honeyman-Buck, Janice C.; Frost, Meryll M.; Staab, Edward V.

    1995-05-01

    Picture archiving and communication systems (PACS) have been quite successful at the University of Florida in the areas of CT, MR, and nuclear medicine. In each case, although we have not always been able to provide the optimal level of performance, we have been able to solve a problem and the systems are used extensively. Ultrasound images are required in a number of locations and the multiformat camera print capability was no longer adequate for the growing volume in the ultrasound section. Although we were certain we could successfully implement PACS for ultrasound, new forces in health care dictate that we justify our system in terms of cost. We analyzed the feasibility of a PACS solution for ultrasound and designed a system that meets our needs and is cost effective. We evaluated the ultrasound operation in terms of image acquisition patterns and throughput requirements. An inventory of existing and PACS equipment was made to determine the feasibility of interfacing the two systems. Commercial systems were evaluated for functionality and cost and a system was designed to meet our needs. The only way to achieve our goal of installing a cost effective ultrasound PACS was to eliminate film and use the cost savings to offset the cost of new equipment and development. We designed a system that could be produced using inexpensive components and existing hardware and software to meet our needs. A commercial vendor was chosen to provide the ultrasound acquisition. The Radiology Information System interface used at the University provides the necessary data to build a DICOM header, and an existing DICOM server routes the images to the appropriate workstations, archives, and printers. Additional storage is added to an existing archive to accommodate the ultrasound images and two existing workstations are evaluated for use in ultrasound.

  6. Cost-effectiveness and pricing of antibacterial drugs.

    Science.gov (United States)

    Verhoef, Talitha I; Morris, Stephen

    2015-01-01

    Growing resistance to antibacterial agents has increased the need for the development of new drugs to treat bacterial infections. Given increasing pressure on limited health budgets, it is important to study the cost-effectiveness of these drugs, as well as their safety and efficacy, to find out whether or not they provide value for money and should be reimbursed. In this article, we systematically reviewed 38 cost-effectiveness analyses of new antibacterial agents. Most studies showed the new antibacterial drugs were cost-effective compared to older generation drugs. Drug pricing is a complicated process, involving different stakeholders, and has a large influence on cost-effectiveness. Value-based pricing is a method to determine the price of a drug at which it can be cost-effective. It is currently unclear what the influence of value-based pricing will be on the prices of new antibacterial agents, but an important factor will be the definition of 'value', which as well as the impact of the drug on patient health might also include other factors such as wider social impact and the health impact of disease. © 2015 The Authors. Chemical Biology & Drug Design Published by John Wiley & Sons Ltd.

  7. Global cost-effectiveness of GDM screening and management

    DEFF Research Database (Denmark)

    Weile, Louise K K; Kahn, James G; Marseille, Elliot

    2015-01-01

    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...... and varying results in the existing body of evidence, we find it unreasonable to outline any global recommendations. For future economic studies, we recommend inclusion of long-term outcomes and adaptation to local preferences, as well as examination of the impact of the diagnostic criteria recently proposed...

  8. Cost-effectiveness studies as part of an ALARA program

    Energy Technology Data Exchange (ETDEWEB)

    Baum, J.W.

    1986-01-01

    Recent studies of cost effectiveness of engineering modifications for dose reduction at nuclear power plants conducted at BNL will be considered in this report. Since each of these items has the potential for a 50% to 60% reduction in collective dose, it appears there is large potential for dose reduction from engineering type modifications. The question that must be answered for each plant is ''which modifications or improvements are required for optimization (ALARA). The purpose of this paper is to illustrate that quantified optimization need not be costly and can often be highly beneficial.

  9. Cost-Driven Design of a Large Scale X-Plane

    Science.gov (United States)

    Welstead, Jason R.; Frederic, Peter C.; Frederick, Michael A.; Jacobson, Steven R.; Berton, Jeffrey J.

    2017-01-01

    A conceptual design process focused on the development of a low-cost, large scale X-plane was developed as part of an internal research and development effort. One of the concepts considered for this process was the double-bubble configuration recently developed as an advanced single-aisle class commercial transport similar in size to a Boeing 737-800 or Airbus A320. The study objective was to reduce the contractor cost from contract award to first test flight to less than $100 million, and having the first flight within three years of contract award. Methods and strategies for reduced cost are discussed.

  10. Cost-effectiveness analysis in Chagas' disease vectors control interventions

    Directory of Open Access Journals (Sweden)

    A. M. Oliveira Filho

    1989-01-01

    Full Text Available After a large scale field trial performed in central Brazil envisaging the control of Chagas' disease vectors in an endemic area colonized by Triatoma infestans and T. sordida the cost-effectiveness analysis for each insecticide/formulation was performed. It considered the operational costs and the prices of insecticides and formulations, related to the activity and persistence of each one. The end point was considered to be less than 90% of domicilliary unitis (house + annexes free of infestation. The results showed good cost-effectiveness for a slow-release emulsifiable suspension (SRES based on PVA and containing malathion as active ingredient, as well as for the pyrethroids tested in this assay-cyfluthrin, cypermethrin, deltamethrin and permethrin.

  11. Cost effectiveness of surveillance for GI cancers.

    Science.gov (United States)

    Omidvari, Amir-Houshang; Meester, Reinier G S; Lansdorp-Vogelaar, Iris

    2016-12-01

    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.

  12. Procedure for estimating nonfuel operation and maintenance costs for large steam-electric power plants

    Energy Technology Data Exchange (ETDEWEB)

    Myers, M.L.; Fuller, L.C.

    1979-01-01

    Revised guidelines are presented for estimating annual nonfuel operation and maintenance costs for large steam-electric power plants, specifically light-water-reactor plants and coal-fired plants. Previous guidelines were published in October 1975 in ERDA 76-37, a Procedure for Estimating Nonfuel Operating and Maintenance Costs for Large Steam-Electric Power Plants. Estimates for coal-fired plants include the option of limestone slurry scrubbing for flue gas desulfurization. A computer program, OMCOST, is also presented which covers all plant options.

  13. Contractors and the Cost of War: Research into Economic and Cost-Effectiveness Arguments

    Science.gov (United States)

    2006-12-01

    32 Figure 4. Transaction Cost Economics Framework ........................................................50 x...the cost-effectiveness debate, there are a myriad of other issues that exist. For example, Transaction Cost Economics (TCE) yields key insights on...Perspectives on Public Choice. New York: Cambridge University Press, 455 – 480; qtd in Williamson, “Public and Private Bureaucracies: A Transaction Cost Economics

  14. Controlling Campylobacter in the chicken meat chain - Cost-effectiveness and cost-utility analysis

    NARCIS (Netherlands)

    Mangen MJJ; Havelaar AH; Nauta MJ; Koeijer AA de; Wit GA de; LEI; Animal Sciences Group; PZO; MGB

    2005-01-01

    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 costs-of-illnes

  15. Large-scale, low-cost synthesis of monodispersed gold nanorods using a gemini surfactant

    Science.gov (United States)

    Xu, Yong; Zhao, Yang; Chen, Lei; Wang, Xuchun; Sun, Jianxia; Wu, Haihua; Bao, Feng; Fan, Jian; Zhang, Qiao

    2015-04-01

    In this work, we demonstrate that monodispersed gold nanorods (AuNRs) can be obtained in a large-scale and cost-effective way. By using an industrial grade gemini surfactant (P16-8-16), the cost of the synthesis of high-quality AuNRs can be significantly reduced by 90%. The synthesis can be scaled up to over 4 L. The aspect ratio of AuNRs can be well tuned from ~2.4 to ~6.3, resulting in a wide tunability of the SPR properties. Systematic studies reveal that P16-8-16 could have a dual function: it can not only act as a capping ligand to stabilize AuNRs but also it can pre-reduce Au3+ to Au+ by the unsaturated C&z.dbd;C bond. Furthermore, the shape of AuNRs can be tailored from straight nanorods to ``dog-bones'' by simply varying the concentration of the surfactant. A mechanistic study shows that the shape change can be attributed to the presence of excess bromide ions because of the complex effect between bromide ions and gold ions. This work will not only help to achieve the industrial production of AuNRs, but also promote research into practical applications of various nanomaterials.In this work, we demonstrate that monodispersed gold nanorods (AuNRs) can be obtained in a large-scale and cost-effective way. By using an industrial grade gemini surfactant (P16-8-16), the cost of the synthesis of high-quality AuNRs can be significantly reduced by 90%. The synthesis can be scaled up to over 4 L. The aspect ratio of AuNRs can be well tuned from ~2.4 to ~6.3, resulting in a wide tunability of the SPR properties. Systematic studies reveal that P16-8-16 could have a dual function: it can not only act as a capping ligand to stabilize AuNRs but also it can pre-reduce Au3+ to Au+ by the unsaturated C&z.dbd;C bond. Furthermore, the shape of AuNRs can be tailored from straight nanorods to ``dog-bones'' by simply varying the concentration of the surfactant. A mechanistic study shows that the shape change can be attributed to the presence of excess bromide ions because of the

  16. Long-term cost-effectiveness of single indirect restorations in selected dental practices.

    Science.gov (United States)

    Kelly, P G; Smales, R J

    2004-05-22

    To determine the relative cost-effectiveness of alternative methods for restoring large tooth substance loss in adults. Long-term survival estimates and discounted costs for 245 large indirect restorations were used to calculate their incremental cost-effectiveness over 15 years when compared with direct placement Class II cusp-overlay amalgams and Class IV multisurface resin composites, placed in 100 patients from three private dental practices. The direct placement restorations were more cost-effective than the indirect restorations at all time intervals over the 15-year study period. The full gold crown and the ceramometal crown were the most cost-effective indirect posterior and anterior restorations respectively. The cast gold onlay and the porcelain jacket crown were the least cost-effective indirect posterior and anterior restorations respectively. When clinically practicable, large direct placement restorations should be placed initially in preference to indirect restorations.

  17. Costing Generated Runtime Execution Plans for Large-Scale Machine Learning Programs

    OpenAIRE

    Boehm, Matthias

    2015-01-01

    Declarative large-scale machine learning (ML) aims at the specification of ML algorithms in a high-level language and automatic generation of hybrid runtime execution plans ranging from single node, in-memory computations to distributed computations on MapReduce (MR) or similar frameworks like Spark. The compilation of large-scale ML programs exhibits many opportunities for automatic optimization. Advanced cost-based optimization techniques require---as a fundamental precondition---an accurat...

  18. Cost effective optical coupling for polymer optical fiber communication

    Science.gov (United States)

    Chandrappan, Jayakrishnan; Zhang, Jing; Mohan, Ramkumar V.; Gomez, Philbert Oliver; Aung, Than Aye; Xiao, Yongfei; Ramana, Pamidighantam V.; Lau, John Hon Shing; Kwong, Dim Lee

    2008-02-01

    Polymer Optical Fiber (POF) optical modules are gaining momentum due to their applications in short distance communications. POFs offer more flexibility for plug and play applications and provide cost advantages. They also offer significant weight advantage in automotive and avionic networks. One of the most interesting field of application is home networking. Low cost optical components are required, since cost is a major concern in local and home networks. In this publication, a fast and easy to install, low cost solution for efficient light coupling in and out of Step Index- POF is explored. The efficient coupling of light from a large core POF to a small area detector is the major challenge faced. We simulated direct coupling, lens coupling and bend losses for step index POF using ZEMAX R optical simulation software. Simulations show that a lensed fiber tip particularly at the receiver side improves the coupling efficiency. The design is optimized for 85% coupling efficiency and explored the low cost fabrication method to implement it in the system level. The two methods followed for lens fabrication is described here in detail. The fabricated fiber lenses are characterized using a beam analyzer. The fabrication process was reiterated to optimize the lens performance. It is observed that, the fabricated lenses converge the POF output spot size by one fourth, there by enabling a higher coupling efficiency. This low cost method proves to be highly efficient and effective optical coupling scheme in POF communications.

  19. Cost comparisons for the use of nonterrestrial materials in space manufacturing of large structures

    Science.gov (United States)

    Bock, E. H.; Risley, R. C.

    1979-01-01

    This paper presents results of a study sponsored by NASA to evaluate the relative merits of constructing solar power satellites (SPS) using resources obtained from the earth and from the moon. Three representative lunar resources utilization (LRU) concepts are developed and compared with a previously defined earth baseline concept. Economic assessment of the alternatives includes cost determination, economic threshold sensitivity to manufacturing cost variations, cost uncertainties, program funding schedule, and present value of costs. Results indicate that LRU for space construction is competitive with the earth baseline approach for a program requiring 100,000 metric tons per year of completed satellites. LRU can reduce earth-launched cargo requirements to less than 10% of that needed to build satellites exclusively from earth materials. LRU is potentially more cost-effective than earth-derived material utilization, due to significant reductions in both transportation and manufacturing costs. Because of uncertainties, cost-effectiveness cannot be ascertained with great confidence. The probability of LRU attaining a lower total program cost within the 30-year program appears to range from 57 to 93%.

  20. Custom LSI plus hybrid equals cost effectiveness

    Science.gov (United States)

    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.

  1. Accidents at work and costs analysis: a field study in a large Italian company.

    Science.gov (United States)

    Battaglia, Massimo; Frey, Marco; Passetti, Emilio

    2014-01-01

    Accidents at work are still a heavy burden in social and economic terms, and action to improve health and safety standards at work offers great potential gains not only to employers, but also to individuals and society as a whole. However, companies often are not interested to measure the costs of accidents even if cost information may facilitate preventive occupational health and safety management initiatives. The field study, carried out in a large Italian company, illustrates technical and organisational aspects associated with the implementation of an accident costs analysis tool. The results indicate that the implementation (and the use) of the tool requires a considerable commitment by the company, that accident costs analysis should serve to reinforce the importance of health and safety prevention and that the economic dimension of accidents is substantial. The study also suggests practical ways to facilitate the implementation and the moral acceptance of the accounting technology.

  2. Computational Comparison of Several Greedy Algorithms for the Minimum Cost Perfect Matching Problem on Large Graphs

    DEFF Research Database (Denmark)

    Wøhlk, Sanne; Laporte, Gilbert

    2017-01-01

    The aim of this paper is to computationally compare several algorithms for the Minimum Cost Perfect Matching Problem on an undirected complete graph. Our work is motivated by the need to solve large instances of the Capacitated Arc Routing Problem (CARP) arising in the optimization of garbage...

  3. An Investigation of Energy Consumption and Cost in Large Air-Conditioned Buildings. An Interim Report.

    Science.gov (United States)

    Milbank, N. O.

    Two similarly large buildings and air conditioning systems are comparatively analyzed as to energy consumption, costs, and inefficiency during certain measured periods of time. Building design and velocity systems are compared to heating, cooling, lighting and distribution capabilities. Energy requirements for pumps, fans and lighting are found to…

  4. Large-scale use of mosquito larval source management for malaria control in Africa: a cost analysis

    Directory of Open Access Journals (Sweden)

    Worrall Eve

    2011-11-01

    Full Text Available Abstract Background At present, large-scale use of two malaria vector control methods, long-lasting insecticidal nets (LLINs and indoor residual spraying (IRS is being scaled up in Africa with substantial funding from donors. A third vector control method, larval source management (LSM, has been historically very successful and is today widely used for mosquito control globally, except in Africa. With increasing risk of insecticide resistance and a shift to more exophilic vectors, LSM is now under re-evaluation for use against afro-tropical vector species. Here the costs of this intervention were evaluated. Methods The 'ingredients approach' was used to estimate the economic and financial costs per person protected per year (pppy for large-scale LSM using microbial larvicides in three ecologically diverse settings: (1 the coastal metropolitan area of Dar es Salaam in Tanzania, (2 a highly populated Kenyan highland area (Vihiga District, and (3 a lakeside setting in rural western Kenya (Mbita Division. Two scenarios were examined to investigate the cost implications of using alternative product formulations. Sensitivity analyses on product prices were carried out. Results The results show that for programmes using the same granular formulation larviciding costs the least pppy in Dar es Salaam (US$0.94, approximately 60% more in Vihiga District (US$1.50 and the most in Mbita Division (US$2.50. However, these costs are reduced substantially if an alternative water-dispensable formulation is used; in Vihiga, this would reduce costs to US$0.79 and, in Mbita Division, to US$1.94. Larvicide and staff salary costs each accounted for approximately a third of the total economic costs per year. The cost pppy depends mainly on: (1 the type of formulation required for treating different aquatic habitats, (2 the human population density relative to the density of aquatic habitats and (3 the potential to target the intervention in space and/or time. Conclusion

  5. CO{sub 2} mitigation costs of large-scale bioenergy technologies in competitive electricity markets

    Energy Technology Data Exchange (ETDEWEB)

    Gustavsson, L. [Mid-Sweden University, Ostersund (Sweden). Dept. of Natural and Environmental Sciences, Ecotechnology; Madlener, R. [Swiss Federal Institute of Technology, Zurich (Switzerland). CEPE

    2003-11-01

    In this study, we compare and contrast the impact of recent technological developments in large biomass-fired and natural-gas-fired cogeneration and condensing plants in terms of CO{sub 2} mitigation costs and under the conditions of a competitive electricity market. The CO{sub 2} mitigation cost indicates the minimum economic incentive required (e.g. in the form of a carbon tax) to equal the cost of a less carbon extensive system with the cost of a reference system. The results show that CO{sub 2} mitigation costs are lower for biomass systems than for natural gas systems with decarbonization. However, in liberalized energy markets and given the sociopolitical will to implement carbon extensive energy systems, market-based policy measures are still required to make biomass and decarbonization options competitive and thus help them to penetrate the market. This cost of cogeneration plants, however, depends on the evaluation method used. If we account for the limitation of heat sinks by expanding the reference entity to include both heat and power, as is typically recommended in life-cycle analysis, then the biomass-based gasification combined cycle (BIG/CC) technology turns out to be less expensive and to exhibit lower CO{sub 2} mitigation costs than biomass-fired steam turbine plants. However, a heat credit granted to cogeneration systems that is based on avoided cost of separate heat production, puts the steam turbine technology despite its lower system efficiency at an advantage. In contrast, when a crediting method based on avoided electricity production in natural gas fired condensing plants is employed, the BIG/CC technology turns out to be more cost competitive than the steam turbine technology for carbon tax levels beyond about $150/t C. Furthermore, steam turbine plants are able to compete with natural gas fired cogeneration plants at carbon tax levels higher than about $90/tC. (author)

  6. An improved set of standards for finding cost for cost-effectiveness analysis.

    Science.gov (United States)

    Barnett, Paul G

    2009-07-01

    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.

  7. A cost effective CO2 strategy

    DEFF Research Database (Denmark)

    , 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...... concerns of the potential measures within those intervention areas: • Reductions in the need to travel • Improved efficiency of the transport system • Improved fuel efficiency of transport activities • Reduced CO2 intensity of the fuels Within each area a number of measures were analysed. The measures...

  8. Effective control of engineering cost measures

    Institute of Scientific and Technical Information of China (English)

    郑虹; 戚悦

    2013-01-01

    the civil engineering cost function mainly lies in the calculation of the required for the construction cost to the sum of al. Civil engineering cost throughout the project, the efective use of human, financial weakness, can beter benefit our investment, so the control of civil engineering cost measures is very necessary.

  9. Fabrication of low cost composite tooling for filament winding large structures

    Science.gov (United States)

    Miller, Timothy S.; Fortin, Christopher J.

    A TQM/concurrent engineering approach has been used to create a low cost filament-winding mandrel for large launch-vehicle structure fabrication. The process involves the fabrication of a low cost/low temperature master model, followed by the building of the mandrel and its backup structure within the master. Mandrels fabricated by these means are able to maintain full vacuum integrity and dimensional stability throughout high-temperature cure cycles; the reduced thermal mass of the mandrel results in part-cure cycles that are shorter than those associated with conventional mandrel materials.

  10. A Project Management Approach to Using Simulation for Cost Estimation on Large, Complex Software Development Projects

    Science.gov (United States)

    Mizell, Carolyn; Malone, Linda

    2007-01-01

    It is very difficult for project managers to develop accurate cost and schedule estimates for large, complex software development projects. None of the approaches or tools available today can estimate the true cost of software with any high degree of accuracy early in a project. This paper provides an approach that utilizes a software development process simulation model that considers and conveys the level of uncertainty that exists when developing an initial estimate. A NASA project will be analyzed using simulation and data from the Software Engineering Laboratory to show the benefits of such an approach.

  11. Assessing cost-effectiveness in the management of multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Ceri J Phillips

    2009-11-01

    Full Text Available Ceri J Phillips, Ioan HumphreysInstitute for Health Research, School of Health Science, Swansea University, Swansea, Wales, UKAbstract: Multiple sclerosis (MS is one of the most common causes of neurological disability in young and middle-aged adults, with current prevalence rates estimated to be 30 per 100,000 populations. Women are approximately twice as susceptible as males, but males are more likely to have progressive disease. The onset of the disease normally occurs between 20 and 40 years of age, with a peak incidence during the late twenties and early thirties, resulting in many years of disability for a large proportion of patients, many of whom require wheelchairs and some nursing home or hospital care. The aim of this study is to update a previous review which considered the cost-effectiveness of disease-modifying drugs (DMDs, such as interferons and glatiramer acetate, with more up to date therapies, such as mitaxantrone hydrochloride and natalizumab in the treatment of MS. The development and availability of new agents has been accompanied byan increased optimism that treatment regimens for MS would be more effective; that the number, severity and duration of relapses would diminish; that disease progression would be delayed; and that disability accumulation would be reduced. However, doubts have been expressed about the effectiveness of these treatments, which has only served to compound the problems associated with endeavors to estimate the relative cost-effectiveness of such interventions.Keywords: multiple sclerosis, disease management, immunomodulatory drugs, cost-effectiveness, cost-effectiveness analysis, cost-utility analysis

  12. A Nonlinear Multiobjective Bilevel Model for Minimum Cost Network Flow Problem in a Large-Scale Construction Project

    Directory of Open Access Journals (Sweden)

    Jiuping Xu

    2012-01-01

    Full Text Available The aim of this study is to deal with a minimum cost network flow problem (MCNFP in a large-scale construction project using a nonlinear multiobjective bilevel model with birandom variables. The main target of the upper level is to minimize both direct and transportation time costs. The target of the lower level is to minimize transportation costs. After an analysis of the birandom variables, an expectation multiobjective bilevel programming model with chance constraints is formulated to incorporate decision makers’ preferences. To solve the identified special conditions, an equivalent crisp model is proposed with an additional multiobjective bilevel particle swarm optimization (MOBLPSO developed to solve the model. The Shuibuya Hydropower Project is used as a real-world example to verify the proposed approach. Results and analysis are presented to highlight the performances of the MOBLPSO, which is very effective and efficient compared to a genetic algorithm and a simulated annealing algorithm.

  13. Using Cost-Effectiveness Tests to Design CHP Incentive Programs

    Energy Technology Data Exchange (ETDEWEB)

    Tidball, Rick [ICF International, Fairfax, VA (United States)

    2014-11-01

    This paper examines the structure of cost-effectiveness tests to illustrate how they can accurately reflect the costs and benefits of CHP systems. This paper begins with a general background discussion on cost-effectiveness analysis of DER and then describes how cost-effectiveness tests can be applied to CHP. Cost-effectiveness results are then calculated and analyzed for CHP projects in five states: Arkansas, Colorado, Iowa, Maryland, and North Carolina. Based on the results obtained for these five states, this paper offers four considerations to inform regulators in the application of cost-effectiveness tests in developing CHP programs.

  14. A low-cost CMOS-MEMS piezoresistive accelerometer with large proof mass.

    Science.gov (United States)

    Khir, Mohd Haris Md; Qu, Peng; Qu, Hongwei

    2011-01-01

    This paper reports a low-cost, high-sensitivity CMOS-MEMS piezoresistive accelerometer with large proof mass. In the device fabricated using ON Semiconductor 0.5 μm CMOS technology, an inherent CMOS polysilicon thin film is utilized as the piezoresistive sensing material. A full Wheatstone bridge was constructed through easy wiring allowed by the three metal layers in the 0.5 μm CMOS technology. The device fabrication process consisted of a standard CMOS process for sensor configuration, and a deep reactive ion etching (DRIE) based post-CMOS microfabrication for MEMS structure release. A bulk single-crystal silicon (SCS) substrate is included in the proof mass to increase sensor sensitivity. In device design and analysis, the self heating of the polysilicon piezoresistors and its effect to the sensor performance is also discussed. With a low operating power of 1.5 mW, the accelerometer demonstrates a sensitivity of 0.077 mV/g prior to any amplification. Dynamic tests have been conducted with a high-end commercial calibrating accelerometer as reference.

  15. A Low-Cost CMOS-MEMS Piezoresistive Accelerometer with Large Proof Mass

    Directory of Open Access Journals (Sweden)

    Mohd Haris Md Khir

    2011-08-01

    Full Text Available This paper reports a low-cost, high-sensitivity CMOS-MEMS piezoresistive accelerometer with large proof mass. In the device fabricated using ON Semiconductor 0.5 μm CMOS technology, an inherent CMOS polysilicon thin film is utilized as the piezoresistive sensing material. A full Wheatstone bridge was constructed through easy wiring allowed by the three metal layers in the 0.5 μm CMOS technology. The device fabrication process consisted of a standard CMOS process for sensor configuration, and a deep reactive ion etching (DRIE based post-CMOS microfabrication for MEMS structure release. A bulk single-crystal silicon (SCS substrate is included in the proof mass to increase sensor sensitivity. In device design and analysis, the self heating of the polysilicon piezoresistors and its effect to the sensor performance is also discussed. With a low operating power of 1.5 mW, the accelerometer demonstrates a sensitivity of 0.077 mV/g prior to any amplification. Dynamic tests have been conducted with a high-end commercial calibrating accelerometer as reference.

  16. Investigation of Low-Cost Surface Processing Techniques for Large-Size Multicrystalline Silicon Solar Cells

    Directory of Open Access Journals (Sweden)

    Yuang-Tung Cheng

    2010-01-01

    Full Text Available The subject of the present work is to develop a simple and effective method of enhancing conversion efficiency in large-size solar cells using multicrystalline silicon (mc-Si wafer. In this work, industrial-type mc-Si solar cells with area of 125×125 mm2 were acid etched to produce simultaneously POCl3 emitters and silicon nitride deposition by plasma-enhanced chemical vapor deposited (PECVD. The study of surface morphology and reflectivity of different mc-Si etched surfaces has also been discussed in this research. Using our optimal acid etching solution ratio, we are able to fabricate mc-Si solar cells of 16.34% conversion efficiency with double layers silicon nitride (Si3N4 coating. From our experiment, we find that depositing double layers silicon nitride coating on mc-Si solar cells can get the optimal performance parameters. Open circuit (Voc is 616 mV, short circuit current (Jsc is 34.1 mA/cm2, and minority carrier diffusion length is 474.16 μm. The isotropic texturing and silicon nitride layers coating approach contribute to lowering cost and achieving high efficiency in mass production.

  17. OPCAB Surgery is cost-effective for elderly patients

    DEFF Research Database (Denmark)

    Holme, Susanne Juel; Jensen Beck, Søren; Houlind, Kim;

    2013-01-01

    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....

  18. Costs and cost-effectiveness of delivering intermittent preventive treatment through schools in western Kenya

    Directory of Open Access Journals (Sweden)

    Jukes Matthew CH

    2008-09-01

    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

  19. Cost optimizing of large-scale offshore wind farms. Summary and conclusion. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-07-01

    The project comprises investigation of the technical and economical possibilities of large-scale offshore wind farms at 3 locations in the eastern Danish waters: Roedsand and Gedser Rev located south of the islands of Falster and Lolland and Omoe Staagrunde located south-west of the island of Zealand plus experiences obtained from British and German offshore wind energy projects. The project included wind and wave measurements at the above 3 locations, data collection, data processing, meteorological analysis, modelling of wind turbine structure, studies of grid connection, design and optimisation of foundations plus estimates of investments and operation and maintenance costs. All costs are in ECU on 1997 basis. The main conclusion of the project financed by the European Commission is: Areas are available for large scale offshore wind farms in the Danish waters; A large wind potential is found on the sites; Park layouts of projects consisting of around 100 wind turbines each has been developed; Design of the foundations has been optimised radically compared to previous designs; A large potential for optimising of the wind turbine design and operation has been found; Grid connection of the first proposed large wind farms is possible with only minor reinforcement of the transmission system; The visual impact is not prohibitive for the projects; A production cost of 4-5 ECUcent/kWh is competitive with current onshore projects. All in all, the results from this project have proven to be very useful for the further development of large-scale wind farms in the Danish waters, and thereby an inspiration for similar projects in other (European) countries. (LN)

  20. Economic costs of rotavirus gastroenteritis and cost-effectiveness of vaccination in developing countries.

    Science.gov (United States)

    Rheingans, Richard D; Antil, Lynn; Dreibelbis, Robert; Podewils, Laura Jean; Bresee, Joseph S; Parashar, Umesh D

    2009-11-01

    Rotavirus is the leading cause of severe gastroenteritis in children worldwide. We evaluated the economic burden of rotavirus and the cost-effectiveness of vaccination from the health care perspective. Estimates were based on existing epidemiological data, cost estimates, vaccine coverage, and efficacy data, as well as hypothetical vaccine prices. Outcome measures included health care and societal costs of rotavirus and benefits and incremental cost-effectiveness ratio of vaccination. Sensitivity analyses evaluated the impact of estimate uncertainty. Treatment costs increased with income level, and health burden decreased; however, burden varied across regions. On the basis of current vaccination coverage and timing, rotavirus vaccination would annually prevent 228,000 deaths, 13.7 million hospital visits, and 8.7 million disability-adjusted life-years, saving $188 million in treatment costs and $243 million in societal costs. At $5 per dose, the incremental cost-effectiveness ratio in low-, lower-middle-, and upper-middle-income countries was $88, $291, and $329 per disability-adjusted life-year averted, respectively, and $3,015, $9,951 and $11,296 per life saved, respectively. Vaccination would prevent approximately 45% of deaths and approximately 58% of associated medical visits and costs. Vaccination is a cost-effective strategy to reduce the health and economic burden of rotavirus. The cost-effectiveness of vaccination depends mostly on vaccine price and reaching children at highest risk of mortality.

  1. Optimal counterterrorism and the recruitment effect of large terrorist attacks

    DEFF Research Database (Denmark)

    Jensen, Thomas

    2011-01-01

    We analyze a simple dynamic model of the interaction between terrorists and authorities. Our primary aim is to study optimal counterterrorism and its consequences when large terrorist attacks lead to a temporary increase in terrorist recruitment. First, we show that an increase in counterterrorism...... makes it more likely that terrorist cells plan small rather than large attacks and therefore may increase the probability of a successful attack. Analyzing optimal counterterrorism we see that the recruitment effect makes authorities increase the level of counterterrorism after large attacks. Therefore......, in periods following large attacks a new attack is more likely to be small compared to other periods. Finally, we analyze the long-run consequences of the recruitment effect. We show that it leads to more counterterrorism, more small attacks, and a higher sum of terrorism damage and counterterrorism costs...

  2. Impact of Generic Alendronate Cost on the Cost-Effectiveness of Osteoporosis Screening and Treatment

    OpenAIRE

    Smita Nayak; Roberts, Mark S.; Greenspan, Susan L.

    2012-01-01

    INTRODUCTION: 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. METHODS: 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 absorp...

  3. Factors Affecting Construction Cost in Mara Large Construction Project: Perspective of Project Management Consultant

    Directory of Open Access Journals (Sweden)

    Aftab Hameed Memon

    2011-07-01

    Full Text Available Project cost is one of the most important criteria of success of project and is of high concern to those who are involved in the construction industry. However, studies show that rarely projects are complete within stipulated budget. This study is focusing on identification of significant causes affecting construction cost in MARA large projects. This paper presents the results of a questionnaire survey conducted among the personnel of Project Management Consultant (PMC. Data was analyzed with statistical tools to determine the rank of factors affecting construction cost. It is concluded that cash flow and financial difficulties faced by contractors, contractor's poor site management and supervision, inadequate contractor experience, shortage of site workers, incorrect planning and scheduling by contractors are most severe factors while changes in scope of project and frequent design changes are least affecting factors on construction cost. Spearman correlation analysis showed that incorrect planning and scheduling by contractor has strong positive relationship with contractor’s poor site management and supervision, inadequate experience of contractors has strong positive relationship with incorrect planning and scheduling; and contractor’s poor site management and supervision, changes in scope of project has strong positive relationship with frequent design changes; and vice versa.

  4. Considerations about Large Area___Low Cost Fast Imaging Photo-detectors

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, John; /Argonne; Attenkofer, Klaus; /Argonne; Delagnes, Eric; /DAPNIA, Saclay; Frisch, Henry; /Chicago U., EFI; Genat, Jean-Francois; /Paris U., VI-VII; Grabas, Herve; /Chicago U., EFI; Heintz, Mary K.; /Chicago U., EFI; May, Edward; /Argonne; Meehan, Samuel; /Argonne; Oberla, Eric; /Argonne; Ruckman, Larry L.; /Hawaii U.; Tang, Fukun; /Chicago U., EFI; Varner, Gary; /Hawaii U.; Vavra, Jaroslav; /SLAC; Wetstein, Matthew; /Argonne

    2012-05-07

    The Large Area Picosecond Photodetectors described in this contribution incorporate a photocathode and a borosilicate glass capillary Micro-Channel Plate (MCP) pair functionalised by atomic layer deposition (ALD) of separate resistive and secondary emission materials. Initial testing with matched pairs of small glass capillary test disks has demonstrated gains of the order of 10{sup 5}-10{sup 6}. Compared to other fast imaging devices, these photodetectors are expected to provide timing resolutions in the 10-100 ps range, and two-dimension position in the sub-millimeter range. If daisy chained, large detectors read at both ends with fast digitising integrated electronics providing zero-suppressed calibrated data should be produced at relatively low cost in large quantities.

  5. Technology, safety, and costs of decommissioning a reference large irradiator and reference sealed sources

    Energy Technology Data Exchange (ETDEWEB)

    Haffner, D.R.; Villelgas, A.J. [Pacific Northwest Lab., Richland, WA (United States)

    1996-01-01

    This report contains the results of a study sponsored by the US Nuclear Regulatory Commission (NRC) to examine the decommissioning of large radioactive irradiators and their respective facilities, and a broad spectrum of sealed radioactive sources and their respective devices. Conceptual decommissioning activities are identified, and the technology, safety, and costs (in early 1993 dollars) associated with decommissioning the reference large irradiator and sealed source facilities are evaluated. The study provides bases and background data for possible future NRC rulemaking regarding decommissioning, for evaluation of the reasonableness of planned decommissioning actions, and for determining if adequate funds are reserved by the licensees for decommissioning of their large irradiator or sealed source facilities. Another purpose of this study is to provide background and information to assist licensees in planning and carrying out the decommissioning of their sealed radioactive sources and respective facilities.

  6. A low-cost iron-cadmium redox flow battery for large-scale energy storage

    Science.gov (United States)

    Zeng, Y. K.; Zhao, T. S.; Zhou, X. L.; Wei, L.; Jiang, H. R.

    2016-10-01

    The redox flow battery (RFB) is one of the most promising large-scale energy storage technologies that offer a potential solution to the intermittency of renewable sources such as wind and solar. The prerequisite for widespread utilization of RFBs is low capital cost. In this work, an iron-cadmium redox flow battery (Fe/Cd RFB) with a premixed iron and cadmium solution is developed and tested. It is demonstrated that the coulombic efficiency and energy efficiency of the Fe/Cd RFB reach 98.7% and 80.2% at 120 mA cm-2, respectively. The Fe/Cd RFB exhibits stable efficiencies with capacity retention of 99.87% per cycle during the cycle test. Moreover, the Fe/Cd RFB is estimated to have a low capital cost of 108 kWh-1 for 8-h energy storage. Intrinsically low-cost active materials, high cell performance and excellent capacity retention equip the Fe/Cd RFB to be a promising solution for large-scale energy storage systems.

  7. The cost and cost-effectiveness of gender-responsive interventions for HIV: a systematic review

    Directory of Open Access Journals (Sweden)

    Michelle Remme

    2014-11-01

    Full Text Available Introduction: Harmful gender norms and inequalities, including gender-based violence, are important structural barriers to effective HIV programming. We assess current evidence on what forms of gender-responsive intervention may enhance the effectiveness of basic HIV programmes and be cost-effective. Methods: Effective intervention models were identified from an existing evidence review (“what works for women”. Based on this, we conducted a systematic review of published and grey literature on the costs and cost-effectiveness of each intervention identified. Where possible, we compared incremental costs and effects. Results: Our effectiveness search identified 36 publications, reporting on the effectiveness of 22 HIV interventions with a gender focus. Of these, 11 types of interventions had a corresponding/comparable costing or cost-effectiveness study. The findings suggest that couple counselling for the prevention of vertical transmission; gender empowerment, community mobilization, and female condom promotion for female sex workers; expanded female condom distribution for the general population; and post-exposure HIV prophylaxis for rape survivors are cost-effective HIV interventions. Cash transfers for schoolgirls and school support for orphan girls may also be cost-effective in generalized epidemic settings. Conclusions: There has been limited research to assess the cost-effectiveness of interventions that seek to address women's needs and transform harmful gender norms. Our review identified several promising, cost-effective interventions that merit consideration as critical enablers in HIV investment approaches, as well as highlight that broader gender and development interventions can have positive HIV impacts. By no means an exhaustive package, these represent a first set of interventions to be included in the investment framework.

  8. Cost-effective and large-area process for the functionalization and surface microstructuring using photo-patternable TiO2 sol-gel process and colloidal photolithography

    Science.gov (United States)

    Berthod, L.; Shavdina, O.; Vocanson, F.; Langlet, M.; Dellea, O.; Veillas, C.; Reynaud, S.; Verrier, I.; Jourlin, Y.

    2016-04-01

    The authors demonstrate a low cost direct process to directly print TiO2 grating on both planar and non-conventional substrate such as cylinder components. A well collimated i-line source emitting at a 365nm wavelength illuminates a mono layer of 1μm diameter silica microspheres deposited on a photosensitive TiO2-based sol-gel layer. No etching process is required since this layer is directly UV photo patternable like a negative photo-resist. Furthermore this thin layer offers interesting optical properties (high refractive index) and good mechanical and chemical stability. The paper describes the photochemistry of the TiO2 sol-gel layer process, the modeling of the electric field distribution below the spheres during the illumination process and preliminary results of TiO2 nanopillars of 200 nm diameter.

  9. Costs and cost-effectiveness of malaria control interventions - a systematic review

    Directory of Open Access Journals (Sweden)

    White Michael T

    2011-11-01

    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

  10. Social costs of robbery and the cost-effectiveness of substance abuse treatment.

    Science.gov (United States)

    Basu, Anirban; Paltiel, A David; Pollack, Harold A

    2008-08-01

    Reduced crime provides a key benefit associated with substance abuse treatment (SAT). Armed robbery is an especially costly and frequent crime committed by some drug-involved offenders. Many studies employ valuation methods that understate the true costs of robbery, and thus the true social benefits of SAT-related robbery reduction. At the same time, regression to the mean and self-report bias may lead pre-post comparisons to overstate crime reductions associated with SAT. Using 1992-1997 data from the National Treatment Improvement Evaluation Study (NTIES), we examined pre-post differences in self-reported robbery among clients in five residential and outpatient SAT modalities. Fixed-effect negative binomial regression was used to examine incidence rate reductions (IRR) in armed robbery. Published data on willingness to pay to avoid robbery were used to determine the social valuation of these effects. Differences in IRR across SAT modalities were explored to bound potential biases.All SAT modalities were associated with large and statistically significant reductions in robbery. The average number of self-reported robberies declined from 0.83/client/year pre-entry to 0.12/client/year following SAT (pcosts of these interventions. Conventional wisdom posits the economic benefits of SAT. We find that SAT is even more beneficial than is commonly assumed.

  11. Assessing the Effects of Construction Delays on MARA Large Projects

    Directory of Open Access Journals (Sweden)

    Aftab Hameed Memon

    2011-01-01

    Full Text Available Construction industry in Malaysia is facing a serious issue of construction delay causing a significant amount of time over run and cost over run. Various studies have addressed the issue of construction delay, however, most of studies focused on identifying causes of delay. Less attention has been paid of assessing effects of construction delay. Hence this study is aimed to assess effects of construction delay on MARA large projects. Investigation approach for study includes the site study of 30 MARA  large projects selected from various areas of Malaysia and structured questionnaire survey among client, consultant and contractor personnel’s. It is important to note that 90% of MARA projects are experiencing time overrun. Data was analyzed with statistical analysis  to calculate rank of the effects of delays and correlation with spearman formula to identify the interrelationship between attributes of effects. Results showed that time over-run and cost over-run are most significant effects of delay on MARA construction projects. Time over-run has high degree of correlation with cost over-run and moderate degree of correlation with disputes.

  12. Improving cost-effectiveness of hypertension management at a ...

    African Journals Online (AJOL)

    Improving cost-effectiveness of hypertension management at a community health centre. ... Log in or Register to get access to full text downloads. ... drugs on prescribing patterns, costs of drug treatment and blood pressure (BP) control. Design ...

  13. Revisiting the Effectiveness of Large Optical Telescopes

    Directory of Open Access Journals (Sweden)

    V. V. Sychev

    2015-01-01

    distortions in the optical path, which includes, actually, a laser resonator, a channel for transportation of powerful laser radiation with beam-deflecting mirrors to form the telescope with a compound main mirror;- forming the efficiency criteria of adaptive optical systems;- multi-loop system for adaptive correction of distortions.The paper discusses test results of transporting powerful laser radiation in the horizontal pathway and shows visual appearance of forming optical system of the test complex bench.It is convincingly proved that the use of offered postulates in development or modernization of optical complexes ensures the minimum level of residual distortions and the overall performance of adaptive optics.The offered postulates of adaptive correction of radiation wave-front and a positive experience of their use in full-scale optical complexes will substantially reduce terms and costs in creating effective aids to watch remote objects, as well as to form and supply the energy to the space objects for its various use such as power supply, communication, fight against space debris, ensuring asteroid safety, etc.It is possible to draw a conclusion that the state of domestic optical science, its potential in creation of adaptive means to provide formation and transportation of powerful laser radiation, and results of theoretical and pilot studies, encourage a reasonable hope for future creating a multi-purpose highly effective large-size optic-electronic facility.

  14. Treatment of large and giant intracranial aneurysms: cost comparison of flow diversion and traditional embolization strategies.

    Science.gov (United States)

    el-Chalouhi, Nohra; Jabbour, Pascal M; Tjoumakaris, Stavropoula I; Starke, Robert M; Dumont, Aaron S; Liu, Haisong; Rosenwasser, Robert; El Moursi, Sedeek; Gonzalez, L Fernando

    2014-11-01

    Flow diversion has emerged as a promising strategy for management of intracranial aneurysms. The purpose of this study was to determine whether treatment of large and giant aneurysms with the pipeline embolization device (PED) is more economical than traditional embolization strategies. We identified 30 consecutive aneurysms larger than 10 mm that were treated with PED at our institution. For each aneurysm treated with PED, theoretical coil embolization was performed by filling volume in a consistent, stepwise fashion until a packing density of 25% was reached. Prices of all equipment and implants were taken from price lists provided by each manufacturer. Median aneurysm volume was 0.90 cm(3). Overall procedure cost was lower with the PED (mean, $23,911) vs. coiling ($30,522, P = .06). Above the median aneurysm volume, PED treatment was significantly less expensive than coiling even if multiple PEDs were used (P = .006). However, below the median aneurysm volume, PED treatment was significantly more expensive than coiling (P = .009). Treatment with multiple PEDs was not cost-beneficial compared with coiling, even above the median aneurysm volume. Potential savings associated with the PED were highly dependent on the type of embolic agent used. The cost of initial treatment of large and giant aneurysms with PED is economically favorable compared to traditional embolization techniques. However, any potential cost benefit depends on aneurysm volume, coil type, and number of PEDs used. Accordingly, PED therapy is more expensive than coiling in aneurysms <0.9 cm(3) or when multiple devices are used. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Study of cost-effectiveness and cost-utility antihypertensive drugs used in hiperdia peaked - PI

    OpenAIRE

    NapoleÃo Moura Dias Neto

    2009-01-01

    Hypertension is a major cause of cardiovascular disease and study the costeffectiveness and cost-utility of anti-hypertensive drugs are rare in Brazil. This paper is a study of type pharmacoeconomic cost-effectiveness and cost-utility analysis of patients enrolled in the program HiperDia the municipality of Picos â PI in the period 20/8/2009 to 30/10/2009. We analyzed the direct costs of treatment, considering only the price of antiretroviral drugs, the effectiveness as measured by mean re...

  16. Costing the distribution of insecticide-treated nets: a review of cost and cost-effectiveness studies to provide guidance on standardization of costing methodology

    Directory of Open Access Journals (Sweden)

    Hanson Kara

    2006-05-01

    Full Text Available Abstract Background Insecticide-treated nets (ITNs are an effective and cost-effective means of malaria control. Scaling-up coverage of ITNs is challenging. It requires substantial resources and there are a number of strategies to choose from. Information on the cost of different strategies is still scarce. To guide the choice of a delivery strategy (or combination of strategies, reliable and standardized cost information for the different options is required. Methods The electronic online database PubMed was used for a systematic search of the published English literature on costing and economic evaluations of ITN distribution programmes. The keywords used were: net, bednet, insecticide, treated, ITN, cost, effectiveness, economic and evaluation. Identified papers were analysed to determine and evaluate the costing methods used. Methods were judged against existing standards of cost analysis to arrive at proposed standards for undertaking and presenting cost analyses. Results Cost estimates were often not readily comparable or could not be adjusted to a different context. This resulted from the wide range of methods applied and measures of output chosen. Most common shortcomings were the omission of certain costs and failure to adjust financial costs to generate economic costs. Generalisability was hampered by authors not reporting quantities and prices of resources separately and not examining the sensitivity of their results to variations in underlying assumptions. Conclusion The observed shortcomings have arisen despite the abundance of literature and guidelines on costing of health care interventions. This paper provides ITN specific recommendations in the hope that these will help to standardize future cost estimates.

  17. A review on cost-effectiveness and cost-utility of psychosocial care in cancer patients

    Directory of Open Access Journals (Sweden)

    Femke Jansen

    2016-01-01

    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.

  18. An fMRI study on sunk cost effect.

    Science.gov (United States)

    Zeng, Jianmin; Zhang, Qinglin; Chen, Changming; Yu, Rongjun; Gong, Qiyong

    2013-06-26

    Sunk cost effect (also called escalation of commitment, etc) is a pervasive, interesting and famous decision bias, which has been intensively discussed in psychology, economics, management, political science, zoology, etc. To date, little has been known about the neural basis of this phenomenon. We investigated it by using functional magnetic resonance imaging (fMRI) to monitor healthy subjects' brain activities when they made decisions in a task wherein sunk cost and incremental cost were systematically manipulated. Higher sunk cost only increased activity of some brain areas (mainly lateral frontal and parietal cortices, which are involved in risk-taking), whereas lower incremental cost mainly increased activity of some brain areas (including striatum and medial prefrontal cortex, which are sensitive to rewards). No overlapping brain areas were found to respond to both sunk cost and incremental cost. These results favor certainty effect over self-justification or diminishing sensitivity as account of sunk cost effect.

  19. Effective Language Teaching in Large Classes

    Institute of Scientific and Technical Information of China (English)

    张丽丽

    2010-01-01

    <正>With more and more people who are jumping into the line of learning the second language (especially English),and also due to the limited resources in language teaching,many foreign language teachers are nowadays confronting the large classes when teaching.So how to teach foreign language effectively in large classes has become an issue as well as a special field to make researches in.

  20. Cost-effectiveness of Voriconasole in treatment of invasive aspregillosis

    Directory of Open Access Journals (Sweden)

    N. N. Climko

    2009-01-01

    Full Text Available Invasive aspergillosis (IA is widespread infectious implication in immunodeficient patients, characterized by severe clinical manifestations and high mortality. This article presents the first case of pharmacoeconomical analysis of Voriconasole in treatment of IA compared with alternative therapies in Russia. Using mathematic modeling methods, we evalued total costs (including costs of IA treatment, clinical effectiveness and IA-related mortality in each therapy group. Obtained results showed the dominating of Voriconasole because of its high effectiveness and lower costs compared with caspofungine or amphotericine B. Total costs of therapy with Voricinasole were up to 30% lower compared with caspofungine and up to 70% lower compared with amphotericine B. Performed univariate sensitivity analysis showed that cost-effectiveness of anti-IA treatment depends mostly on clinical effectiveness of antimycotics rather than drug costs. Thus, treatment with Voriconasole is cost-effective in IA patients.

  1. Systematic review of cost and cost-effectiveness of different TB-screening strategies

    Directory of Open Access Journals (Sweden)

    Costa José

    2011-09-01

    Full Text Available Abstract Background Interferon-γ release assays (IGRAs for TB have the potential to replace the tuberculin skin test (TST in screening for latent tuberculosis infection (LTBI. The higher per-test cost of IGRAs may be compensated for by lower post-screening costs (medical attention, chest x-rays and chemoprevention, given the higher specificity of the new tests as compared to that of the conventional TST. We conducted a systematic review of all publications that have addressed the cost or cost-effectiveness of IGRAs. The objective of this report was to undertake a structured review and critical appraisal of the methods used for the model-based cost-effectiveness analysis of TB screening programmes. Methods Using Medline and Embase, 75 publications that contained the terms "IGRA", "tuberculosis" and "cost" were identified. Of these, 13 were original studies on the costs or cost-effectiveness of IGRAs. Results The 13 relevant studies come from five low-to-medium TB-incidence countries. Five studies took only the costs of screening into consideration, while eight studies analysed the cost-effectiveness of different screening strategies. Screening was performed in high-risk groups: close contacts, immigrants from high-incidence countries and healthcare workers. Two studies used the T-SPOT.TB as an IGRA and the other studies used the QuantiFERON-TB Gold and/or Gold In-Tube test. All 13 studies observed a decrease in costs when the IGRAs were used. Six studies compared the use of an IGRA as a test to confirm a positive TST (TST/IGRA strategy to the use of an IGRA-only strategy. In four of these studies, the two-step strategy and in two the IGRA-only strategy was more cost-effective. Assumptions about TST specificity and progression risk after a positive test had the greatest influence on determining which IGRA strategy was more cost-effective. Conclusion The available studies on cost-effectiveness provide strong evidence in support of the use of IGRAs

  2. Guideline Standardisation, Cost Effectiveness, Industry Needs and Conflict of Interest

    Directory of Open Access Journals (Sweden)

    Ajai R. Singh

    2007-01-01

    Full Text Available 1. A Conference on Guideline Standardization (COGS was convened in April 2002 'to define a standard for guideline reporting that would promote guideline quality and facilitate implementation'. It includes items for standardization, conceptual issues, up gradation, conflict of interest, patient interest and systematization. Even items for individual preferences, choice or values are not neglected. Special mention must be made of items which specify disclosure of conflict of interest both in the Developer (including the organization that develops and the individuals involved in the guideline's formulation, as well as in the sponsor or funding source (and its role in developing and/or reporting the guideline. 2. Recommendations of CPGs and CDR panels are conflicting. One considers effectiveness, the other considers cost-effectiveness. However, CPGs do not adhere to established methodological standards, critical information that would attest to validity is regularly absent, explicit criteria to grade the scientific evidence that supports their recommendations is absent from 82% of guidelines, 87% are not in a position to report whether a systematic literature search was performed, 67% do not describe the type of professionals used in guidelines development, there is such marked variation in the quality of guidelines. Moreover, CPG guideline layers often are conflicted in their interests. The problem can be resolved to a large extent by taking a simple step: making CPG panelists go into cost effectiveness along with recommending Guidelines. What then happens is that they have to consider not only effectiveness but also costs. Now effectiveness can be fudged, cost cannot. Why? Because, what is the cost is well known. Therapies in Guidelines should be recommended and graded according to whether they are Most, Moderately or Least Cost Effective. For that CPGs will have to perform economic analysis as well. This will meet with resistance for obvious

  3. Developing Cost Effective Automation In Soap Manufacturing

    Directory of Open Access Journals (Sweden)

    Rajesh B. Salwe

    2014-01-01

    Full Text Available A low cost automation system for soap manufacturing is to be designed and developed. The setup consists of mixer in which the raw material is mixed for the process of soap making. The mixture is then carried into a tray to a stamping machine. The plunger embosses on raw material of soap to give desired shape and size to the soap in a low cost manner.

  4. Developing Cost Effective Automation In Soap Manufacturing

    OpenAIRE

    Rajesh B. Salwe; Prof.S.V.Dahake

    2014-01-01

    A low cost automation system for soap manufacturing is to be designed and developed. The setup consists of mixer in which the raw material is mixed for the process of soap making. The mixture is then carried into a tray to a stamping machine. The plunger embosses on raw material of soap to give desired shape and size to the soap in a low cost manner.

  5. Cost effectiveness and efficiency in assistive technology service delivery.

    Science.gov (United States)

    Warren, C G

    1993-01-01

    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.

  6. Case studies: low cost, high-strength, large carbon foam tooling

    Energy Technology Data Exchange (ETDEWEB)

    Lucas, R.; Danford, H. [Touchstone Research Laboratory Ltd., Triadelphia, WV (USA)

    2009-01-15

    A new carbon foam tooling system has been developed that results in a low-cost, high-strength material that has been proving attractive for creation of tooling for composite parts. Composites are stronger; lighter and less subject to corrosion and fatigue than materials that are currently used for fabrication of advanced structures. Tools to manufacture these composite parts must be rigid, durable and able to offer a coefficient of thermal expansion (CTE) closely matching that of the composites. Current technology makes it difficult to match the CTE of a composite part in the curing cycle with anything other than a carbon composite or a nickel iron alloy such as Invar. Fabrication of metallic tooling requires many, expensive stages of long duration with a large infrastructure investment. Card ban fiber reinforced polymer resin composite tooling has a shorter lead-time but limited production use because of durability concerns. Coal-based carbon foam material has a compatible CTE and strong durability, that make it an attractive alternative for use in tooling. The use of coal-based carbon foam in tooling for carbon composites is advantageous because of its low cost, light weight, machinability , vacuum integrity and compatibility with a wide range of curing processes. Large-scale tooling case studies will be presented detailing carbon foam's potential for tooling applications.

  7. COST ANALYSIS OF THE PSYCHOLOGICAL EFFECTS OF WASTE DISPOSAL

    Directory of Open Access Journals (Sweden)

    S. A. Oke, K. O. Awofeso

    2006-01-01

    Full Text Available This paper quantifies the cost involved due to the psychological effect of waste disposal. The major costs are quantified as management and personnel costs. Management costs refer to those associated with awareness, recovery and recycling, taskforce and experimental. On the other hand, personnel costs are related to tax and health. The approach utilized is the algebraic sum of these component costs, since dimensional consistency of the formulation is observed. The results obtained indicate that the framework presented could beneficially add to the tool kit of the environmental decision makers. This would make it possible to generate scenarios that would give the decision maker adequate information before decisions are made. The implication of this research is that intuitive decision-making on cost is replaced with scientific backed up decision making. The idea proposed in this work is new since it provides a unique way of measuring cost of the effects of waste disposal on the stakeholders in the system.

  8. Dengue dynamics and vaccine cost-effectiveness in Brazil.

    Science.gov (United States)

    Durham, David P; Ndeffo Mbah, Martial L; Medlock, Jan; Luz, Paula M; Meyers, Lauren A; Paltiel, A David; Galvani, Alison P

    2013-08-20

    Recent Phase 2b dengue vaccine trials have demonstrated the safety of the vaccine and estimated the vaccine efficacy with further trials underway. In anticipation of vaccine roll-out, cost-effectiveness analysis of potential vaccination policies that quantify the dynamics of disease transmission are fundamental to the optimal allocation of available doses. We developed a dengue transmission and vaccination model and calculated, for a range of vaccination costs and willingness-to-pay thresholds, the level of vaccination coverage necessary to sustain herd-immunity, the price at which vaccination is cost-effective and is cost-saving, and the sensitivity of our results to parameter uncertainty. We compared two vaccine efficacy scenarios, one a more optimistic scenario and another based on the recent lower-than-expected efficacy from the latest clinical trials. We found that herd-immunity may be achieved by vaccinating 82% (95% CI 58-100%) of the population at a vaccine efficacy of 70%. At this efficacy, vaccination may be cost-effective for vaccination costs up to US$ 534 (95% CI $369-1008) per vaccinated individual and cost-saving up to $204 (95% CI $39-678). At the latest clinical trial estimates of an average of 30% vaccine efficacy, vaccination may be cost-effective and cost-saving at costs of up to $237 (95% CI $159-512) and $93 (95% CI $15-368), respectively. Our model provides an assessment of the cost-effectiveness of dengue vaccination in Brazil and incorporates the effect of herd immunity into dengue vaccination cost-effectiveness. Our results demonstrate that at the relatively low vaccine efficacy from the recent Phase 2b dengue vaccine trials, age-targeted vaccination may still be cost-effective provided the total vaccination cost is sufficiently low.

  9. Specialty-specific admission: a cost-effective intervention?

    LENUS (Irish Health Repository)

    Slattery, E

    2012-02-01

    INTRODUCTION: Cost effectiveness of healthcare has become an important component in its delivery. Current practices need to be assessed and measured for variations that may lead to financial savings. Speciality specific admission is known not only to lead improved clinical outcomes but also to lead important cost reductions. METHODS: All patients admitted to an Irish teaching hospital via the emergency department over a 2-year period with a gastroenterology (GI) related illness were included in this analysis.GI illness was classified using the Disease related grouping (DRG) system. Mean length of stay (LOS) and patient level costing (PLC) were calculated. Differences between DRGs with respect to speciality (i.e. specialist vs. non-specialist) were calculated for the five commonest DRGs. RESULTS: Significant variations in LOS and PLC were demonstrated in the DRGs. Mean LOS varied with increasing complexity, from 3.2 days for non-complex GI haemorrhage to 14.4 days for complex alcohol related cirrhosis as expected. A substantial difference in LOS within DRG groups was demonstrated by large standard deviations in the mean (up to 8.1 days in some groups) and was independent of complexity of cases. PLC also varied widely in both complex and non-complex cases with standard deviations of up to 17,342 noted. Specialty-specific admission was associated with shorter LOS for most GI admissions. CONCLUSION: Significant disparity exists for both LOS and PLC for most GI diagnoses. Specialty-specific admissions are associated with reduced LOS. Specialty-specific admission would appear to be cost-effective which may also lead to improved clinical outcomes.

  10. Cost Effectiveness of Home Energy Retrofits in Pre-Code Vintage Homes in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Fairey, Philip [BA-PIRC/Florida Solar Energy Center, Cocoa, FL (United States); Parker, Danny [BA-PIRC/Florida Solar Energy Center, Cocoa, FL (United States)

    2012-11-01

    This analytical study examines the opportunities for cost-effective energy efficiency and renewable energy retrofits in residential archetypes constructed prior to 1980 (Pre-Code) in fourteen U.S. cities. These fourteen cities are representative of each of the International Energy Conservation Code (IECC) climate zones in the contiguous United States. The analysis is conducted using an in-house version of EnergyGauge USA v.2.8.05 named CostOpt that has been programmed to perform iterative, incremental economic optimization on a large list of residential energy efficiency and renewable energy retrofit measures. The principle objectives of the study are to determine the opportunities for cost effective source energy reductions in this large cohort of existing residential building stock as a function of local climate and energy costs; and to examine how retrofit financing alternatives impact the source energy reductions that are cost effectively achievable.

  11. Prime focus architectures for large space telescopes: reduce surfaces to save cost

    Science.gov (United States)

    Breckinridge, J. B.; Lillie, C. F.

    2016-07-01

    Conceptual architectures are now being developed to identify future directions for post JWST large space telescope systems to operate in the UV Optical and near IR regions of the spectrum. Here we show that the cost of optical surfaces within large aperture telescope/instrument systems can exceed $100M/reflection when expressed in terms of the aperture increase needed to over come internal absorption loss. We recommend a program in innovative optical design to minimize the number of surfaces by considering multiple functions for mirrors. An example is given using the Rowland circle imaging spectrometer systems for UV space science. With few exceptions, current space telescope architectures are based on systems optimized for ground-based astronomy. Both HST and JWST are classical "Cassegrain" telescopes derived from the ground-based tradition to co-locate the massive primary mirror and the instruments at the same end of the metrology structure. This requirement derives from the dual need to minimize observatory dome size and cost in the presence of the Earth's 1-g gravitational field. Space telescopes, however function in the zero gravity of space and the 1- g constraint is relieved to the advantage of astronomers. Here we suggest that a prime focus large aperture telescope system in space may have potentially have higher transmittance, better pointing, improved thermal and structural control, less internal polarization and broader wavelength coverage than Cassegrain telescopes. An example is given showing how UV astronomy telescopes use single optical elements for multiple functions and therefore have a minimum number of reflections.

  12. Cost effective processes by using negative-tone development application

    Science.gov (United States)

    Yamamoto, Kei; Kato, Keita; Ou, Keiyu; Shirakawa, Michihiro; Kamimura, Sou

    2015-03-01

    The high volume manufacturing with extreme ultraviolet (EUV) lithography is delaying due to its light source issue. Therefore, ArF-immersion lithography has still been the most promising technology for down scaling of device pitch. As the limitation of ArF-immersion single patterning is considered to be nearly 40nm half pitch (hp), ArF-immersion lithography has necessity to be extended by combining processes to achieve sub- 20nm hp patterning. Recently, there are many reports about the extension of ArF-immersion lithography, e.g., self-aligned multiple patterning (SAMP) and litho-etch-litho-etch (LELE) process. These methods have been realized by the combination of lithography, deposition, and etching. On the other aspect, 1-D layout is adopted for leading devices, which contains additional cut or block litho and etch processes to form 2-D like layout. Thus, according to the progress of down scaling technologies, number of processes increases and the cost of ownership (CoO) can not be neglected. Especially, the number of lithography steps and etching steps has been expanded by the combination of processes, and it has come to occupy a large portion of total manufacturing cost. We have reported that negative tone development (NTD) system using organic solvent developer have enough resolution to achieve fine narrow trench or contact hole patterning, since negative tone imaging enables to apply bright mask for these pattern with significantly high optical image contrast compared to positive tone imaging, and it has contributed high throughput multiple patterning. On the other hand, NTD system is found to be useful not only for leading device node, but also for cost effective process. In this report, we propose the cost effective process using NTD application. In the viewpoint of cost down at exposure tool, we have developed KrF-NTD resist which is customized for organic solvent developer. Our KrF-NTD resist has resolution comparable with ArF positive tone development

  13. Cost-effectiveness of vaccination against herpes zoster.

    Science.gov (United States)

    de Boer, Pieter T; Wilschut, Jan C; Postma, Maarten J

    2014-01-01

    Herpes zoster (HZ) is a common disease among elderly, which may develop into a severe pain syndrome labeled postherpetic neuralgia (PHN). A live-attenuated varicella zoster virus vaccine has been shown to be effective in reducing the incidence and burden of illness of HZ and PHN, providing the opportunity to prevent significant health-related and financial consequences of HZ. In this review, we summarize the available literature on cost-effectiveness of HZ vaccination and discuss critical parameters for cost-effectiveness results. A search in PubMed and EMBASE was performed to identify full cost-effectiveness studies published before April 2013. Fourteen cost-effectiveness studies were included, all performed in western countries. All studies evaluated cost-effectiveness among elderly above 50 years and used costs per quality-adjusted life year (QALY) gained as primary outcome. The vast majority of studies showed vaccination of 60- to 75-year-old individuals to be cost-effective, when duration of vaccine efficacy was longer than 10 years. Duration of vaccine efficacy, vaccine price, HZ incidence, HZ incidence and discount rates were influential to the incremental cost-effectiveness ratio (ICER). HZ vaccination may be a worthwhile intervention from a cost-effectiveness point of view. More extensive reporting on methodology and more detailed results of sensitivity analyses would be desirable to address uncertainty and to guarantee optimal comparability between studies, for example regarding model structure, discounting, vaccine characteristics and loss of quality of life due to HZ and PHN.

  14. The Kyoto Protocol Is Cost-effective

    Directory of Open Access Journals (Sweden)

    Giulio A. De Leo

    2002-06-01

    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.

  15. Surface effects on large deflection of nanowires

    Institute of Scientific and Technical Information of China (English)

    杨帆

    2015-01-01

    Surface effects play an important role in the mechanical behavior of nanosized structural elements owing to the increased ratio of surface area to volume. The surface effects on the large deflection of nanowires were considered. Both geometric nonlinearity in finite deformation and surface effects at nanoscale were taken into account to analyze the bending of nanowires subjected to a concentrated force. For simply supported beams and clamped-clamped beams, the influence of surface effects and geometric nonlinearity were discussed in detail. It is found that both surface effects and geometric nonlinearity tend to decrease the deflection of bending nanowires and thus increase the effective elastic modulus of nanowires. Surface effects yield the size dependent behavior of nanowires.

  16. Cost and Training Effectiveness Analysis Performance Guide

    Science.gov (United States)

    1980-07-23

    value is treated as a reduction in the cost of the alternative for wnioh the use of the assets is intended. The fair market value may be determined...imputed value of the facility should be used. These costs can be based on fair market value, scrap value, or alternative use. In any event, discuss this...1 MM 1 i l 1 1 SOFTIS 1X1 X XI 1 1 ’ 1 1 I Ml 1 1 1 i M 3SOFTA 1 1X 1 IX X i 1 1

  17. Cost Effectiveness Analysis, A DTIC Bibliography.

    Science.gov (United States)

    1980-07-01

    Model for Estimating * 0 6 DUGAS. DORIS J. Software Life Cycle Costs (ModelGuidelines for Attracting Private *4Concept). Volume 1.Capital to Corp$ of...of Category It Test Program A0-A023 442 An Econometric Analysis of aitonance Data. VOlunteer Enlistments of service AD-AO21 258 HUMPHREYS . THOMAS H

  18. Atomoxetine's Effect on Societal Costs in Sweden

    Science.gov (United States)

    Myren, Karl-Johan; Thernlund, Gunilla; Nylen, Asa; Schacht, Alexander; Svanborg, Par

    2010-01-01

    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…

  19. [Cost-effectiveness study of internist joint practices].

    Science.gov (United States)

    Dupierry, Raphael Patrick; Kaschny, Martin

    2008-07-15

    Practicing doctors are managers of their own practice. A doctor, who manages his practice besides his technical qualification, considering business aspects, enables a solid economic base. The objective of this article is to point out key starting points for an effective management of internist doctors' practices. Within the article it has particularly been analyzed, to what extent cooperations make an impact on the return and cost structure. For this purpose, a total of 495 business assessments from the DATEV eG of internist doctors' practices have been analyzed. The percental returns of smaller internistic joint practices (averaged turnover: 573,071 Euros) is about 6% higher than the percental returns of internistic doctors' practices (averaged turnover: 384,049 Euros). This result shows that small internistic joint practices work more efficiently. In contrast to this result bigger joint practices (averaged turnover: 1,618,608 Euros) gain an about 6% lower percental return than internistic doctors' practices. The reasons for this result are, compared to the internistic doctors' practices, the higher consumption of materials (+7%), the higher personnel costs (+3.5%), and the higher occupancy costs (+0.2%). On the basis of these results it can be concluded, that medium-sized internistic joint practices work more efficiently than internistic doctors' practices as well as large internistic joint practices. On the basis of the results it can be concluded, that internist cooperations can make good economic sense. However, the extent of cost efficiency and profit increase is particularly dependent on the size of the practice, the offered service portfolio, and the human resource management.

  20. Non-traditional settings for influenza vaccination of adults: costs and cost effectiveness.

    Science.gov (United States)

    Prosser, Lisa A; O'Brien, Megan A; Molinari, Noelle-Angelique M; Hohman, Katherine H; Nichol, Kristin L; Messonnier, Mark L; Lieu, Tracy A

    2008-01-01

    Influenza vaccination rates remain far below national goals in the US. Expanding influenza vaccination in non-traditional settings such as worksites and pharmacies may be a way to enhance vaccination coverage for adults, but scant data exist on the cost effectiveness of this strategy. The aims of this study were to (i) describe the costs of vaccination in non-traditional settings such as pharmacies and mass vaccination clinics; and (ii) evaluate the projected health benefits, costs and cost effectiveness of delivering influenza vaccination to adults of varying ages and risk groups in non-traditional settings compared with scheduled doctor's office visits. All analyses are from the US societal perspective. We evaluated the costs of influenza vaccination in non-traditional settings via detailed telephone interviews with representatives of organizations that conduct mass vaccination clinics and pharmacies that use pharmacists to deliver vaccinations. Next, we constructed a decision tree to compare the projected health benefits and costs of influenza vaccination delivered via non-traditional settings or during scheduled doctor's office visits with no vaccination. The target population was stratified by age (18-49, 50-64 and >or=65 years) and risk status (high or low risk for influenza-related complications). Probabilities and costs (direct and opportunity) for uncomplicated influenza illness, outpatient visits, hospitalizations, deaths, vaccination and vaccine adverse events were derived from primary data and from published and unpublished sources. The mean cost (year 2004 values) of vaccination was lower in mass vaccination (dollars US 17.04) and pharmacy (dollars US 11.57) settings than in scheduled doctor's office visits (dollars US 28.67). Vaccination in non-traditional settings was projected to be cost saving for healthy adults aged >or=50 years, and for high-risk adults of all ages. For healthy adults aged 18-49 years, preventing an episode of influenza would

  1. The effect of pediatric knowledge on hospice care costs.

    Science.gov (United States)

    Lindley, Lisa C; Mixer, Sandra J; Cozad, Melanie J

    2014-05-01

    The cost of hospice care is rising. Although providing care for children at end of life may be costly for hospices, it is unclear whether or not gaining pediatric knowledge and even establishing a pediatric program may be done cost effectively. The purpose of our study was to examine the effect of possessing pediatric knowledge (i.e., pediatric program, pediatric experience) on core hospice care costs. Using 2002 to 2008 California hospice data, the findings of the regression analysis suggest that having pediatric knowledge does not significantly increase nursing, physician, and medical social service costs. Having a pediatric program was related to increased counseling costs. Our findings shed important light on the minimal costs incurred when hospices decide to develop pediatric knowledge.

  2. The patterns and costs of the Da Vinci robotic surgery system in a large academic institution.

    Science.gov (United States)

    Prewitt, Rhonda; Bochkarev, Victor; McBride, Corrigan L; Kinney, Sonja; Oleynikov, Dmitry

    2008-05-01

    The da Vinci ™Robotic System (dVRS) is the latest advancement in laparoscopic surgery allowing the surgeon more accurate and precise control of instrumentation with an added three-dimensional image. Technology comes with a price, $1.3 million. Due to charitable contributions from the Durham family, the University of Nebraska was the eighth Medical Center in the USA to obtain a dVRS in June 2000. UNMC analyzed 224 dVRS surgical procedures from July 2000 to February 2007. These procedures were designated by surgical service and further scrutinized for length of stay, and cost. We also reviewed trends in operative usage, academic and public relations components with this innovative technology. The dVRS was used for multiple other purposes that were beneficial including research with engineering graduate students, training for surgical residents, display and demos as a means for public relations. Primarily general and urologic surgeons utilized the dVRS. General surgeons were the early adopters of the new technology, the greatest growth and utilization of the equipment has been in urologic procedures, which has outpaced general surgery in the past year. Cost analysis shows a subtle benefit with a reduced length of stay by an average of 4 days. Average direct costs were found to be greater with the dVRS by $1,470. Overall, the effects of the dVRS are vast reaching and are fundamental to the growth of an academic institution and continued progress in minimally invasive surgery.

  3. The Low-Cost UAV-Based Remote Sensing System Capabilities for Large Scale Cadaster Mapping

    Science.gov (United States)

    Aries Rokhmana, Catur; Utomo, Susilo

    2016-11-01

    There is at least 190 million hectare of Indonesia's land part area that should be mapped in large scale cadaster maps. The completion of cadaster maps up to scale 1/2500 are still an open problems. The very high resolution images with spatial resolution less than 10cm can be a good choice to be able to see a parcel boundary. The use of Unmanned Aerial Vehicle- based remote sensing system can produce aerial photograph with spatial resolution less than 10cm. For keeping UAV-based system low-cost, the system architecture consists of (1) aerial platform from hobby aeromodelling; (2) consumers grade camera sensor; (3) a low-cost GPS logger for ground control survey; (4) an open source structure from motion processing; and (5) an open source GIS software. This system was tested for producing a cadaster base map in a paddy field area at Trimulyo village at Bantul Region. The high resolution image with Ground Sampling Distance up to 7 cm can easily to see a parcel boundary and some of boundary markers. Some of the parcel areas were used for geometric evaluation. The bundle adjustment with 9 Ground Control Points (GCP) shows the error less than 12 cm in all coordinates component. Meanwhile, the percentage of area differences from some parcel samples show less than 5% of differences. In future, the potential use of a GPS kinematic assisted photo flight should be explored in accordance to reduce the need for GCP survey.

  4. On option pricing in the large risk aversion, small transaction cost limit

    CERN Document Server

    Hynd, Ryan

    2011-01-01

    G. Barles and H. Soner considered the problem of option pricing in the large risk aversion, small transaction cost limit within the framework of indifference pricing. This problem turns out to be one of asymptotic analysis of nonlinear parabolic PDE and the interesting feature is the role of an ODE eigenvalue problem. Solving the eigenvalue problem almost explicitly helped these authors characterize the limiting option price as a solution of a nonlinear PDE. We study a model problem in the multi-asset setting where it is necessary to develop new methods as the corresponding PDE eigenvalue problem cannot be solved by trivial means. We deduce important properties of the eigenvalue function which aids us in proving a convergence theorem analogous to the aforementioned result in the single-asset case.

  5. Cost optimizing of large-scale offshore wind arms in UK waters

    Energy Technology Data Exchange (ETDEWEB)

    Bean, D. [National wind Power Ltd. (United Kingdom)

    1999-07-01

    As part of the study `Cost Optimising of Large Scale Offshore Wind Farms`, National Wind Power`s objective is to broaden the scope of the study into the UK context. The suitability of an offshore wind farm development has been reviewed for a variety of regions around the UK, culminating in the selection of a reference site off the east coast of England. A design basis for this site has been derived, and a preliminary foundation design has been performed from within the consortium. Due primarily to the increased wave exposure at the UK reference site, the resulting gravity and monopile designs were larger and therefore more expensive than their Danish counterparts. A summary of the required consents for an offshore wind farm in UK waters is presented, together with an update on the recent consultation process initiated by UK Government on offshore wind energy. (au) EFP-96; JOULE-3. 22 refs.

  6. Cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention.

    Science.gov (United States)

    Dilley, Sarah E; Havrilesky, Laura J; Bakkum-Gamez, Jamie; Cohn, David E; Michael Straughn, J; Caughey, Aaron B; Rodriguez, Maria I

    2017-08-01

    Data suggesting a link between the fallopian tube and ovarian cancer have led to an increase in rates of salpingectomy at the time of pelvic surgery, a practice known as opportunistic salpingectomy (OS). However, the potential benefits, risks and costs for this new practice are not well established. Our objective was to assess the cost-effectiveness of opportunistic salpingectomy at the time of laparoscopic permanent contraception or hysterectomy for benign indications. We created two models to compare the cost-effectiveness of salpingectomy versus usual care. The hypothetical study population is 50,000 women aged 45 undergoing laparoscopic hysterectomy with ovarian preservation for benign indications, and 300,000 women aged 35 undergoing laparoscopic permanent contraception. SEER data were used for probabilities of ovarian cancer cases and deaths. The ovarian cancer risk reduction, complication rates, utilities and associated costs were obtained from published literature. Sensitivity analyses and Monte Carlo simulation were performed, and incremental cost-effectiveness ratios (ICERs) were calculated to determine the cost per quality adjusted life year (QALY) gained. In the laparoscopic hysterectomy cohort, OS is cost saving and would yield $23.9 million in health care dollars saved. In the laparoscopic permanent contraception cohort, OS is cost-effective with an ICER of $31,432/QALY compared to tubal ligation, and remains cost-effective as long as it reduces ovarian cancer risk by 54%. Monte Carlo simulation demonstrated cost-effectiveness with hysterectomy and permanent contraception in 62.3% and 55% of trials, respectively. Opportunistic salpingectomy for low-risk women undergoing pelvic surgery may be a cost-effective strategy for decreasing ovarian cancer risk at time of hysterectomy or permanent contraception. In our model, salpingectomy was cost-effective with both procedures, but the advantage greater at time of hysterectomy. Copyright © 2017. Published by

  7. Proton therapy of cancer: Potential clinical advantages and cost-effectiveness

    Energy Technology Data Exchange (ETDEWEB)

    Lundkvist, Jonas; Ekman, Mattias [Stockholm Health Economics, Stockholm (Sweden); Rehn Ericsson, Suzanne [Univ. Hospital, Uppsala (Sweden). Dept. of Oncology, Radiology and Clinical Immunology; Joensson, Bengt [Stockholm School of Economics, Stockholm (Sweden); Glimelius, Bengt [Karolinska Inst., Stockholm (Sweden). Dept. of Oncology and Pathology; Akademiska sjukhuset, Uppsala (Sweden). Dept. of Oncology, Radiology and Clinical Immunology

    2005-12-01

    Proton therapy may offer potential clinical advantages compared with conventional radiation therapy for many cancer patients. Due to the large investment costs for building a proton therapy facility, however, the treatment cost with proton radiation is higher than with conventional radiation. It is therefore important to evaluate whether the medical benefits of proton therapy are large enough to motivate the higher costs. We assessed the cost-effectiveness of proton therapy in the treatment of four different cancers: left-sided breast cancer, prostate cancer, head and neck cancer, and childhood medulloblastoma. A Markov cohort simulation model was created for each cancer type and used to simulate the life of patients treated with radiation. Cost and quality adjusted life years (QALYs) were used as primary outcome measures. The results indicated that proton therapy was cost-effective if appropriate risk groups were chosen. The average cost per QALY gained for the four types of cancer assessed was about Euro 10,130. If the value of a QALY was set to Euro 55,000, the total yearly net benefit of treating 925 cancer patients with the four types of cancer was about Euro 20.8 million. Investment in a proton facility may thus be cost-effective. The results must be interpreted with caution, since there is a lack of data, and consequently large uncertainties in the assumptions used.

  8. Large Chiroptical Effects in Planar Chiral Metamaterials

    Science.gov (United States)

    Ye, Weimin; Yuan, Xiaodong; Guo, Chucai; Zhang, Jianfa; Yang, Biao; Zhang, Shuang

    2017-05-01

    Chiroptical effects characterized by different optical responses for left- (LCP) and right-handed circularly polarized light (RCP) are powerful and valuable tools in optics with wide applications in polarization-resolved imaging and sensing. Previously observed strong chiroptical effects are limited to metamaterials with complex three-dimensional chiral structures at the subwavelength scale. Although asymmetrical transmission of LCP and RCP have been investigated in planar chiral metasurfaces, the observed weak chiroptical effects result from anisotropic Ohmic dissipation of the metal constituents. Here, we demonstrate by theory and proof-of-concept experiments that a large difference in transmittances of LCP and RCP can be attained in a single-layer planar chiral metamaterial with a subwavelength thickness. Without violating the reciprocity and mirror symmetry, the strong chiroptical effect, independent of dielectric loss, arises from a mechanism of multimode interference. The described effect may lead to a gateway towards chiral manipulations of light and chiral optical devices.

  9. Cost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis.

    Science.gov (United States)

    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

    2016-12-01

    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.

  10. Cost-effectiveness analysis of sandhill crane habitat management

    Science.gov (United States)

    Kessler, Andrew C.; Merchant, James W.; Shultz, Steven D.; Allen, Craig R.

    2013-01-01

    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.

  11. Cost Effective Campaigning in Social Networks

    CERN Document Server

    Kotnis, Bhushan

    2016-01-01

    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 t...

  12. Implant marketing: cost effective implant dentistry.

    Science.gov (United States)

    Wohrle, P S; Levin, R P

    1996-01-01

    The application of the KAL-Technique to the field of implant dentistry allows both patients and dental practices to benefit. It is an exciting advance that decreases frustration and stress in providing implant procedures and lowers overall costs. Professionals using the KAL-Technique report significant predictability in achieving passive framework fit. They are also lowering overall cost of implant cases, which increases the number of patients who can accept implant treatment. It has been well established that the more individuals in a practice that receive implants, the more referrals a practice will gain. This is because implant patients find tremendous advances in the quality of life, and do not hesitate to tell others who can take advantage of this opportunity. Implant dentistry is one of the fastest growing fields in dentistry today. While some other areas of dentistry begin to decline in volume and need, implant dentistry provides the opportunity to keep practices strong and to insure long-term success.

  13. Critical Research for Cost-Effective Photoelectrochemical Production of Hydrogen

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Liwei [Midwest Optoelectronics, LLC, Toledo, OH (United States); Deng, Xunming [Univ. of Toledo, OH (United States); Abken, Anka [Midwest Optoelectronics, LLC, Toledo, OH (United States); Cao, Xinmin [Midwest Optoelectronics, LLC, Toledo, OH (United States); Du, Wenhui [Midwest Optoelectronics, LLC, Toledo, OH (United States); Vijh, Aarohi [Xunlight Corporation, Toledo, OH (United States); Ingler, William [Univ. of Toledo, OH (United States); Chen, Changyong [Univ. of Toledo, OH (United States); Fan, Qihua [Univ. of Toledo, OH (United States); Collins, Robert [Univ. of Toledo, OH (United States); Compaan, Alvin [Univ. of Toledo, OH (United States); Yan, Yanfa [Univ. of Toledo, OH (United States); Giolando, Dean [Univ. of Toledo, OH (United States); Turner, John [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2014-10-29

    The objective of this project is to develop critical technologies required for cost-effective production of hydrogen from sunlight and water using a-Si triple junction solar cell based photo-electrodes. In this project, Midwest Optoelectronics, LLC (MWOE) and its collaborating organizations utilize triple junction a-Si thin film solar cells as the core element to fabricate photoelectrochemical (PEC) cells. Triple junction a-Si/a-SiGe/a-SiGe solar cell is an ideal material for making cost-effective PEC system which uses sun light to split water and generate hydrogen. It has the following key features: 1) It has an open circuit voltage (Voc ) of ~ 2.3V and has an operating voltage around 1.6V. This is ideal for water splitting. There is no need to add a bias voltage or to inter-connect more than one solar cell. 2) It is made by depositing a-Si/a-SiGe/aSi-Ge thin films on a conducting stainless steel substrate which can serve as an electrode. When we immerse the triple junction solar cells in an electrolyte and illuminate it under sunlight, the voltage is large enough to split the water, generating oxygen at the Si solar cell side (for SS/n-i-p/sunlight structure) and hydrogen at the back, which is stainless steel side. There is no need to use a counter electrode or to make any wire connection. 3) It is being produced in large rolls of 3ft wide and up to 5000 ft long stainless steel web in a 25MW roll-to-roll production machine. Therefore it can be produced at a very low cost. After several years of research with many different kinds of material, we have developed promising transparent, conducting and corrosion resistant (TCCR) coating material; we carried out extensive research on oxygen and hydrogen generation catalysts, developed methods to make PEC electrode from production-grade a-Si solar cells; we have designed and tested various PEC module cases and carried out extensive outdoor testing; we were able to obtain a solar to hydrogen conversion efficiency (STH

  14. Cost-Effectiveness of a Health System-Based Smoking Cessation Program.

    Science.gov (United States)

    Levy, Douglas E; Klinger, Elissa V; Linder, Jeffrey A; Fleegler, Eric W; Rigotti, Nancy A; Park, Elyse R; Haas, Jennifer S

    2016-09-17

    Project CLIQ (Community Link to Quit) was a proactive population-outreach strategy using an electronic health records-based smoker registry and interactive voice recognition technology to connect low- to moderate-income smokers with cessation counseling, medications, and social services. A randomized trial demonstrated that the program increased cessation. We evaluated the cost-effectiveness of CLIQ from a provider organization's perspective if implemented outside the trial framework. We calculated the cost, cost per smoker, incremental cost per additional quit, and, secondarily, incremental cost per additional life year saved of the CLIQ system compared to usual care using data from a 2011-2013 randomized trial assessing the effectiveness of the CLIQ system. Sensitivity analyses considered economies of scale and initial versus ongoing costs. Over a 20-month period (the duration of the trial) the program cost US $283 027 (95% confidence interval [CI] $209 824-$389 072) more than usual care in a population of 8544 registry-identified smokers, 707 of whom participated in the program. The cost per smoker was $33 (95% CI 28-40), incremental cost per additional quit was $4137 (95% CI $2671-$8460), and incremental cost per additional life year saved was $7301 (95% CI $4545-$15 400). One-time costs constituted 28% of costs over 20 months. Ongoing costs were dominated by personnel costs (71% of ongoing costs). Sensitivity analyses showed sharp gains in cost-effectiveness as the number of identified smokers increased because of the large initial costs. The CLIQ system has favorable cost-effectiveness compared to other smoking cessation interventions. Cost-effectiveness will be greatest for health systems with high numbers of smokers and with the high smoker participation rates. Health information systems capable of establishing registries of patients who are smokers are becoming more prevalent. This economic analysis illustrates the cost implications for health care systems

  15. Cost effective campaigning in social networks

    Science.gov (United States)

    Kotnis, Bhushan; Kuri, Joy

    2016-05-01

    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.

  16. Cost-effectiveness of Lung Cancer Screening in Canada.

    Science.gov (United States)

    Goffin, John R; Flanagan, William M; Miller, Anthony B; Fitzgerald, Natalie R; Memon, Saima; Wolfson, Michael C; Evans, William K

    2015-09-01

    The US National Lung Screening Trial supports screening for lung cancer among smokers using low-dose computed tomographic (LDCT) scans. The cost-effectiveness of screening in a publically funded health care system remains a concern. To assess the cost-effectiveness of LDCT scan screening for lung cancer within the Canadian health care system. The Cancer Risk Management Model (CRMM) simulated individual lives within the Canadian population from 2014 to 2034, incorporating cancer risk, disease management, outcome, and cost data. Smokers and former smokers eligible for lung cancer screening (30 pack-year smoking history, ages 55-74 years, for the reference scenario) were modeled, and performance parameters were calibrated to the National Lung Screening Trial (NLST). The reference screening scenario assumes annual scans to age 75 years, 60% participation by 10 years, 70% adherence to screening, and unchanged smoking rates. The CRMM outputs are aggregated, and costs (2008 Canadian dollars) and life-years are discounted 3% annually. The incremental cost-effectiveness ratio. Compared with no screening, the reference scenario saved 51,000 quality-adjusted life-years (QALY) and had an incremental cost-effectiveness ratio of CaD $52,000/QALY. If smoking history is modeled for 20 or 40 pack-years, incremental cost-effectiveness ratios of CaD $62,000 and CaD $43,000/QALY, respectively, were generated. Changes in participation rates altered life years saved but not the incremental cost-effectiveness ratio, while the incremental cost-effectiveness ratio is sensitive to changes in adherence. An adjunct smoking cessation program improving the quit rate by 22.5% improves the incremental cost-effectiveness ratio to CaD $24,000/QALY. Lung cancer screening with LDCT appears cost-effective in the publicly funded Canadian health care system. An adjunct smoking cessation program has the potential to improve outcomes.

  17. The Cost-Effectiveness of NBPTS Teacher Certification

    Science.gov (United States)

    Yeh, Stuart S.

    2010-01-01

    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…

  18. Cost-effectiveness of online positive psychology: Randomized controlled trial

    NARCIS (Netherlands)

    Bolier, Linda; Majo, Cristina; Smit, Filip; Westerhof, Gerben Johan; Haverman, Merel; Walburg, J.A.; Riper, Heleen; Bohlmeijer, Ernst Thomas

    2014-01-01

    As yet, no evidence is available about the cost-effectiveness of positive psychological interventions. When offered via the Internet, these interventions may be particularly cost-effective, because they are highly scalable and do not rely on scant resources such as therapists’ time. Alongside a rand

  19. Service contribution and cost-effectiveness of specialist registrars in NHS trusts: a survey and costing analysis.

    Science.gov (United States)

    Dafydd, Derfel Ap; Baskaradas, Aroon; Bobdiwala, Shabnam; Anwar, Muhammad Saleem; Abrahams, Rachel; Jeremy, Levy

    2016-06-01

    Since the introduction of the European Working Time Directive, specialist registrars arguably contribute less to clinical service. The purpose of this study was to broadly quantify the service contribution of specialist registrars across a range of specialties and their value to an NHS organisation. A questionnaire-based survey of the clinical activities of specialist registrars in a large NHS trust was undertaken. Simple costing analyses of this -clinical activity were performed. Responses from 66 specialist registrars in 24 specialties showed an average of 51% overall clinical autonomy. Trainees attended an average of 2.7 outpatient clinics per week and spent 3.5 sessions a week doing ward work. Medical trainees took more referrals and attended more clinics. An analysis of costings suggested that surgical trainees might have generated around £700,000 income per year for the trust. Overall, specialist registrars make a substantial contribution to NHS clinical service and are cost-effective.

  20. Development of cost effective nutrient management strategies for a watershed with the DSS FyrisCOST

    Science.gov (United States)

    Collentine, D.; Johnsson, H.; Larsson, P.; Markensten, H.; Widén Nilsson, E.

    2012-12-01

    This paper describes an application of the FyrisCOST model to calculate the cost efficiency of alternative scenarios for nitrogen management in a small agricultural catchment in Southern Sweden. The scenarios include the spatial distribution by sub-catchment of a set of nitrogen abatement measures that have been identified as eligible for financial support under the Swedish Rural Development Program (wetlands, catch crops, spring plowing and a combination of these) with alternative crop distributions. The model FyrisCOST is a catchment scale DSS that has been developed for the evaluation of alternative nutrient mitigation strategies. This model is able to evaluate a range of mitigation approaches for phosphorous and nitrogen from several sources (point and diffuse). This allows cost efficiency to be estimated for a catchment based on a combination of measures. The model is currently being used to develop a data base for the Swedish Water Authorities on the cost efficiency of buffer zones for all small catchments in Sweden. Hydrological flows in the FyrisCOST model are built on the dynamic model FyrisNP and nutrient losses are derived from simulations from the Nutrient Leaching Coefficient Calculation System (NLeCCS) which includes the ICECREAMDB model for estimating phosphorus losses and the SOILNDB model for soil nitrogen leaching. FyrisCOST calculates nitrogen concentrations in effluent water for each sub-catchment. The concentration of nitrogen is dependent on the current land use and geographical conditions. In order to evaluate agricultural scenarios in FyrisCOST a method for calculating N leaching from agricultural land was constructed. The calculation includes crop rotations and tillage systems and differentiates between annual and perennial crops. The model is able to take into account the probability that a primary crop is followed by a specific crop/tillage system and the effect on nutrient losses estimated using a specially developed leaching

  1. Decentralized robust guaranteed cost control for a class of interconnected singular large-scale systems with time-delay and parameter uncertainty

    Institute of Scientific and Technical Information of China (English)

    Wo Songlin; Shi Guodong; Zou Yun

    2007-01-01

    The decentralized robust guaranteed cost control problem is studied for a class ofinterconnected singular large-scale systems with time-delay and norm-bounded time-invariant parameter uncertainty under a given quadratic cost performance function. The problem that is addressed in this study is to design a decentralized robust guaranteed cost state feedback controller such that the closed-loop system is not only regular, impulse-free and stable, but also guarantees an adequate level of performance for all admissible uncertainties. A sufficient condition for the existence of the decentralized robust guaranteed cost state feedback controllers is proposed in terms of a linear matrix inequality (LMI) via LMI approach. When this condition is feasible, the desired state feedback decentralized robust guaranteed cost controller gain matrices can be obtained. Finally, an illustrative example is provided to demonstrate the effectiveness of the proposed approach.

  2. The costs, effects and cost-effectiveness of counteracting overweight on a population level. A scientific base for policy targets for the Dutch national plan for action.

    NARCIS (Netherlands)

    Bemelmans, W.; Baal, van P.; Wendel-Vos, G.C.W.; Schuit, J.; Feskens, E.J.M.; Ament, A.; Hoogenveen, R.

    2008-01-01

    Objectives. To gain insight in realistic policy targets for overweight at a population level and the accompanying costs. Therefore, the effect on overweight prevalence was estimated of large scale implementation of a community intervention (applied to 90% of general population) and an intensive life

  3. Cost-effectiveness evaluation of an RCT in rehabilitation after lumbar spinal fusion: a low-cost, behavioural approach is cost-effective over individual exercise therapy

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Laurberg, Ida; Christensen, Finn B

    2008-01-01

    (indicated by chronic low back pain and localized pathology) were randomized 3 months after their spinal fusion. Validated pain- and disability index scales were applied at baseline and at 2 years postoperative. Costs were measured in a full-scale societal perspective. The probability of the behavioural...... approach being cost-effective was close to 1 given pain as the prioritized effect measure, and 0.8 to 0.6 (dependent on willingness to pay per effect unit) given disability as the prioritized effect measure. The probability of the exercise therapy approach being cost-effective was modest due to inferior...... cost-effective, whereas the cost-effectiveness of increasing frequency and guidance of a traditional physiotherapeutic regimen was unlikely in present trial setting. Udgivelsesdato: 2008-Feb...

  4. A prospective study of direct medical costs in a large cohort of consecutively enrolled patients with refractory epilepsy in Italy.

    Science.gov (United States)

    Luoni, Chiara; Canevini, Maria Paola; Capovilla, Giuseppe; De Sarro, Giovambattista; Galimberti, Carlo Andrea; Gatti, Giuliana; Guerrini, Renzo; La Neve, Angela; Mazzucchelli, Iolanda; Rosati, Eleonora; Specchio, Luigi Maria; Striano, Salvatore; Tinuper, Paolo; Perucca, Emilio

    2015-07-01

    To evaluate direct medical costs and their predictors in patients with refractory epilepsy enrolled into the SOPHIE study (Study of Outcomes of PHarmacoresistance In Epilepsy) in Italy. Adults and children with refractory epilepsy were enrolled consecutively at 11 tertiary referral centers and followed for 18 months. At entry, all subjects underwent a structured interview and a medical examination, and were asked to keep records of diagnostic examinations, laboratory tests, specialist consultations, treatments, hospital admissions, and day-hospital days during follow-up. Study visits included assessments every 6 months of seizure frequency, health-related quality of life (Quality of Life in Epilepsy Inventory 31), medication-related adverse events (Adverse Event Profile) and mood state (Beck Depression Inventory-II). Cost items were priced by applying Italian tariffs. Cost estimates were adjusted to 2013 values. Of 1,124 enrolled individuals, 1,040 completed follow-up. Average annual cost per patient was € 4,677. The highest cost was for antiepileptic drug (AED) treatment (50%), followed by hospital admissions (29% of overall costs). AED polytherapy, seizure frequency during follow-up, grade III pharmacoresistance, medical and psychiatric comorbidities, and occurrence of status epilepticus during follow-up were identified as significant predictors of higher costs. Age between 6 and 11 years, and genetic (idiopathic) generalized epilepsies were associated with the lowest costs. Costs showed prominent variation across centers, largely due to differences in the clinical characteristics of cohorts enrolled at each center and the prescribing of second-generation AEDs. Individual outliers associated with high costs related to hospital admissions had a major influence on costs in many centers. Refractory epilepsy is associated with high costs that affect individuals and society. Costs differ across centers in relation to the characteristics of patients and the extent of

  5. Effect of seed priming on agronomic performance and cost ...

    African Journals Online (AJOL)

    Effect of seed priming on agronomic performance and cost effectiveness of rainfed, dry-seeded nerica rice. ... Open Access DOWNLOAD FULL TEXT ... vitamin (Ascorbate) priming, hardening, osmohardening, and a non-primed control.

  6. Tiotropium's cost-effectiveness for the treatment of COPD: a cost-utility analysis under real-world conditions

    Directory of Open Access Journals (Sweden)

    Thiry Nancy

    2010-09-01

    Full Text Available Abstract Background Tiotropium is reimbursed since March 2004 in Belgium for the treatment of Chronic Obstructive Pulmonary Disease (COPD. Questions however remain on this product's value for money. The purpose of this study is to calculate tiotropium's cost-effectiveness under real-world conditions. Methods Strengths of both observational and RCT data were combined in a model. A large longitudinal (2002-2006 observational dataset of regular tiotropium users (56 321 patients was analysed to retrieve the baseline risk for exacerbations and exacerbation-related hospitalisations the year before the first delivery of tiotropium. The relative treatment effect from the UPLIFT (Understanding Potential Long-term Impacts on Function with Tiotropium trial was then applied to this baseline risk to reflect the effect of tiotropium treatment and calculate the intervention's incremental cost-effectiveness ratio (ICER. Results After 1000 Latin Hypercube simulations, the incremental benefit expressed as quality-adjusted life years (QALY gained is on average 0.00048 (95% confidence interval (CI 0.00009 - 0.00092. In combination with a substantial mean incremental cost of €373 per patient (95% CI 279 - 475, this results in an unfavourable average ICER of €1 244 023 (95% CI 328 571 - 4 712 704 per QALY gained. Results were most sensitive to the treatment effect on hospitalisations. Based on our large observational database, up to 89% of the patients were not hospitalised for COPD in the year before the first tiotropium delivery. Conclusions The main cause for tiotropium's unfavourable cost-effectiveness ratio is a combination of a relative high price for tiotropium, a low number of hospitalisations without tiotropium treatment (on average 0.14/year and a non-significant treatment effect (on average 0.94 with respect to avoiding exacerbation-related hospitalisations. From an economic point of view, a revision of reimbursement modalities (e.g. with a lower price

  7. Analysis of the cost-effectiveness and costs rationalization of antidepressants consumption in Lithuania

    OpenAIRE

    2013-01-01

    In recent years, there has been much debate regarding the rationality of consumption and cost effectiveness of antidepressants. The economic aspects of treating depression are becoming more frequently evaluated as newer antidepressants become available and as healthcare entities attempt to address increasing costs. The aim of the research. To investigate and assess the possibilities of a more rational use of the public and private funds of the Lithuanian population in the cases of medicam...

  8. Cost effectiveness and cost utility of the noncoding blood glucose meter CONTOUR® TS

    Directory of Open Access Journals (Sweden)

    Przemyslaw Holko

    2011-02-01

    Full Text Available Przemyslaw Holko, Pawal KawalecHTA Centre, Kraków, PolandAims: This study assessed the cost efficacy and cost utility of the automatic blood glucose meter CONTOUR® TS from the public payer (National Health Fund [NHF] and payer (patient and NHF perspectives over a 26-year analysis horizon.Methods: Clinical effectiveness data were obtained from prior clinical studies of automatic versus manually coded blood glucose meters. Cost data were obtained from the NHF. The probability of procedure use related to diabetic complications was obtained from four medical centers in Poland. The incremental cost-effectiveness ratio related to 1 life year gained and the incremental cost-utility ratio related to 1 quality-adjusted life year gained were calculated.Results: Assuming co-funding from public funds, introduction of the CONTOUR® TS is associated with savings of Polish złoty (PLN 31,846.19 (€8916.93 and PLN 113,018.19 (€31,645.09 per life year gained from the payer and public payer perspectives, respectively. Cost utility analyses showed that the CONTOUR® TS is associated with savings of PLN 40,465.59 (€11,330.37 and PLN 11,434.82 (€3201.75 per quality-adjusted life year gained from the payer and the public payer perspectives, respectively.Conclusion: The CONTOUR® TS appears superior to manually coded meters available in Poland both from the payer and the public payer perspectives and may represent an improved strategy for glycemic control.Keywords: blood glucose self monitoring, costs and cost analysis, health care costs, diabetes mellitus, diabetes complications 

  9. Reliable and cost effective micro hydro power

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1998-03-01

    A 14 kW hydroelectric power plant in British Columbia that generates enough power to run a small farm was described. It was developed as an alternative to bringing in power from BC Hydro, which would have cost about the same initially, but would also have entailed about $300 per month of utility bills. The system operates at a fraction of its capacity at practically no operating cost and the capital outlay will have been recovered in six to seven years. The system uses a Lima generator directly coupled to a pelton turbine. Some 1,400 feet of five inch PCV pipe running down a hillside provides 136 psi of static pressure. The pressurized water in the pipeline squirts through a nozzle and the jet of water strikes the buckets of the pelton turbine. The energy in the water is transferred to the turbine and provides the shaft power to drive the generator. Two electrically heated dwellings, a workshop and a barn containing 300 pigs are supplied by the power plant.

  10. A Web-Based Physical Activity Intervention for Spanish-Speaking Latinas: A Costs and Cost-Effectiveness Analysis.

    Science.gov (United States)

    Larsen, Britta; Marcus, Bess; Pekmezi, Dori; Hartman, Sheri; Gilmer, Todd

    2017-02-22

    Latinas report particularly low levels of physical activity and suffer from greater rates of lifestyle-related conditions such as obesity and diabetes. Interventions are needed that can increase physical activity in this growing population in a large-scale, cost-effective manner. Web-based interventions may have potential given the increase in Internet use among Latinas and the scalability of Web-based programs. To examine the costs and cost-effectiveness of a Web-based, Spanish-language physical activity intervention for Latinas compared to a wellness contact control. Healthy adult Latina women (N=205) were recruited from the community and randomly assigned to receive a Spanish-language, Web-based, individually tailored physical activity intervention (intervention group) or were given access to a website with content on wellness topics other than physical activity (control group). Physical activity was measured using the 7-Day Physical Activity Recall interview and ActiGraph accelerometers at baseline, 6 months (ie, postintervention), and 12 months (ie, maintenance phase). Costs were estimated from a payer perspective and included all features necessary to implement the intervention in a community setting, including staff time (ie, wages, benefits, and overhead), materials, hardware, website hosting, and routine website maintenance. At 6 months, the costs of running the intervention and control groups were US $17 and US $8 per person per month, respectively. These costs fell to US $12 and US $6 per person per month at 12 months, respectively. Linear interpolation showed that intervention participants increased their physical activity by 1362 total minutes at 6 months (523 minutes by accelerometer) compared to 715 minutes for control participants (186 minutes by accelerometer). At 6 months, each minute increase in physical activity for the intervention group cost US $0.08 (US $0.20 by accelerometer) compared to US $0.07 for control participants (US $0.26 by

  11. A Web-Based Physical Activity Intervention for Spanish-Speaking Latinas: A Costs and Cost-Effectiveness Analysis

    Science.gov (United States)

    Marcus, Bess; Pekmezi, Dori; Hartman, Sheri; Gilmer, Todd

    2017-01-01

    Background Latinas report particularly low levels of physical activity and suffer from greater rates of lifestyle-related conditions such as obesity and diabetes. Interventions are needed that can increase physical activity in this growing population in a large-scale, cost-effective manner. Web-based interventions may have potential given the increase in Internet use among Latinas and the scalability of Web-based programs. Objective To examine the costs and cost-effectiveness of a Web-based, Spanish-language physical activity intervention for Latinas compared to a wellness contact control. Methods Healthy adult Latina women (N=205) were recruited from the community and randomly assigned to receive a Spanish-language, Web-based, individually tailored physical activity intervention (intervention group) or were given access to a website with content on wellness topics other than physical activity (control group). Physical activity was measured using the 7-Day Physical Activity Recall interview and ActiGraph accelerometers at baseline, 6 months (ie, postintervention), and 12 months (ie, maintenance phase). Costs were estimated from a payer perspective and included all features necessary to implement the intervention in a community setting, including staff time (ie, wages, benefits, and overhead), materials, hardware, website hosting, and routine website maintenance. Results At 6 months, the costs of running the intervention and control groups were US $17 and US $8 per person per month, respectively. These costs fell to US $12 and US $6 per person per month at 12 months, respectively. Linear interpolation showed that intervention participants increased their physical activity by 1362 total minutes at 6 months (523 minutes by accelerometer) compared to 715 minutes for control participants (186 minutes by accelerometer). At 6 months, each minute increase in physical activity for the intervention group cost US $0.08 (US $0.20 by accelerometer) compared to US $0.07 for

  12. Cost-effectiveness of asthma therapy: a comprehensive review.

    Science.gov (United States)

    Domínguez-Ortega, Javier; Phillips-Anglés, Elsa; Barranco, Pilar; Quirce, Santiago

    2015-01-01

    Asthma has an important impact in terms of both direct and indirect costs. In Europe, the disease costs € 19 000 million a year. Moreover, the cost is greater among patients with severe uncontrolled asthma and is even higher when the work productivity is also taken into account. Improved control of the disease results in cost savings. In this context, cost-effectiveness and cost-utility studies offer important information for clinicians in deciding the best treatment options for asthmatic patients and contribute to ensure an efficient use of the available healthcare resources. An English and Spanish literature search using electronic search engines (PubMed and EMBASE) was conducted in peer-review journals, from 2009 to June 2014. In order to perform the search for the most suitable and representative articles, key words were selected ("asthma", "cost-effectiveness", "cost-utility", "QALY", "cost-benefit", "economic impact of asthma" "healthcare cost", "asthma treatment" and "work productivity with asthma"). Two-hundred forty-three titles and abstracts were identified by the primary literature search. The full text of the potentially 76 eligible papers was reviewed, and 22 articles were qualified to be finally included. This article provides a comprehensive review on the evidence of cost-effectiveness of asthma treatments derived from the published literature and offers an overall summary of the socioeconomic burden of asthma and its relationship with the degree of disease control. Management alternatives, such as the use of combination therapy with ICS/LABA or omalizumab, when administered according to their current therapeutic indications, have been shown to be cost-effective.

  13. Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia

    Directory of Open Access Journals (Sweden)

    Vos Theo

    2011-05-01

    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

  14. The Effects of Collaboration on Logistical Performance and Transaction Costs

    Directory of Open Access Journals (Sweden)

    Vieira, J.G.V.

    2015-05-01

    Full Text Available This paper assesses the effect of supplier-retailer collaboration on logistical performance and transaction costs from the viewpoint of retail sector suppliers. The methodology consists of an empirical study conducted over nine months in the logistics department of a large Brazilian supermarket retailer and a survey of 125 representatives of 90 manufacturers. The results show collaboration contributes to an improvement in logistical performance related to urgent deliveries and deliveries that occur during periods of high demand. Interpersonal collaboration and joint actions contribute to the reduction of uncertainties among the participants. These joint actions, together with strategic collaboration, contribute to an increase in investment in specific assets, such as dedicated production lines or specialised vehicle fleets to serve partners. The study provides an analysis of logistical performance and transaction cost elements not previously investigated, including urgent deliveries and deliveries during periods of high demand, contract negotiation and renegotiation, waiting time for agreements to be reached, contingency logistics planning, and various cultural, psychosocial and geographical aspects of the supplier-retailer relationship. Managerial implications, research limitation and future research are also discussed.

  15. Effective Calibration of Low-Cost Soil Water Content Sensors

    Directory of Open Access Journals (Sweden)

    Heye Reemt Bogena

    2017-01-01

    Full Text Available Soil water content is a key variable for understanding and modelling ecohydrological processes. Low-cost electromagnetic sensors are increasingly being used to characterize the spatio-temporal dynamics of soil water content, despite the reduced accuracy of such sensors as compared to reference electromagnetic soil water content sensing methods such as time domain reflectometry. Here, we present an effective calibration method to improve the measurement accuracy of low-cost soil water content sensors taking the recently developed SMT100 sensor (Truebner GmbH, Neustadt, Germany as an example. We calibrated the sensor output of more than 700 SMT100 sensors to permittivity using a standard procedure based on five reference media with a known apparent dielectric permittivity (1 < Ka < 34.8. Our results showed that a sensor-specific calibration improved the accuracy of the calibration compared to single “universal” calibration. The associated additional effort in calibrating each sensor individually is relaxed by a dedicated calibration setup that enables the calibration of large numbers of sensors in limited time while minimizing errors in the calibration process.

  16. The cost-effectiveness of heat pumps in specific buildings in South Africa

    Energy Technology Data Exchange (ETDEWEB)

    Greyvenstein, G.P.; Meyer, J.P. (Potchefstroom Univ. for CHE (South Africa). Dept. of Mechanical Engineering)

    1993-09-01

    Water heating heat pumps are extremely energy efficient and large savings can be realized when they are compared to direct electrical resistance heaters. In spite of the energy efficiency of heat pumps, a large number of residential buildings in South Africa still use electrical heaters to heat water. The reason for this is that heat pumps are considerably more expensive than electrical heaters. Building owners tend to choose the system with the smallest initial cost and do not compare the two systems on the basis of life-cycle cost. It is also difficult to calculate the life-cycle cost of a heat pump because it depends on many factors like climatological conditions and water temperature. In this paper a methodology is developed to calculate the life-cycle cost of a heat pump hot water installation. The model is used to investigate the effect of daily runtime, electricity tariff, hot water consumption and geographical location on the cost-effectiveness of heat pumps. The cost-effectiveness of heat pumps increases with daily run time, water consumption and electricity tariff. Heat pumps are more cost-effective near the coast than in the interior. If sized correctly, heat pumps are more cost-effective than electrical heaters for all major cities in South Africa. The cost-effectiveness of heat pumps for two specific buildings, one a university student hostel in Potchefstroom and the other a hotel in Durban, is also investigated. For both cases it was found that heat pumps are more cost-effective than direct electrical resistance heaters. (author)

  17. Economics of infection control surveillance technology: cost-effective or just cost?

    Science.gov (United States)

    Furuno, Jon P; Schweizer, Marin L; McGregor, Jessina C; Perencevich, Eli N

    2008-04-01

    Previous studies have suggested that informatics tools, such as automated alert and decision support systems, may increase the efficiency and quality of infection control surveillance. However, little is known about the cost-effectiveness of these tools. We focus on 2 types of economic analyses that have utility in assessing infection control interventions (cost-effectiveness analysis and business-case analysis) and review the available literature on the economics of computerized infection control surveillance systems. Previous studies on the effectiveness of computerized infection control surveillance have been limited to assessments of whether these tools increase the sensitivity and specificity of surveillance over traditional methods. Furthermore, we identified only 2 studies that assessed the costs associated with computerized infection control surveillance. Thus, it remains unknown whether computerized infection control surveillance systems are cost-effective and whether use of these systems improves patient outcomes. The existing data are insufficient to allow for a summary conclusion on the cost-effectiveness of infection control surveillance technology. All future studies of computerized infection control surveillance systems should aim to collect outcomes and economic data to inform decision making and assist hospitals with completing business-cases analyses.

  18. Accidents at Work and Costs Analysis: A Field Study in a Large Italian Company

    National Research Council Canada - National Science Library

    BATTAGLIA, Massimo; FREY, Marco; PASSETTI, Emilio

    2014-01-01

    ... to individuals and society as a whole. However, companies often are not interested to measure the costs of accidents even if cost information may facilitate preventive occupational health and safety management initiatives...

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

    Science.gov (United States)

    Jayaratne, K. S. U.

    2015-01-01

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

  20. Cost-effectiveness of early treatment for retinopathy of prematurity.

    Science.gov (United States)

    Kamholz, Karen L; Cole, Cynthia H; Gray, James E; Zupancic, John A F

    2009-01-01

    The Early Treatment for Retinopathy of Prematurity trial demonstrated that peripheral retinal ablation of eyes with high-risk prethreshold retinopathy of prematurity (early treatment) is associated with improved visual outcomes at 9 months' corrected gestational age compared with treatment at threshold disease (conventional management). However, early treatment increased the frequency of laser therapy, anesthesia with intubation, treatment-related systemic complications, and the need for repeat treatments. To determine the cost-effectiveness of an early treatment strategy for retinopathy of prematurity compared with conventional management. We developed a stochastic decision analytic model to assess the incremental cost of early treatment per eye with severe visual impairment prevented. We derived resource-use and efficacy estimates from the Early Treatment for Retinopathy of Prematurity trial's published outcome data. We used a third-party payer perspective. Our primary analysis focused on outcomes from birth through 9 months' corrected gestational age. A secondary analysis used a lifetime horizon. Parameter uncertainty was quantified by using probabilistic and deterministic sensitivity analyses. The incremental cost-effectiveness of early treatment was $14,200 per eye with severe visual impairment prevented. There was a 90% probability that the cost-effectiveness of early treatment would be less than $40,000 per eye with severe visual impairment prevented and a 0.5% probability that early treatment would be cost-saving (less costly and more effective). Limiting early treatment to more severely affected eyes (eyes with "type 1 retinopathy of prematurity" as defined by the Early Treatment for Retinopathy of Prematurity trial) had a cost-effectiveness of $6,200 per eye with severe visual impairment prevented. Analyses that considered long-term costs and outcomes found that early treatment was cost-saving. Early treatment of retinopathy of prematurity is both

  1. Clinical benefits, costs, and cost-effectiveness of neonatal intensive care in Mexico.

    Directory of Open Access Journals (Sweden)

    Jochen Profit

    Full Text Available BACKGROUND: 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. METHODS AND FINDINGS: 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

  2. Clinical Benefits, Costs, and Cost-Effectiveness of Neonatal Intensive Care in Mexico

    Science.gov (United States)

    Profit, Jochen; Lee, Diana; Zupancic, John A.; Papile, LuAnn; Gutierrez, Cristina; Goldie, Sue J.; Gonzalez-Pier, Eduardo; Salomon, Joshua A.

    2010-01-01

    Background 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. Methods and Findings 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

  3. Cost-effectiveness of telemonitoring of diabetic foot ulcer patients.

    Science.gov (United States)

    Fasterholdt, Iben; Gerstrøm, Marie; Rasmussen, Benjamin Schnack Brandt; Yderstræde, Knud Bonnet; Kidholm, Kristian; Pedersen, Kjeld Møller

    2016-09-16

    This study compared the cost-effectiveness of telemonitoring with standard monitoring for patients with diabetic foot ulcers. The economic evaluation was nested within a pragmatic randomised controlled trial. A total of 374 patients were randomised to either telemonitoring or standard monitoring. Telemonitoring consisted of two tele-consultations in the patient's own home and one consultation at the outpatient clinic; standard monitoring consisted of three outpatient clinic consultations. Total healthcare costs were estimated over a 6-month period at individual patient level, from a healthcare sector perspective. The bootstrap method was used to calculate the incremental cost-effectiveness ratio, and one-way sensitivity analyses were performed. Telemonitoring costs were found to be €2039 less per patient compared to standard monitoring; however, this difference was not statistically significant. Amputation rate was similar in the two groups. In conclusion, a telemonitoring service in this form had similar costs and effects as standard monitoring. © The Author(s) 2016.

  4. Cost-benefit and cost-effectiveness analysis of drug therapy.

    Science.gov (United States)

    Dao, T D

    1985-04-01

    A model for cost-benefit analysis and cost-effectiveness analysis (CBA-CEA) of pharmaceutical intervention is presented, and CBA-CEA research methods reported in the literature are reviewed. The cost versus benefit and the cost effectiveness of drug therapy can be analyzed in societal as well as private terms. Since CBA measures costs and outcomes in monetary terms, it can be used to compare net benefits of all types of interventions. CEA, however, can be used only in comparing alternative interventions that can produce a similar health outcome. Research activities needed for identification of treatment protocols, alternative therapies and their respective outcomes, and resource use are described. Quantification of benefits and costs is discussed and inherent strengths and weaknesses of CBA-CEA are summarized. For the wide variety of research activities involved in CBA-CEA, the expertise of economists, physicians, clinical pharmacists and pharmacologists, epidemiologists, sociologists, and psychologists is needed. Inherent in CBA-CEA for drug therapy are judgments, either by analysts or by policy decision makers, about how to value life, pain, anxiety, and happiness and how to distribute health-care resources. When results of CBA-CEA are presented and interpreted with care, this analysis can be an important tool for policy decision makers.

  5. Cost-effective conservation of an endangered frog under uncertainty.

    Science.gov (United States)

    Rose, Lucy E; Heard, Geoffrey W; Chee, Yung En; Wintle, Brendan A

    2016-04-01

    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

  6. Cost-effectiveness of hepatitis B vaccination of prison inmates.

    Science.gov (United States)

    Pisu, Maria; Meltzer, Martin Isaac; Lyerla, Rob

    2002-12-13

    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 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.

  7. Operating Dedicated Data Centers - Is It Cost-Effective?

    Science.gov (United States)

    Ernst, M.; Hogue, R.; Hollowell, C.; Strecker-Kellog, W.; Wong, A.; Zaytsev, A.

    2014-06-01

    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.

  8. Cost-Effectiveness Analysis of Family Planning Services Offered by ...

    African Journals Online (AJOL)

    USER

    Keywords: Mobile clinics; Staic clinic; Family planning; Cost-effectiveness. Résumé ... revealed surprisingly low use of mobile clinic services ... provider point of view. Cost data ..... this is an even more attractive strategy than tying free IUDs to ...

  9. Cost-Effectiveness of Training in Developing Countries.

    Science.gov (United States)

    Bas, Daniel

    1988-01-01

    The author defines the output and effectiveness of training and its monetary and psychological costs and discusses the cost-benefit implications of institution-based training, enterprise-based training, apprenticeships, self-instruction, and new educational technologies. He argues that an examination of these implications is indispensible for…

  10. Flipping the Calculus Classroom: A Cost-Effective Approach

    Science.gov (United States)

    Young, Andrea

    2015-01-01

    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.

  11. Flipping the Calculus Classroom: A Cost-Effective Approach

    Science.gov (United States)

    Young, Andrea

    2015-01-01

    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.

  12. Systemic cost-effectiveness analysis of food hazard reduction

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Lawson, Lartey Godwin; Lund, Mogens

    2015-01-01

    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...

  13. Cost-effectiveness of colorectal cancer screening - An overview

    NARCIS (Netherlands)

    I. Lansdorp-Vogelaar (Iris); A.B. Knudsen (Amy); H. Brenner (Hermann)

    2010-01-01

    textabstractThere are several modalities available for a colorectal cancer (CRC) screening program. When determining which CRC screening program to implement, the costs of such programs should be considered in comparison to the health benefits they are expected to provide. Cost-effectiveness analysi

  14. Cost-effectiveness of a ROPS retrofit education campaign.

    Science.gov (United States)

    Myers, M L; Cole, H P; Westneat, S C

    2004-05-01

    A community educational campaign implemented in two Kentucky counties was effective in influencing farmers to retrofit their tractors with rollover protective structures (ROPS) to protect tractor operators from injury in the event of an overturn. This article reports on the cost-effectiveness of this program in the two counties when compared to no program in a control county. A decision analysis indicated that it would be effective at averting 0.27 fatal and 1.53 nonfatal injuries over a 20-year period, and when this analysis was extended statewide, 7.0 fatal and 40 nonfatal injuries would be averted in Kentucky. Over the 20-year period, the cost-per-injury averted was calculated to be $172,657 at a 4% annual discount rate. This cost compared favorably with a national cost of $489,373 per injury averted despite the additional program cost in Kentucky. The principle reason for the increased cost-effectiveness of the Kentucky program was the three-fold higher propensity for tractors to overturn in Kentucky. The cost-per-injury averted in one of the two counties was $112,535. This lower cost was attributed principally to incentive awards financed locally for farmers to retrofit their tractors with ROPS.

  15. Cost Effectiveness of Infant Vaccination for Rotavirus in Canada

    Directory of Open Access Journals (Sweden)

    Doug Coyle

    2012-01-01

    Full Text Available INTRODUCTION: Rotavirus is the main cause of gastroenteritis in Canadian children younger than five years of age, resulting in significant morbidity and cost. The present study provides evidence on the cost effectiveness of two alternative rotavirus vaccinations (RotaTeq [Merck Frosst Canada Ltd, Canada] and Rotarix [GlaxoSmithKline, Canada] available in Canada.

  16. SEM-PLS analysis of inhibiting factors of cost performance for large construction projects in Malaysia: perspective of clients and consultants.

    Science.gov (United States)

    Memon, Aftab Hameed; Rahman, Ismail Abdul

    2014-01-01

    This study uncovered inhibiting factors to cost performance in large construction projects of Malaysia. Questionnaire survey was conducted among clients and consultants involved in large construction projects. In the questionnaire, a total of 35 inhibiting factors grouped in 7 categories were presented to the respondents for rating significant level of each factor. A total of 300 questionnaire forms were distributed. Only 144 completed sets were received and analysed using advanced multivariate statistical software of Structural Equation Modelling (SmartPLS v2). The analysis involved three iteration processes where several of the factors were deleted in order to make the model acceptable. The result of the analysis found that R(2) value of the model is 0.422 which indicates that the developed model has a substantial impact on cost performance. Based on the final form of the model, contractor's site management category is the most prominent in exhibiting effect on cost performance of large construction projects. This finding is validated using advanced techniques of power analysis. This vigorous multivariate analysis has explicitly found the significant category which consists of several causative factors to poor cost performance in large construction projects. This will benefit all parties involved in construction projects for controlling cost overrun.

  17. SEM-PLS Analysis of Inhibiting Factors of Cost Performance for Large Construction Projects in Malaysia: Perspective of Clients and Consultants

    Directory of Open Access Journals (Sweden)

    Aftab Hameed Memon

    2014-01-01

    Full Text Available This study uncovered inhibiting factors to cost performance in large construction projects of Malaysia. Questionnaire survey was conducted among clients and consultants involved in large construction projects. In the questionnaire, a total of 35 inhibiting factors grouped in 7 categories were presented to the respondents for rating significant level of each factor. A total of 300 questionnaire forms were distributed. Only 144 completed sets were received and analysed using advanced multivariate statistical software of Structural Equation Modelling (SmartPLS v2. The analysis involved three iteration processes where several of the factors were deleted in order to make the model acceptable. The result of the analysis found that R2 value of the model is 0.422 which indicates that the developed model has a substantial impact on cost performance. Based on the final form of the model, contractor’s site management category is the most prominent in exhibiting effect on cost performance of large construction projects. This finding is validated using advanced techniques of power analysis. This vigorous multivariate analysis has explicitly found the significant category which consists of several causative factors to poor cost performance in large construction projects. This will benefit all parties involved in construction projects for controlling cost overrun.

  18. Influence of wiring cost on the large-scale architecture of human cortical connectivity.

    Science.gov (United States)

    Samu, David; Seth, Anil K; Nowotny, Thomas

    2014-04-01

    In the past two decades some fundamental properties of cortical connectivity have been discovered: small-world structure, pronounced hierarchical and modular organisation, and strong core and rich-club structures. A common assumption when interpreting results of this kind is that the observed structural properties are present to enable the brain's function. However, the brain is also embedded into the limited space of the skull and its wiring has associated developmental and metabolic costs. These basic physical and economic aspects place separate, often conflicting, constraints on the brain's connectivity, which must be characterized in order to understand the true relationship between brain structure and function. To address this challenge, here we ask which, and to what extent, aspects of the structural organisation of the brain are conserved if we preserve specific spatial and topological properties of the brain but otherwise randomise its connectivity. We perform a comparative analysis of a connectivity map of the cortical connectome both on high- and low-resolutions utilising three different types of surrogate networks: spatially unconstrained ('random'), connection length preserving ('spatial'), and connection length optimised ('reduced') surrogates. We find that unconstrained randomisation markedly diminishes all investigated architectural properties of cortical connectivity. By contrast, spatial and reduced surrogates largely preserve most properties and, interestingly, often more so in the reduced surrogates. Specifically, our results suggest that the cortical network is less tightly integrated than its spatial constraints would allow, but more strongly segregated than its spatial constraints would necessitate. We additionally find that hierarchical organisation and rich-club structure of the cortical connectivity are largely preserved in spatial and reduced surrogates and hence may be partially attributable to cortical wiring constraints. In contrast

  19. Influence of wiring cost on the large-scale architecture of human cortical connectivity.

    Directory of Open Access Journals (Sweden)

    David Samu

    2014-04-01

    Full Text Available In the past two decades some fundamental properties of cortical connectivity have been discovered: small-world structure, pronounced hierarchical and modular organisation, and strong core and rich-club structures. A common assumption when interpreting results of this kind is that the observed structural properties are present to enable the brain's function. However, the brain is also embedded into the limited space of the skull and its wiring has associated developmental and metabolic costs. These basic physical and economic aspects place separate, often conflicting, constraints on the brain's connectivity, which must be characterized in order to understand the true relationship between brain structure and function. To address this challenge, here we ask which, and to what extent, aspects of the structural organisation of the brain are conserved if we preserve specific spatial and topological properties of the brain but otherwise randomise its connectivity. We perform a comparative analysis of a connectivity map of the cortical connectome both on high- and low-resolutions utilising three different types of surrogate networks: spatially unconstrained ('random', connection length preserving ('spatial', and connection length optimised ('reduced' surrogates. We find that unconstrained randomisation markedly diminishes all investigated architectural properties of cortical connectivity. By contrast, spatial and reduced surrogates largely preserve most properties and, interestingly, often more so in the reduced surrogates. Specifically, our results suggest that the cortical network is less tightly integrated than its spatial constraints would allow, but more strongly segregated than its spatial constraints would necessitate. We additionally find that hierarchical organisation and rich-club structure of the cortical connectivity are largely preserved in spatial and reduced surrogates and hence may be partially attributable to cortical wiring constraints

  20. Methods for analyzing cost effectiveness data from cluster randomized trials

    Directory of Open Access Journals (Sweden)

    Clark Allan

    2007-09-01

    Full Text Available Abstract Background Measurement of individuals' costs and outcomes in randomized trials allows uncertainty about cost effectiveness to be quantified. Uncertainty is expressed as probabilities that an intervention is cost effective, and confidence intervals of incremental cost effectiveness ratios. Randomizing clusters instead of individuals tends to increase uncertainty but such data are often analysed incorrectly in published studies. Methods We used data from a cluster randomized trial to demonstrate five appropriate analytic methods: 1 joint modeling of costs and effects with two-stage non-parametric bootstrap sampling of clusters then individuals, 2 joint modeling of costs and effects with Bayesian hierarchical models and 3 linear regression of net benefits at different willingness to pay levels using a least squares regression with Huber-White robust adjustment of errors, b a least squares hierarchical model and c a Bayesian hierarchical model. Results All five methods produced similar results, with greater uncertainty than if cluster randomization was not accounted for. Conclusion Cost effectiveness analyses alongside cluster randomized trials need to account for study design. Several theoretically coherent methods can be implemented with common statistical software.

  1. Is the societal approach wide enough to include relatives? Incorporating relatives' costs and effects in a cost-effectiveness analysis.

    Science.gov (United States)

    Davidson, Thomas; Levin, Lars-Ake

    2010-01-01

    It is important for economic evaluations in healthcare to cover all relevant information. However, many existing evaluations fall short of this goal, as they fail to include all the costs and effects for the relatives of a disabled or sick individual. The objective of this study was to analyse how relatives' costs and effects could be measured, valued and incorporated into a cost-effectiveness analysis. In this article, we discuss the theories underlying cost-effectiveness analyses in the healthcare arena; the general conclusion is that it is hard to find theoretical arguments for excluding relatives' costs and effects if a societal perspective is used. We argue that the cost of informal care should be calculated according to the opportunity cost method. To capture relatives' effects, we construct a new term, the R-QALY weight, which is defined as the effect on relatives' QALY weight of being related to a disabled or sick individual. We examine methods for measuring, valuing and incorporating the R-QALY weights. One suggested method is to estimate R-QALYs and incorporate them together with the patient's QALY in the analysis. However, there is no well established method as yet that can create R-QALY weights. One difficulty with measuring R-QALY weights using existing instruments is that these instruments are rarely focused on relative-related aspects. Even if generic quality-of-life instruments do cover some aspects relevant to relatives and caregivers, they may miss important aspects and potential altruistic preferences. A further development and validation of the existing caregiving instruments used for eliciting utility weights would therefore be beneficial for this area, as would further studies on the use of time trade-off or Standard Gamble methods for valuing R-QALY weights. Another potential method is to use the contingent valuation method to find a monetary value for all the relatives' costs and effects. Because cost-effectiveness analyses are used for

  2. The costs and cost-effectiveness of a school-based comprehensive intervention study on childhood obesity in China.

    Directory of Open Access Journals (Sweden)

    Liping Meng

    Full Text Available BACKGROUND: The dramatic rise of overweight and obesity among Chinese children has greatly affected the social economic development. However, no information on the cost-effectiveness of interventions in China is available. The objective of this study is to evaluate the cost and the cost-effectiveness of a comprehensive intervention program for childhood obesity. We hypothesized the integrated intervention which combined nutrition education and physical activity (PA is more cost-effective than the same intensity of single intervention. METHODS: And Findings: A multi-center randomized controlled trial conducted in six large cities during 2009-2010. A total of 8301 primary school students were categorized into five groups and followed one academic year. Nutrition intervention, PA intervention and their shared common control group were located in Beijing. The combined intervention and its' control group were located in other 5 cities. In nutrition education group, 'nutrition and health classes' were given 6 times for the students, 2 times for the parents and 4 times for the teachers and health workers. "Happy 10" was carried out twice per day in PA group. The comprehensive intervention was a combination of nutrition and PA interventions. BMI and BAZ increment was 0.65 kg/m(2 (SE 0.09 and 0.01 (SE 0.11 in the combined intervention, respectively, significantly lower than that in its' control group (0.82 ± 0.09 for BMI, 0.10 ± 0.11 for BAZ. No significant difference were found neither in BMI nor in BAZ change between the PA intervention and its' control, which is the same case in the nutrition intervention. The single intervention has a relative lower intervention costs compared with the combined intervention. Labor costs in Guangzhou, Shanghai and Jinan was higher compared to other cities. The cost-effectiveness ratio was $120.3 for BMI and $249.3 for BAZ in combined intervention, respectively. CONCLUSIONS: The school-based integrated obesity

  3. The costs and cost-effectiveness of a school-based comprehensive intervention study on childhood obesity in China.

    Science.gov (United States)

    Meng, Liping; Xu, Haiquan; Liu, Ailing; van Raaij, Joop; Bemelmans, Wanda; Hu, Xiaoqi; Zhang, Qian; Du, Songming; Fang, Hongyun; Ma, Jun; Xu, Guifa; Li, Ying; Guo, Hongwei; Du, Lin; Ma, Guansheng

    2013-01-01

    The dramatic rise of overweight and obesity among Chinese children has greatly affected the social economic development. However, no information on the cost-effectiveness of interventions in China is available. The objective of this study is to evaluate the cost and the cost-effectiveness of a comprehensive intervention program for childhood obesity. We hypothesized the integrated intervention which combined nutrition education and physical activity (PA) is more cost-effective than the same intensity of single intervention. And Findings: A multi-center randomized controlled trial conducted in six large cities during 2009-2010. A total of 8301 primary school students were categorized into five groups and followed one academic year. Nutrition intervention, PA intervention and their shared common control group were located in Beijing. The combined intervention and its' control group were located in other 5 cities. In nutrition education group, 'nutrition and health classes' were given 6 times for the students, 2 times for the parents and 4 times for the teachers and health workers. "Happy 10" was carried out twice per day in PA group. The comprehensive intervention was a combination of nutrition and PA interventions. BMI and BAZ increment was 0.65 kg/m(2) (SE 0.09) and 0.01 (SE 0.11) in the combined intervention, respectively, significantly lower than that in its' control group (0.82 ± 0.09 for BMI, 0.10 ± 0.11 for BAZ). No significant difference were found neither in BMI nor in BAZ change between the PA intervention and its' control, which is the same case in the nutrition intervention. The single intervention has a relative lower intervention costs compared with the combined intervention. Labor costs in Guangzhou, Shanghai and Jinan was higher compared to other cities. The cost-effectiveness ratio was $120.3 for BMI and $249.3 for BAZ in combined intervention, respectively. The school-based integrated obesity intervention program was cost-effectiveness for

  4. Cost-Effectiveness of a New Nordic Diet as a Strategy for Health Promotion

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Saxe, Henrik; Denver, Sigrid

    2015-01-01

    . This study assesses whether a large-scale introduction of NND is a cost-effective health promotion strategy by combining an economic model for estimating the utility-maximizing composition of NND, a life cycle assessment model to assess environmental effects of the dietary change, and a health impact model...

  5. Cost-effective forensic image enhancement

    Science.gov (United States)

    Dalrymple, Brian E.

    1998-12-01

    In 1977, a paper was presented at the SPIE conference in Reston, Virginia, detailing the computer enhancement of the Zapruder film. The forensic value of this examination in a major homicide investigation was apparent to the viewer. Equally clear was the potential for extracting evidence which is beyond the reach of conventional detection techniques. The cost of this technology in 1976, however, was prohibitive, and well beyond the means of most police agencies. Twenty-two years later, a highly efficient means of image enhancement is easily within the grasp of most police agencies, not only for homicides but for any case application. A PC workstation combined with an enhancement software package allows a forensic investigator to fully exploit digital technology. The goal of this approach is the optimization of the signal to noise ratio in images. Obstructive backgrounds may be diminished or eliminated while weak signals are optimized by the use of algorithms including Fast Fourier Transform, Histogram Equalization and Image Subtraction. An added benefit is the speed with which these processes are completed and the results known. The efficacy of forensic image enhancement is illustrated through case applications.

  6. Cost Effective Machining Of Ceramics (CEMOC)

    Energy Technology Data Exchange (ETDEWEB)

    Barkman, W.E.

    1997-04-18

    The purpose of the CEMOC program was to support U.S. industry needs in fabricating precision components, from difficult to machine materials, while maintaining and enhancing the precision manufacturing skills of the Oak Ridge Complex. Oak Ridge and partner company personnel worked in a team relationship wherein each contributed equally to the success of the program. In general, Oak Ridge contributed a wider range of expertise to a given task while the companies provided operations-specific equipment and shop-floor services. Process control technologies, machining procedures and parameters, and coolant-related environmental tasks were the primary focus areas. The companies were very pleased with the results of the CRADAs and are planning on continuing the relationships. Finish machining operations contribute the majority of the costs associated with fabricating high quality ceramic products. These components are typically used in harsh environments such as diesel engines, defense machinery, and automotive components. The required finishing operations involve a variety of technologies including process controls, machine coolants, product certification, etc. and are not limited only to component grinding methods. The broad range of manufacturing problem solving expertise available in Oak Ridge provided resources that were far beyond what are typically available to the CRADA partners. These partners contributed equipment, such as state-of-the-art machine tools, and operation-specific experience base. In addition, addressing these challenging tasks enabled Oak Ridge personnel to maintain familiarity with rapidly advancing technologies, such as those associated with computer control systems.

  7. Cost Effective Rumor Containment in Social Networks

    CERN Document Server

    Kotnis, Bhushan

    2014-01-01

    The spread of rumors through social media and online social networks can not only disrupt the daily lives of citizens but also result in loss of life and property. A rumor spreads when individuals, who are unable decide the authenticity of the information, mistake the rumor as genuine information and pass it on to their acquaintances. We propose a solution where a set of individuals (based on their degree) in the social network are trained and provided resources to help them distinguish a rumor from genuine information. By formulating an optimization problem we calculate the optimum set of individuals, who must undergo training, and the quality of training that minimizes the expected training cost and ensures an upper bound on the size of the rumor outbreak. Our primary contribution is that although the optimization problem turns out to be non convex, we show that the problem is equivalent to solving a set of linear programs. This result also allows us to solve the problem of minimizing the size of rumor outb...

  8. Cost-effectiveness of HPV vaccination in Belize.

    Science.gov (United States)

    Walwyn, Leslie; Janusz, Cara Bess; Clark, Andrew David; Prieto, Elise; Waight, Eufemia; Largaespada, Natalia

    2015-05-07

    Among women in Belize, cervical cancer is both the leading cancer and the leading cause of cancer deaths. Both the quadrivalent and bivalent human papillomavirus (HPV) vaccines are licensed in Belize. The Ministry of Health of Belize convened a multidisciplinary team to estimate the costs, health benefits, and cost-effectiveness of adding an HPV vaccine to the national immunization schedule. The CERVIVAC cost-effectiveness model (Version 1.123) was used to assess the lifetime health and economic outcomes of vaccinating one cohort of girls aged 10 years against HPV. The comparator was no HPV vaccination. The PAHO Revolving Fund negotiated price of US$ 13.79 per dose was used (for the quadrivalent vaccine) and national data sources were used to define demography, cervical cancer incidence and mortality, cervical cancer treatment costs, and vaccine delivery costs. Estimates from international agencies were used in scenario analysis. In a cohort of ∼4000 Belizean girls tracked over a lifetime, HPV vaccination is estimated to prevent 69 new cases of cervical cancer (undiscounted), and 51 cervical cancer deaths (undiscounted). Considering the potential cervical cancer treatment costs and lost wages avoided by households (societal perspective), the cost per disability-adjusted life year (DALY) averted was estimated to be US$ 429. This increased to US$ 1320 when cervical cancer treatment costs and lost wages were excluded from the analysis. Both estimates are far below the gross domestic product (GDP) per capita of Belize (US$ 4795). The lifetime health care costs saved by the women and their families represent more than 60% of the investment cost needed by the Government for the vaccine. Routine HPV vaccination would be highly cost-effective in Belize. If affordable, efforts should be made to expedite the introduction of this vaccine into the Belizean national immunization program. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. The cost-effectiveness of rotavirus vaccination in Armenia.

    Science.gov (United States)

    Jit, Mark; Yuzbashyan, Ruzanna; Sahakyan, Gayane; Avagyan, Tigran; Mosina, Liudmila

    2011-11-01

    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.

  10. Can aging in place be cost effective? A systematic review.

    Science.gov (United States)

    Graybill, Erin M; McMeekin, Peter; Wildman, John

    2014-01-01

    To systematically review cost, cost-minimization and cost-effectiveness studies for assisted living technologies (ALTs) that specifically enable older people to 'age in place' and highlight what further research is needed to inform decisions regarding aging in place. People aged 65+ and their live-in carers (where applicable), using an ALT to age in place at home opposed to a community-dwelling arrangement. Studies were identified using a predefined search strategy on two key economic and cost evaluation databases NHS EED, HEED. Studies were assessed using methods recommended by the Campbell and Cochrane Economic Methods Group and presented in a narrative synthesis style. Eight eligible studies were identified from North America spread over a diverse geographical range. The majority of studies reported the ALT intervention group as having lower resource use costs than the control group; though the low methodological quality and heterogeneity of the individual costs and outcomes reported across studies must be considered. The studies suggest that in some cases ALTs may reduce costs, though little data were identified and what there were was of poor quality. Methods to capture quality of life gains were not used, therefore potential effects on health and wellbeing may be missed. Further research is required using newer developments such as the capabilities approach. High quality studies assessing the cost-effectiveness of ALTs for ageing in place are required before robust conclusion on their use can be drawn.

  11. Can aging in place be cost effective? A systematic review.

    Directory of Open Access Journals (Sweden)

    Erin M Graybill

    Full Text Available PURPOSE OF THE STUDY: To systematically review cost, cost-minimization and cost-effectiveness studies for assisted living technologies (ALTs that specifically enable older people to 'age in place' and highlight what further research is needed to inform decisions regarding aging in place. DESIGN: People aged 65+ and their live-in carers (where applicable, using an ALT to age in place at home opposed to a community-dwelling arrangement. METHODS: Studies were identified using a predefined search strategy on two key economic and cost evaluation databases NHS EED, HEED. Studies were assessed using methods recommended by the Campbell and Cochrane Economic Methods Group and presented in a narrative synthesis style. RESULTS: Eight eligible studies were identified from North America spread over a diverse geographical range. The majority of studies reported the ALT intervention group as having lower resource use costs than the control group; though the low methodological quality and heterogeneity of the individual costs and outcomes reported across studies must be considered. IMPLICATIONS: The studies suggest that in some cases ALTs may reduce costs, though little data were identified and what there were was of poor quality. Methods to capture quality of life gains were not used, therefore potential effects on health and wellbeing may be missed. Further research is required using newer developments such as the capabilities approach. High quality studies assessing the cost-effectiveness of ALTs for ageing in place are required before robust conclusion on their use can be drawn.

  12. Analyses of Blood Bank Efficiency, Cost-Effectiveness and Quality

    Science.gov (United States)

    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

  13. Power and sample size in cost-effectiveness analysis.

    Science.gov (United States)

    Laska, E M; Meisner, M; Siegel, C

    1999-01-01

    For resource allocation under a constrained budget, optimal decision rules for mutually exclusive programs require that the treatment with the highest incremental cost-effectiveness ratio (ICER) below a willingness-to-pay (WTP) criterion be funded. This is equivalent to determining the treatment with the smallest net health cost. The designer of a cost-effectiveness study needs to select a sample size so that the power to reject the null hypothesis, the equality of the net health costs of two treatments, is high. A recently published formula derived under normal distribution theory overstates sample-size requirements. Using net health costs, the authors present simple methods for power analysis based on conventional normal and on nonparametric statistical theory.

  14. How to Appropriately Extrapolate Costs and Utilities in Cost-Effectiveness Analysis.

    Science.gov (United States)

    Bojke, Laura; Manca, Andrea; Asaria, Miqdad; Mahon, Ronan; Ren, Shijie; Palmer, Stephen

    2017-05-03

    Costs and utilities are key inputs into any cost-effectiveness analysis. Their estimates are typically derived from individual patient-level data collected as part of clinical studies the follow-up duration of which is often too short to allow a robust quantification of the likely costs and benefits a technology will yield over the patient's entire lifetime. In the absence of long-term data, some form of temporal extrapolation-to project short-term evidence over a longer time horizon-is required. Temporal extrapolation inevitably involves assumptions regarding the behaviour of the quantities of interest beyond the time horizon supported by the clinical evidence. Unfortunately, the implications for decisions made on the basis of evidence derived following this practice and the degree of uncertainty surrounding the validity of any assumptions made are often not fully appreciated. The issue is compounded by the absence of methodological guidance concerning the extrapolation of non-time-to-event outcomes such as costs and utilities. This paper considers current approaches to predict long-term costs and utilities, highlights some of the challenges with the existing methods, and provides recommendations for future applications. It finds that, typically, economic evaluation models employ a simplistic approach to temporal extrapolation of costs and utilities. For instance, their parameters (e.g. mean) are typically assumed to be homogeneous with respect to both time and patients' characteristics. Furthermore, costs and utilities have often been modelled to follow the dynamics of the associated time-to-event outcomes. However, cost and utility estimates may be more nuanced, and it is important to ensure extrapolation is carried out appropriately for these parameters.

  15. EFFECTIVE SAVINGS IN PRODUCTION TIMES AND COST

    African Journals Online (AJOL)

    ES OBE

    THROUGH MONITORING OF THE EFFECT OF ADDITIVES AND ... planning, using the in-depth knowledge of gel times, can there be a saving in production times and prevention of material ..... production lines staff handlay-up laminators and ...

  16. Stimulating cost effective behavior in hospitals.

    Science.gov (United States)

    Neuhauser, D

    1987-04-01

    Types of influence on the delivery of medical care are divided into monetary and other. These incentives effect care at the system, hospital, care team, physician and patient levels. Selected examples, primarily from the USA, are discussed.

  17. Cost effectiveness analysis of hemiarthroplasty and total shoulder arthroplasty.

    Science.gov (United States)

    Mather, Richard C; Watters, Tyler S; Orlando, Lori A; Bolognesi, Michael P; Moorman, Claude T

    2010-04-01

    Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are two viable surgical treatment options for glenohumeral osteoarthritis. Recent systematic reviews and randomized trials suggest that TSA, while more costly initially, may have superior outcomes with regard to pain, function and quality of life with lower revision rates. This study compared the cost-effectiveness of TSA with HA. A Markov decision model was constructed for a cost-utility analysis of TSA compared to HA in a cohort of 64-year-old patients. Outcome probabilities and effectiveness were derived from the literature. Costs were estimated from the societal perspective using the national average Medicare reimbursement for the procedures in 2008 US dollars. Effectiveness was expressed in quality-adjusted life years (QALYs) gained. Principal outcome measures were average incremental costs, incremental effectiveness, incremental QALYs, and net health benefits. In the base case, HA resulted in a lower number of average QALYs gained at a higher average cost to society and was, therefore, dominated by the TSA strategy for the treatment of glenohumeral osteoarthritis. The cost effectiveness ratio for TSA and HA were $957/QALY and $1,194/QALY respectively. Sensitivity analysis revealed that if the utility of TSA is equal to, or revision rate lower than HA, TSA continues to be a dominant strategy. Total shoulder arthroplasty with a cemented glenoid is a cost-effective procedure, resulting in greater utility for the patient at a lower overall cost to the payer. These findings suggest that TSA is the preferred treatment for certain populations from both a patient and payer perspective. 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  18. Cost-effectiveness of treatments reducing coronary heart disease mortality in Ireland, 2000 to 2010.

    LENUS (Irish Health Repository)

    Bennett, Kathleen

    2009-01-01

    OBJECTIVE: Coronary heart disease (CHD) is associated with a large burden of disease in Ireland and is responsible for more than 6000 deaths annually. This study examined the cost-effectiveness of specific CHD treatments in Ireland. METHODS: Irish epidemiological data on patient numbers and median survival in specific groups, plus the uptake, effectiveness, and costs of specific interventions, all stratified by age and sex, were incorporated into a previously validated CHD mortality model, the IMPACT model. This model calculates the number of life-years gained (LYGs) by specific cardiology interventions to generate incremental cost-effectiveness ratios (ICERs) per LYG for each intervention. RESULTS: In 2000, medical and surgical treatments together prevented or postponed approximately 1885 CHD deaths in patients aged 25 to 84 years, and thus generated approximately 14,505 extra life-years (minimum 7270, maximum 22,475). In general, all the cardiac interventions investigated were highly cost-effective in the Irish setting. Aspirin, beta-blockers, ACE inhibitors, spironolactone, and warfarin for specific conditions were the most cost-effective interventions (< euro 3000\\/LYG), followed by the statins for secondary prevention (< euro 6500\\/LYG). Revascularization for chronic angina and primary angioplasty for myocardial infarction, although still cost-effective, had the highest ICER (between euro 12,000 and euro 20,000\\/LYG). CONCLUSIONS: Using a comprehensive standardized methodology, cost-effectiveness ratios in this study clearly favored simple medical treatments for myocardial infarction, secondary prevention, angina, and heart failure.

  19. Cost-effectiveness of Intensive Blood Pressure Management

    DEFF Research Database (Denmark)

    Richman, Ilana B; Fairley, Michael; Jørgensen, Mads Emil

    2016-01-01

    . Objective: To evaluate the incremental cost-effectiveness of intensive blood pressure management compared with standard management. Design, Setting, and Participants: This cost-effectiveness analysis conducted from September 2015 to August 2016 used a Markov cohort model to estimate cost-effectiveness...... of intensive blood pressure management among 68-year-old high-risk adults with hypertension but not diabetes. We used the Systolic Blood Pressure Intervention Trial (SPRINT) to estimate treatment effects and adverse event rates. We used Centers for Disease Control and Prevention Life Tables to project age....... Interventions: Treatment of hypertension to a systolic blood pressure goal of 120 mm Hg (intensive management) or 140 mm Hg (standard management). Main Outcomes and Measures: Lifetime costs and quality-adjusted life-years (QALYs), discounted at 3% annually. Results: Standard management yielded 9.6 QALYs...

  20. The clinical utility and cost effectiveness of routine thyroid screening ...

    African Journals Online (AJOL)

    depression, cognitive impairment, and psychosis, while ... the utility and cost effectiveness of the current protocol used in thyroid testing in adult psychiatric patients presenting at .... Antidepressants were prescribed to 302 (28%) of patients,.

  1. Cost-effectiveness analysis of Mectizan treatment Programmes for ...

    African Journals Online (AJOL)

    Cost-effectiveness analysis of Mectizan treatment Programmes for Onchocerciasis Control: Operational Experiences in two districts of Southwestern Nigeria. ... Vol 8, No 1 (2009) >. Log in or Register to get access to full text downloads.

  2. Exploring cost-effective maize integrated weed management ...

    African Journals Online (AJOL)

    Exploring cost-effective maize integrated weed management approaches under intensive farming systems. ... Log in or Register to get access to full text downloads. ... Kamuliand Iganga districts with one hand-hoe weeding (1hh) as the control.

  3. Cost-effectiveness of private umbilical cord blood banking.

    Science.gov (United States)

    Kaimal, Anjali J; Smith, Catherine C; Laros, Russell K; Caughey, Aaron B; Cheng, Yvonne W

    2009-10-01

    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.

  4. Cost-effectiveness analysis of computer-based assessment

    Directory of Open Access Journals (Sweden)

    Pauline Loewenberger

    2003-12-01

    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.

  5. Key aspects of cost effective collector and solar field design

    Science.gov (United States)

    von Reeken, Finn; Nicodemo, Dario; Keck, Thomas; Weinrebe, Gerhard; Balz, Markus

    2016-05-01

    A study has been performed where different key parameters influencing solar field cost are varied. By using levelised cost of energy as figure of merit it is shown that parameters like GoToStow wind speed, heliostat stiffness or tower height should be adapted to respective site conditions from an economical point of view. The benchmark site Redstone (Northern Cape Province, South Africa) has been compared to an alternate site close to Phoenix (AZ, USA) regarding site conditions and their effect on cost-effective collector and solar field design.

  6. Minimum Cost Design of Distributed Energy Resources with Studying the Effect of Capital Cost and Replacement Cost

    Directory of Open Access Journals (Sweden)

    Mehdi Nafar

    2012-02-01

    Full Text Available This study presents an optimized design of HPS in a distribution system including sources like, photovoltaic array, Diesel generator and battery bank.In this research, an algorithm has been developed for evaluation and cost optimization HPS. The costs include capital cost, replacement cost, operation and maintenance cost, fuel cost and production cost for HPS and DG power during different load profile. Then an objective function with aim to minimizing of total costs has been considered. A genetic algorithm approach is employed to obtain the best cost value of HPS construction. This study tested on case study network on Mardasht city in Iran.

  7. Cost-effectiveness and cost utility of community screening for glaucoma in urban India.

    Science.gov (United States)

    John, Denny; Parikh, Rajul

    2017-07-01

    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

  8. Groundwater remediation and the cost effectiveness of phytoremediation.

    Science.gov (United States)

    Compernolle, T; Van Passel, S; Weyens, N; Vangronsveld, J; Lebbe, L; Thewys, T

    2012-10-01

    In 1999, phytoremediation was applied at the site of a Belgian car factory to contain two BTEX plumes. This case study evaluates the cost effectiveness of phytoremediation compared to other remediation options, applying a tailored approach for economic evaluation. Generally, when phytoremediation is addressed as being cost effective, the cost effectiveness is only determined on an average basis. This study however, demonstrates that an incremental analysis may provide a more nuanced conclusion. When the cost effectiveness is calculated on an average basis, in this particular case, the no containment strategy (natural attenuation) has the lowest cost per unit mass removed and hence, should be preferred. However, when the cost effectiveness is determined incrementally, no containment should only be preferred if the value of removing an extra gram of contaminant mass is lower than 320 euros. Otherwise, a permeable reactive barrier should be adopted. A similar analysis is provided for the effect determined on the basis of remediation time. Phytoremediation is preferred compared to 'no containment' if reaching the objective one year earlier is worth 7 000 euros.

  9. Costs and cost-effectiveness of family CBT versus individual CBT in clinically anxious children

    NARCIS (Netherlands)

    D.H.M. Bodden; C.D. Dirksen; S.M. Bögels; M.H. Nauta; E. de Haan; J. Ringrose; C. Appelboom; A.G. Brinkman; K.C.M.M.J. Appelboom-Geerts

    2008-01-01

    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

  10. Cost Effective Regional Ballistic Missile Defense

    Science.gov (United States)

    2016-02-16

    Defense Agency, Huntsville, AL; Chief, Materiel Fielding Team ( Automotive ), Materiel Fielding and Training Directorate, TACOM Life Cycle Management...Executive Office Ground Combat Systems, Detroit Arsenal, Michigan; Training With Industry Officer, EADS North America, Huntsville, Alabama; and Product...identify the ways and means to counter this imbalance or risk future erosion of our military effectiveness, diminished allied confidence, and unnecessarily

  11. Cost-effectiveness of anti-retroviral therapy at a district hospital in southern Ethiopia

    Directory of Open Access Journals (Sweden)

    Robberstad Bjarne

    2009-07-01

    Full Text Available Abstract Background As the resource implications of expanding anti-retroviral therapy (ART are likely to be large, there is a need to explore its cost-effectiveness. So far, there is no such information available from Ethiopia. Objective To assess the cost-effectiveness of ART for routine clinical practice in a district hospital setting in Ethiopia. Methods We estimated the unit cost of HIV-related care from the 2004/5 fiscal year expenditure of Arba Minch Hospital in southern Ethiopia. We estimated outpatient and inpatient service use from HIV-infected patients who received care and treatment at the hospital between January 2003 and March 2006. We measured the health effect as life years gained (LYG for patients receiving ART compared with those not receiving such treatment. The study adopted a health care provider perspective and included both direct and overhead costs. We used Markov model to estimate the lifetime costs, health benefits and cost-effectiveness of ART. Findings ART yielded an undiscounted 9.4 years expected survival, and resulted in 7.1 extra LYG compared to patients not receiving ART. The lifetime incremental cost is US$2,215 and the undiscounted incremental cost per LYG is US$314. When discounted at 3%, the additional LYG decreases to 5.5 years and the incremental cost per LYG increases to US$325. Conclusion The undiscounted and discounted incremental costs per LYG from introducing ART were less than the per capita GDP threshold at the base year. Thus, ART could be regarded as cost-effective in a district hospital setting in Ethiopia.

  12. Risk Costs for New Dams: Economic Analysis and Effects of Monitoring

    Science.gov (United States)

    Paté-Cornell, M. Elisabeth; Tagaras, George

    1986-01-01

    This paper presents new developments and illustrations of the introduction of risk and costs in cost-benefit analysis for new dams. The emphasis is on a method of evaluation of the risk costs based on the structure of the local economy. Costs to agricultural property as well as residential, commercial, industrial, and public property are studied in detail. Of particular interest is the case of sequential dam failure and the evaluation of the risk costs attributable to a new dam upstream from an existing one. Three real cases are presented as illustrations of the method: the Auburn Dam, the Dickey-Lincoln School Project, and the Teton Dam, which failed in 1976. This last case provides a calibration tool for the estimation of loss ratios. For these three projects, the risk-modified benefit-cost ratios are computed to assess the effect of the risk on the economic performance of the project. The role of a warning system provided by systematic monitoring of the dam is analyzed: by reducing the risk costs, the warning system attenuates their effect on the benefit-cost ratio. The precursors, however, can be missed or misinterpreted: monitoring does not guarantee that the risks to human life can be reduced to zero. This study shows, in particular, that it is critical to consider the risk costs in the decision to build a new dam when the flood area is large and densely populated.

  13. A cost-effectiveness analysis of screening urine dipsticks in well-child care.

    Science.gov (United States)

    Sekhar, Deepa L; Wang, Li; Hollenbeak, Christopher S; Widome, Mark D; Paul, Ian M

    2010-04-01

    Despite data suggesting that routine urine screening for chronic kidney disease (CKD) has low diagnostic yield and the American Academy of Pediatrics 2007 recommendation to discontinue this screening, pediatricians may not have recognized this change. Because the new recommendation marks a major alteration in the practice guidelines, we sought to evaluate the cost-effectiveness of dipstick urinalysis for detection of CKD from the primary care practitioner's perspective. Decision analysis was used to model a screening dipstick urinalysis strategy relative to a no-screening strategy. Data on the incidence of hematuria and proteinuria in children were derived from published reports of large cohorts of school-aged children. Direct costs were estimated from the perspective of the primary care practitioner. The measure of effectiveness was the rate of diagnoses of CKD. Cost-effectiveness was evaluated by using an incremental cost-effectiveness ratio. Expected costs and effectiveness for the no-screening strategy were 0 dollars because no resources were used and no cases of CKD were diagnosed. The screening strategy involved a cost per dipstick of 3.05 dollars. Accounting for both true-positive and false-positive initial screens, 14.2% of the patients required a second dipstick as per typical clinical care, bringing the expected cost of the screening strategy to 3.47 dollars per patient. In the screening strategy, 1 case of CKD was diagnosed per 800 screened, and the incremental cost-effectiveness ratio was 2779.50 dollars per case diagnosed. Urine dipstick is inexpensive, but it is a poor screening test for CKD and a cost-ineffective procedure for the primary care provider. These data support the change in the American Academy of Pediatrics guidelines on the use of screening dipstick urinalysis. Clinicians must consider the cost-effectiveness of preventive care procedures to make better use of available resources.

  14. Methodological considerations in the analysis of cost effectiveness in dentistry.

    Science.gov (United States)

    Antczak-Bouckoms, A A; Tulloch, J F; White, B A; Capilouto, E I

    1989-01-01

    Cost-effectiveness analysis is a technique applied with increasing frequency to help make rational decisions in health care resource allocation. This article reviews the ten general principles of cost-effectiveness analysis outlined by the Office of Technology Assessment of the US Congress and describes a model for such analyses used widely in medicine, but only recently applied in dentistry. The imperative for the formulation of the best current information on both the effectiveness of dental practices and their costs is made more urgent because of the now universally recognized belief that resources available to meet the demands for health care are limited. Today's environment requires critical allocation decisions within categorical health problems, across diseases, or relative to other health problems. If important health benefits or cost savings are to be realized, then these analytic approaches must become widely understood, accepted, and appropriately applied by key decision makers in the dental health sector.

  15. Cost effectiveness of routine duodenal biopsies in iron deficiency anemia

    Science.gov (United States)

    Broide, Efrat; Matalon, Shay; Kriger-Sharabi, Ofra; Richter, Vered; Shirin, Haim; Leshno, Moshe

    2016-01-01

    AIM To investigate the cost effectiveness of routine small bowel biopsies (SBBs) in patients with iron deficiency anemia (IDA) independent of their celiac disease (CD) serology test results. METHODS We used a state transition Markov model. Two strategies were compared: routine SBBs during esophagogastroduodenoscopy (EGD) in all patients with IDA regardless their celiac serology status (strategy A) vs SBBs only in IDA patients with positive serology (strategy B). The main outcomes were quality adjusted life years (QALY), average cost and the incremental cost effectiveness ratio (ICER). One way sensitivity analysis was performed on all variables and two way sensitivity analysis on selected variables were done. In order to validate the results, a Monte Carlo simulation of 100 sample trials with 10, and an acceptability curve were performed. RESULTS Strategy A of routine SBBs yielded 19.888 QALYs with a cost of $218.10 compared to 19.887 QALYs and $234.17 in strategy B. In terms of cost-effectiveness, strategy A was the dominant strategy, as long as the cost of SBBs stayed less than $67. In addition, the ICER of strategy A was preferable, providing the cost of biopsy stays under $77. Monte Carlo simulation demonstrated that strategy A yielded the same QALY but with lower costs than strategy B. CONCLUSION Our model suggests that EGD with routine SBBs is a cost-effective approach with improved QALYs in patients with IDA when the prevalence of CD is 5% or greater. SBBs should be a routine screening tool for CD among patients with IDA, regardless of their celiac antibody status. PMID:27678365

  16. Cost-effectiveness of the Norwegian breast cancer screening program.

    Science.gov (United States)

    van Luijt, P A; Heijnsdijk, E A M; de Koning, H J

    2017-02-15

    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.

  17. Taking ART to scale: determinants of the cost and cost-effectiveness of antiretroviral therapy in 45 clinical sites in Zambia.

    Directory of Open Access Journals (Sweden)

    Elliot Marseille

    Full Text Available BACKGROUND: We estimated the unit costs and cost-effectiveness of a government ART program in 45 sites in Zambia supported by the Centre for Infectious Disease Research Zambia (CIDRZ. METHODS: We estimated per person-year costs at the facility level, and support costs incurred above the facility level and used multiple regression to estimate variation in these costs. To estimate ART effectiveness, we compared mortality in this Zambian population to that of a cohort of rural Ugandan HIV patients receiving co-trimoxazole (CTX prophylaxis. We used micro-costing techniques to estimate incremental unit costs, and calculated cost-effectiveness ratios with a computer model which projected results to 10 years. RESULTS: The program cost $69.7 million for 125,436 person-years of ART, or $556 per ART-year. Compared to CTX prophylaxis alone, the program averted 33.3 deaths or 244.5 disability adjusted life-years (DALYs per 100 person-years of ART. In the base-case analysis, the net cost per DALY averted was $833 compared to CTX alone. More than two-thirds of the variation in average incremental total and on-site cost per patient-year of treatment is explained by eight determinants, including the complexity of the patient-case load, the degree of adherence among the patients, and institutional characteristics including, experience, scale, scope, setting and sector. CONCLUSIONS AND SIGNIFICANCE: The 45 sites exhibited substantial variation in unit costs and cost-effectiveness and are in the mid-range of cost-effectiveness when compared to other ART programs studied in southern Africa. Early treatment initiation, large scale, and hospital setting, are associated with statistically significantly lower costs, while others (rural location, private sector are associated with shifting cost from on- to off-site. This study shows that ART programs can be significantly less costly or more cost-effective when they exploit economies of scale and scope, and initiate

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

    Science.gov (United States)

    2012-01-01

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

  19. Cost-effectiveness of intravenous thrombolysis with alteplase within a 3-hour window after acute ischemic stroke

    DEFF Research Database (Denmark)

    Ehlers, Lars; Andersen, Grethe; Clausen, Lone Beltoft

    2006-01-01

    was designed to calculate the marginal cost-effectiveness ratios for time spans of 1, 2, 3 and 30 years. Effect data were extracted from a meta-analysis of six large-scale randomized and placebo-controlled studies of thrombolytic therapy with alteplase. Cost data were extracted from thrombolysis treatment...

  20. Cost and Cost-Effectiveness of the Mediterranean Diet: Results of a Systematic Review

    Directory of Open Access Journals (Sweden)

    Rosella Saulle

    2013-11-01

    Full Text Available The growing impact of chronic degenerative pathologies (such as cardiovascular disease, type 2 diabetes and Alzheimer’s disease requires and pushes towards the development of new preventive strategies to reduce the incidence and prevalence of these diseases. Lifestyle changes, especially related to the Mediterranean diet, have the potential to modify disease outcomes and ultimately costs related to their management. The objective of the study was to perform a systematic review of the scientific literature, to gauge the economic performance and the cost-effectiveness of the adherence to the Mediterranean diet as a prevention strategy against degenerative pathologies. We investigated the monetary costs of adopting Mediterranean dietary patterns by determining cost differences between low and high adherence. Research was conducted using the PubMed and Scopus databases. Eight articles met the pre-determined inclusion criteria and were reviewed. Quality assessment and data extraction was performed. The adherence to the Mediterranean diet has been extensively reported to be associated with a favorable health outcome and a better quality of life. The implementation of a Mediterranean dietary pattern may lead to the prevention of degenerative pathologies and to an improvement in life expectancy, a net gain in health and a reduction in total lifetime costs.

  1. Bariatric surgery: cost-effectiveness and budget impact.

    Science.gov (United States)

    Terranova, Lorenzo; Busetto, Luca; Vestri, Annarita; Zappa, Marco Antonio

    2012-04-01

    Bariatric surgery is to date the most effective treatment for morbid obesity and it has been proven to reduce obesity-related comorbidities and total mortality. As any medical treatment, bariatric surgery is costly and doubts about its affordability have been raised. On the other hand, bariatric surgery may reduce the direct and indirect costs of obesity and related comorbidities. The appreciation of the final balance between financial investments and savings is critical from a health economic perspective. In this paper, we try to provide a brief updated review of the most recent studies on the cost-efficacy of bariatric surgery, with particular emphasis on budget analysis. A brief overview of the economic costs of obesity will also be provided. The epidemic of obesity may cause a significant reduction in life expectancy and overwhelming direct and indirect costs for citizens and societies. Cost-efficacy analyses included in this review consistently demonstrated that the additional years of lives gained through bariatric surgery may be obtained at a reasonable and affordable cost. In groups of patients with very high obesity-related health costs, like patients with type 2 diabetes, the use of bariatric surgery required an initial economic investment, but may save money in a relatively short period of time.

  2. Cost-effectiveness analysis of rotavirus vaccination in Argentina.

    Science.gov (United States)

    Urueña, Analía; Pippo, Tomás; Betelu, María Sol; Virgilio, Federico; Hernández, Laura; Giglio, Norberto; Gentile, Ángela; Diosque, Máximo; Vizzotti, Carla

    2015-05-07

    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

  3. Cost-effectiveness analysis of computerized ECG interpretation system in an ambulatory health care organization.

    Science.gov (United States)

    Carel, R S

    1982-04-01

    The cost-effectiveness of a computerized ECG interpretation system in an ambulatory health care organization has been evaluated in comparison with a conventional (manual) system. The automated system was shown to be more cost-effective at a minimum load of 2,500 patients/month. At larger monthly loads an even greater cost-effectiveness was found, the average cost/ECG being about $2. In the manual system the cost/unit is practically independent of patient load. This is primarily due to the fact that 87% of the cost/ECG is attributable to wages and fees of highly trained personnel. In the automated system, on the other hand, the cost/ECG is heavily dependent on examinee load. This is due to the relatively large impact of equipment depreciation on fixed (and total) cost. Utilization of a computer-assisted system leads to marked reduction in cardiologists' interpretation time, substantially shorter turnaround time (of unconfirmed reports), and potential provision of simultaneous service at several remotely located "heart stations."

  4. Using Cost-Effectiveness Analysis to Address Health Equity Concerns.

    Science.gov (United States)

    Cookson, Richard; Mirelman, Andrew J; Griffin, Susan; Asaria, Miqdad; Dawkins, Bryony; Norheim, Ole Frithjof; Verguet, Stéphane; J Culyer, Anthony

    2017-02-01

    This articles serves as a guide to using cost-effectiveness analysis (CEA) to address health equity concerns. We first introduce the "equity impact plane," a tool for considering trade-offs between improving total health-the objective underpinning conventional CEA-and equity objectives, such as reducing social inequality in health or prioritizing the severely ill. Improving total health may clash with reducing social inequality in health, for example, when effective delivery of services to disadvantaged communities requires additional costs. Who gains and who loses from a cost-increasing health program depends on differences among people in terms of health risks, uptake, quality, adherence, capacity to benefit, and-crucially-who bears the opportunity costs of diverting scarce resources from other uses. We describe two main ways of using CEA to address health equity concerns: 1) equity impact analysis, which quantifies the distribution of costs and effects by equity-relevant variables, such as socioeconomic status, location, ethnicity, sex, and severity of illness; and 2) equity trade-off analysis, which quantifies trade-offs between improving total health and other equity objectives. One way to analyze equity trade-offs is to count the cost of fairer but less cost-effective options in terms of health forgone. Another method is to explore how much concern for equity is required to choose fairer but less cost-effective options using equity weights or parameters. We hope this article will help the health technology assessment community navigate the practical options now available for conducting equity-informative CEA that gives policymakers a better understanding of equity impacts and trade-offs.

  5. Cost-Effectiveness of Health Coaching: An Integrative Review.

    Science.gov (United States)

    Hale, Rachel; Giese, Jeannie

    The purpose of this review was to evaluate published literature to distinguish how health coaching influences the cost of chronic disease management in insured adults with chronic conditions. An integrated literature review was conducted. MEDLINE, Business Source Complete, and OneSearch were searched for the years 2001-2016 utilizing the following key words: health coaching, health coaching AND insurance companies, health coaching AND cost, health coaching AND health insurance, and health coaching AND insurance cost. A total of 67 articles met inclusion criteria and were assessed for applicability. Of those, 27 articles were found to be relevant to the research question. The practice settings of these articles are mostly primary care and wellness programs. Throughout the literature, health coaching has been found effective in chronic disease management such as hypertension, diabetes, and hyperlipidemia. Studies evaluating the cost-effectiveness of health coaching are limited. The current literature does not clearly demonstrate that health coaching lowers expenditures and patient copayments in the short term but projects future savings. Health coaching has the potential to improve chronic disease management and lower health care expenditures. Further long-term research is needed to evaluate the cost-effectiveness of health coaching. It has been projected that the cost-effectiveness of health coaching will be long-term or over 12 months after initiating the health coaching program.

  6. Cost-effectiveness assessment in outpatient sinonasal surgery.

    Science.gov (United States)

    Mortuaire, G; Theis, D; Fackeure, R; Chevalier, D; Gengler, I

    2017-09-15

    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.

  7. Dynamic modeling of cost-effectiveness of rotavirus vaccination, Kazakhstan.

    Science.gov (United States)

    Freiesleben de Blasio, Birgitte; Flem, Elmira; Latipov, Renat; Kuatbaeva, Ajnagul; Kristiansen, Ivar Sønbø

    2014-01-01

    The government of Kazakhstan, a middle-income country in Central Asia, is considering the introduction of rotavirus vaccination into its national immunization program. We performed a cost-effectiveness analysis of rotavirus vaccination spanning 20 years by using a synthesis of dynamic transmission models accounting for herd protection. We found that a vaccination program with 90% coverage would prevent ≈880 rotavirus deaths and save an average of 54,784 life-years for children vaccine cost at vaccination program costs would be entirely offset. To further evaluate efficacy of a vaccine program, benefits of indirect protection conferred by vaccination warrant further study.

  8. Effect of Congestion Costs on Shortest Paths Through Complex Networks

    Science.gov (United States)

    Ashton, Douglas J.; Jarrett, Timothy C.; Johnson, Neil F.

    2005-02-01

    We analyze analytically the effect of congestion costs within a physically relevant, yet exactly solvable, network model featuring central hubs. These costs lead to a competition between centralized and decentralized transport pathways. In stark contrast to conventional no-cost networks, there now exists an optimal number of connections to the central hub in order to minimize the shortest path. Our results shed light on an open problem in biology, informatics, and sociology, concerning the extent to which decentralized versus centralized design benefits real-world complex networks.

  9. A hybrid qPCR/SNP array approach allows cost efficient assessment of KIR gene copy numbers in large samples

    National Research Council Canada - National Science Library

    Pontikos, Nikolas; Smyth, Deborah J; Schuilenburg, Helen; Howson, Joanna M M; Walker, Neil M; Burren, Oliver S; Guo, Hui; Onengut-Gumuscu, Suna; Chen, Wei-Min; Concannon, Patrick; Rich, Stephen S; Jayaraman, Jyothi; Jiang, Wei; Traherne, James A; Trowsdale, John; Todd, John A; Wallace, Chris

    2014-01-01

    .... Quantitative Polymerase Chain Reaction (qPCR) assays address this issue. However, their cost is prohibitive at the sample sizes required for detecting effects typically observed in complex genetic diseases...

  10. Forecasting the Socio-Economic Impact of the Large Hadron Collider: a Cost-Benefit Analysis to 2025 and Beyond

    CERN Document Server

    Florio, Massimo; Sirtori, Emanuela

    2016-01-01

    In this paper we develop a cost-benefit analysis of a major research infrastructure, the Large Hadron Collider (LHC), the highest-energy accelerator in the world, currently operating at CERN. We show that the evaluation of benefits can be made quantitative by estimating their welfare effects on different types of agents. Four classes of direct benefits are identified, according to the main social groups involved: (a) scientists; (b) students and young researchers; (c) firms in the procurement chain and other organizations; (d) the general public, including onsite and website visitors and other media users. These benefits are respectively related to the knowledge output of scientists; human capital formation; technological spillovers; and direct cultural effects for the general public. Welfare effects for taxpayers can also be estimated by the contingent valuation of the willingness to pay for a pure public good for which there is no specific direct use (i.e., as non-use value). Using a Monte Carlo approach, w...

  11. Cost-effectiveness of telemonitoring of diabetic foot ulcer patients

    DEFF Research Database (Denmark)

    Fasterholdt, Iben; Gerstrøm, Marie; Rasmussen, Benjamin Schnack Brandt

    2017-01-01

    This study compared the cost-effectiveness of telemonitoring with standard monitoring for patients with diabetic foot ulcers. The economic evaluation was nested within a pragmatic randomised controlled trial. A total of 374 patients were randomised to either telemonitoring or standard monitoring....... Telemonitoring consisted of two tele-consultations in the patient's own home and one consultation at the outpatient clinic; standard monitoring consisted of three outpatient clinic consultations. Total healthcare costs were estimated over a 6-month period at individual patient level, from a healthcare sector...... perspective. The bootstrap method was used to calculate the incremental cost-effectiveness ratio, and one-way sensitivity analyses were performed. Telemonitoring costs were found to be €2039 less per patient compared to standard monitoring; however, this difference was not statistically significant...

  12. The Effect of Labor Supply Shortages on Asymmetric Cost Behavior

    DEFF Research Database (Denmark)

    Hoffmann, Kira

    This study examines the effect of shortages in labor supply on asymmetric cost behavior. Building on the labor demand literature, it is argued that labor supply shortages increase adjustment costs for hiring new employees. Consistent with this explanation, results provide evidence that companies...... facing restrictions in labor supply increase costs (and resources) less than companies operating with sufficient access to additional personnel. This leads to a more symmetrical cost behavior for increasing activity compared to decreasing activity. Additional analyses show that shortages in labor supply...... induce firms to increase selling prices but also to temporarily expect more effort from their current employees. The effect decreases with the length of the labor supply shock and is more pronounced for companies located in less populated regions. Results are robust to alternative explanations...

  13. Costs and net health effects of contraceptive methods.

    Science.gov (United States)

    Sonnenberg, Frank A; Burkman, Ronald T; Hagerty, C Greg; Speroff, Leon; Speroff, Theodore

    2004-06-01

    Pregnancy and contraceptive methods both have important health effects that include risks and benefits. The net impact of contraception on women's health has not been reported previously. This is a cost-utility analysis using a Markov model evaluated by Monte Carlo simulation using the societal perspective for costs. The analysis compared 13 methods of contraception to nonuse of contraception with respect to healthcare costs and quality-adjusted life years (QALYs). Discounting was applied for future costs and health effects. The base-case analysis applies to women of average health and fertility, ranging from 15 to 50 years of age, who are sexually active in a mutually monogamous relationship; smoking rates observed in women of reproductive age were used. Sensitivity analysis extended the analysis to nonmonogamous status and smoking status. Compared with use of no contraception, contraceptive methods of all types result in substantial cost savings over 2 years, ranging from US$5907 per woman for tubal sterilization to US$9936 for vasectomy and health gains ranging from 0.088 QALYs for diaphragm to 0.147 QALYs for depot medroxyprogesterone acetate. Compared with nonuse, even with a time horizon as short as 1 year, use of any method other than sterilization results in financial savings and health gains. Most of the financial savings and health gains were due to contraceptive effects. In a population of patients, even modest increases in the use of the most effective methods result in financial savings and health gains. Every method of contraception dominates nonuse in most clinical settings. Increasing the use of more effective methods even modestly at the expense of less effective methods will improve health and reduce costs. Methods that require action by the user less frequently than daily are both less costly and more effective than methods requiring action on a daily basis. Copyright 2004 Elsevier Inc.

  14. Cost effectiveness of type 2 diabetes screening: A systematic review.

    Science.gov (United States)

    Najafi, Behzad; Farzadfar, Farshad; Ghaderi, Hossein; Hadian, Mohammad

    2016-01-01

    Although studies reported diabetes mellitus screening cost effective, the mass screening for type2 diabetes remains controversial. In this study we reviewed the recently evidence about the cost effectiveness of mass screening systematically. We reviewed the MEDLINE, Scopus, Web of Science (WOS), and Cochrane library databases by MeSH terms to identify relevant studies from 2000 to 2013. We had 4 inclusion and 6 exclusion criteria and used the Drummond's checklist for appraising the quality of studies. The initial search yielded 358 potentially related studies from selected databases. 6 studies met our inclusion and exclusion criteria and included in final review. 3 and 2 of them were conducted in Europe and America and only one of them in Asia. Quality-adjusted life year (QALY) was the main outcome to appraise the effectiveness in the studies. Incremental cost effectiveness ratio (ICER) was computed in range from $516.33 to $126,238 per QALY in the studies. A review of previous diabetes screening cost effectiveness analysis showed that the studies varied in some aspects but reached similar conclusions. They concluded that the screening may be cost effective, however further studies is required to support the diabetes mass screening.

  15. Low-Cost Composite Technology for Large Rocket Payload Fairings Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The Commission on the Future of the U.S. Aerospace Industry states that reducing the cost to orbit is an essential ingredient for progress. This Phase I project will...

  16. Cost Effectiveness Analysis of Optimal Malaria Control Strategies in Kenya

    Directory of Open Access Journals (Sweden)

    Gabriel Otieno

    2016-03-01

    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

  17. Cost of pneumococcal infections and cost-effectiveness analysis of pneumococcal vaccination at risk adults and elderly in Turkey.

    Science.gov (United States)

    Akin, Levent; Kaya, Mehmet; Altinel, Serdar; Durand, Laure

    2011-04-01

    Pneumococcal infections have a substantial burden in Turkey, particularly in the elderly (> 60 years) and at-risk adults (18-59 years). VCR are low at approximately 2%. The first aim of this study was the evaluation of the burden of pneumococcal infections (pneumonia and bacteremia) from a public payer perspective in elderly and at-risk adults. The second aim was the evaluation of cost effectiveness of implementing a large PPV program in these populations. A decision tree model was employed using demographic and epidemiological input obtained from Turkish official sources and international literature. Vaccination was assumed to protect for 5 years with 60% and 50% effectiveness against BPP in elderly and at-risk adults respectively. Vaccination effectiveness of 21% against NBPP was assumed for both populations. Costs input were obtained from a previous study conducted between 2002 and 2008 in a public university hospital in Ankara, Turkey. Univariate sensitivity analyses and Monte-Carlo simulations were performed. The vaccination program was cost effective and cost saving compared to no vaccination, pneumococcal vaccination with 60% coverage led to a mean of 4,695 LYG in the elderly and 2,134 LYG in at-risk adults with 40% coverage. Mean incremental savings reached 45.4 million YTL in the elderly and 21.8 million YTL in at-risk adults. This analysis suggests that pneumococcal vaccination of elderly and at-risk adults is associated with a positive return on investment from a public payer perspective and supports the continued recommendation of pneumococcal vaccines, as well as their full funding in Turkey.

  18. Systematic Review of the Cost and Cost-Effectiveness of Rapid Endovascular Therapy for Acute Ischemic Stroke.

    Science.gov (United States)

    Sevick, Laura K; Ghali, Sarah; Hill, Michael D; Danthurebandara, Vishva; Lorenzetti, Diane L; Noseworthy, Tom; Spackman, Eldon; Clement, Fiona

    2017-09-01

    Rapid endovascular therapy (EVT) is an emerging treatment option for acute ischemic stroke. Several economic evaluations have been published examining the cost-effectiveness of EVT, and many international bodies are currently making adoption decisions. The objective of this study was to establish the cost-effectiveness of EVT for ischemic stroke patients and to synthesize all the publicly available economic literature. A systematic review of the published literature was conducted to identify economic evaluations and cost analyses of EVT for acute ischemic stroke patients. Systematic review best practices were followed, and study quality was assessed. Four-hundred sixty-three articles were identified from electronic databases. After deduplication, abstract review, and full-text review, 17 studies were included. Seven of the studies were cost analyses, and 10 were cost-effectiveness studies. Generally, the cost analyses reported on the cost of the approach/procedure or the hospitalization costs associated with EVT. All of the cost-effectiveness studies reported a cost per quality-adjusted life year as the primary outcomes. Studies varied in regards to the costs considered, the perspective adopted, and the time horizon used. All the studies reported a cost per quality-adjusted life year of <$50 000 as the primary outcome. There is a robust body of evidence for the cost and cost-effectiveness of EVT. The cost analyses suggested that although EVT was associated with higher costs, it also resulted in improved patient outcomes. From the cost-effectiveness studies, EVT seems to be good value for money when a threshold of $50 000 per quality-adjusted life year gained is adopted. © 2017 American Heart Association, Inc.

  19. HPV testing for cervical cancer screening appears more cost-effective than Papanicolau cytology in Mexico.

    Science.gov (United States)

    Flores, Yvonne N; Bishai, David M; Lorincz, Attila; Shah, Keerti V; Lazcano-Ponce, Eduardo; Hernández, Mauricio; Granados-García, Víctor; Pérez, Ruth; Salmerón, Jorge

    2011-02-01

    To determine the incremental costs and effects of different HPV testing strategies, when compared to Papanicolau cytology (Pap), for cervical cancer screening in Mexico. A cost-effectiveness analysis (CEA) examined the specific costs and health outcomes associated with (1) no screening; (2) only the Pap test; (3) only self-administered HPV; (4) only clinician administered HPV; and (5) clinician administered HPV plus the Pap test. The costs of self- and clinician-HPV testing, as well as with the Pap test, were identified and quantified. Costs were reported in 2008 US dollars. The health outcome associated with these screening strategies was defined as the number of high-grade cervical intraepithelial neoplasia or cervical cancer cases detected. This CEA was performed using the perspective of the Mexican Institute of Social Security (IMSS) in Morelos, Mexico. Screening women between the ages of 30-80 for cervical cancer using clinical-HPV testing or the combination of clinical-HPV testing, and the Pap is always more cost-effective than using the Pap test alone. This CEA indicates that HPV testing could be a cost-effective screening alternative for a large health delivery organization such as IMSS. These results may help policy-makers implement HPV testing as part of the IMSS cervical cancer screening program.

  20. Systematic screening for Chlamydia trachomatis : Estimating cost-effectiveness using dynamic modeling and Dutch data

    NARCIS (Netherlands)

    de Vries, R.; Van Bergen, J.E.A.M.; de Jong-van den Berg, Lolkje; Postma, Maarten

    2006-01-01

    To estimate the cost-effectiveness of a systematic one-off Chlamydia trachomatis (CT) screening program including partner treatment for Dutch young adults. Data on infection prevalence, participation rates, and sexual behavior were obtained from a large pilot study conducted in The Netherlands. Oppo

  1. A Cost-Effective Two-Part Experiment for Teaching Introductory Organic Chemistry Techniques

    Science.gov (United States)

    Sadek, Christopher M.; Brown, Brenna A.; Wan, Hayley

    2011-01-01

    This two-part laboratory experiment is designed to be a cost-effective method for teaching basic organic laboratory techniques (recrystallization, thin-layer chromatography, column chromatography, vacuum filtration, and melting point determination) to large classes of introductory organic chemistry students. Students are exposed to different…

  2. Improving parental involvement in primary education in Indonesia : Implementation, effects and costs

    NARCIS (Netherlands)

    van der Werf, Greetje; Creemers, Bert; Guldemond, H

    2001-01-01

    Ina large-scale school improvement project in Indonesia the implementation, effects and costs of initiatives to increase parental involvement were compared with those of other interventions (teacher development, educational management and books and learning materials). It turned out that although pa

  3. Cost-effectiveness analysis of Chlamydia trachomatis screening in Dutch pregnant women

    NARCIS (Netherlands)

    Rours, G I J G; Smith-Norowitz, Tamar Anne; Ditkowsky, Jared; Hammerschlag, Margaret R; Verkooyen, R P; de Groot, R.; Verbrugh, H A; Postma, Maarten

    2016-01-01

    Chlamydia trachomatis infections during pregnancy may have serious consequences for women and their offspring. Chlamydial infections are largely asymptomatic. Hence, prevention is based on screening. The objective of this study was to estimate the cost-effectiveness of C. trachomatis screening durin

  4. Cost-effectiveness analysis of Chlamydia trachomatis screening in Dutch pregnant women

    NARCIS (Netherlands)

    G.I.J.G. Rours (Ingrid); Smith-Norowitz, T.A. (Tamar Anne); Ditkowsky, J. (Jared); M.R. Hammerschlag; R.P.A.J. Verkooyen (Roel); de Groot, R.; H.A. Verbrugh (Henri); M.J. Postma (Maarten)

    2016-01-01

    textabstractChlamydia trachomatis infections during pregnancy may have serious consequences for women and their offspring. Chlamydial infections are largely asymptomatic. Hence, prevention is based on screening. The objective of this study was to estimate the cost-effectiveness of C. trachomatis scr

  5. Cost-effective wavelength selectable light source using DFB fiber laser array

    DEFF Research Database (Denmark)

    Liu, Fenghai; Xueyan, Zheng; Pedersen, Rune Johan Skullerud

    2000-01-01

    A cost-effective wavelength selectable light source comprising a distributed feedback (DFB) fibre laser array is proposed. A large number of wavelengths can be selected via optical space switches using only one shared pump laser. The structure is a good candidate for use as a wavelength selectabl...

  6. Updating the cost-effectiveness of rotavirus vaccination in The Netherlands

    NARCIS (Netherlands)

    Rozenbaum, M.H.; Hak, E.; Wilschut, J.C.; Postma, M.J.

    2010-01-01

    OBJECTIVES: To investigated the most important factors responsible for the large differences in previously estimated cost-effectiveness ratios and to update the costeffectiveness of rotavirus vaccination in the The Netherlands applying assumptions resulting from 2 consensus meetings with national an

  7. Is population screening for abdominal aortic aneurysm cost-effective?

    Directory of Open Access Journals (Sweden)

    Jensen Lotte

    2008-11-01

    Full Text Available Abstract Background Ruptured abdominal aortic aneurysm (AAA is responsible for 1–2% of all male deaths over the age of 65 years. Early detection of AAA and elective surgery can reduce the mortality risk associated with AAA. However, many patients will not be diagnosed with AAA and have therefore an increased death risk due to the untreated AAA. It has been suggested that population screening for AAA in elderly males is effective and cost-effective. The purpose of this study was to perform a systematic review of published cost-effectiveness analyses of screening elderly men for AAA. Methods We performed a systematic search for economic evaluations in NHSEED, EconLit, Medline, Cochrane, Embase, Cinahl and two Scandinavian HTA data bases (DACEHTA and SBU. All identified studies were read in full and each study was systematically assessed according to international guidelines for critical assessment of economic evaluations in health care. Results The search identified 16 cost-effectiveness studies. Most studies considered only short term cost consequences. The studies seemed to employ a number of "optimistic" assumptions in favour of AAA screening, and included only few sensitivity analyses that assessed less optimistic assumptions. Conclusion Further analyses of cost-effectiveness of AAA screening are recommended.

  8. An improved effective cost review process for value engineering.

    Science.gov (United States)

    Joo, D S; Park, J I

    2014-01-01

    Second-look value engineering (VE) is an approach that aims to lower the costs of products for which target costs are not being met during the production stage. Participants in second-look VE typically come up with a variety of ideas for cost cutting, but the outcomes often depend on their levels of experience, and not many good alternatives are available during the production stage. Nonetheless, good ideas have been consistently generated by VE experts. This paper investigates past second-look VE cases and the thinking processes of VE experts and proposes a cost review process as a systematic means of investigating cost-cutting ideas. This cost review process includes the use of an idea checklist and a specification review process. In addition to presenting the process, this paper reports on its feasibility, based on its introduction into a VE training course as part of a pilot study. The results indicate that the cost review process is effective in generating ideas for later analysis.

  9. The Production Effect: Costs and Benefits in Free Recall

    Science.gov (United States)

    Jones, Angela C.; Pyc, Mary A.

    2014-01-01

    The production effect, the memorial benefit for information read aloud versus silently, has been touted as a simple memory improvement tool. The current experiments were designed to evaluate the relative costs and benefits of production using a free recall paradigm. Results extend beyond prior work showing a production effect only when production…

  10. Cost-effectiveness of the "helping babies breathe" program in a missionary hospital in rural Tanzania.

    Directory of Open Access Journals (Sweden)

    Corinna Vossius

    Full Text Available The Helping Babies Breathe" (HBB program is an evidence-based curriculum in basic neonatal care and resuscitation, utilizing simulation-based training to educate large numbers of birth attendants in low-resource countries. We analyzed its cost-effectiveness at a faith-based Haydom Lutheran Hospital (HLH in rural Tanzania.Data about early neonatal mortality and fresh stillbirth rates were drawn from a linked observational study during one year before and one year after full implementation of the HBB program. Cost data were provided by the Tanzanian Ministry of Health and Social Welfare (MOHSW, the research department at HLH, and the manufacturer of the training material Lærdal Global Health.Costs per life saved were USD 233, while they were USD 4.21 per life year gained. Costs for maintaining the program were USD 80 per life saved and USD 1.44 per life year gained. Costs per disease adjusted life year (DALY averted ranged from International Dollars (ID; a virtual valuta corrected for purchasing power world-wide 12 to 23, according to how DALYs were calculated.The HBB program is a low-cost intervention. Implementation in a very rural faith-based hospital like HLH has been highly cost-effective. To facilitate further global implementation of HBB a cost-effectiveness analysis including government owned institutions, urban hospitals and district facilities is desirable for a more diverse analysis to explore cost-driving factors and predictors of enhanced cost-effectiveness.

  11. Cost-Effective Marine Protection--A Pragmatic Approach.

    Directory of Open Access Journals (Sweden)

    Soile Oinonen

    Full Text Available This paper puts forward a framework for probabilistic and holistic cost-effectiveness analysis to provide support in selecting the least-cost set of measures to reach a multidimensional environmental objective. Following the principles of ecosystem-based management, the framework includes a flexible methodology for deriving and populating criteria for effectiveness and costs and analyzing complex ecological-economic trade-offs under uncertainty. The framework is applied in the development of the Finnish Programme of Measures (PoM for reaching the targets of the EU Marine Strategy Framework Directive (MSFD. The numerical results demonstrate that substantial cost savings can be realized from careful consideration of the costs and multiple effects of management measures. If adopted, the proposed PoM would yield improvements in the state of the Baltic Sea, but the overall objective of the MSFD would not be reached by the target year of 2020; for various environmental and administrative reasons, it would take longer for most measures to take full effect.

  12. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

    Directory of Open Access Journals (Sweden)

    V. V. Omel'yanovskiy

    2011-01-01

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

  13. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

    Directory of Open Access Journals (Sweden)

    V. V. Omel'yanovskiy

    2016-01-01

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

  14. Priority Setting, Cost-Effectiveness, and the Affordable Care Act.

    Science.gov (United States)

    Persad, Govind

    2015-01-01

    The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA's provisions concerning priority setting and their developing interpretations, this Article attempts to defend three substantive propositions. First, I argue that the ACA is neither uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality. Second, I argue that the ACA does not take a single, unified approach to priority setting; rather, its guidance varies depending on the aspect of the healthcare system at issue (Patient Centered Outcomes Research Institute, Medicare, essential health benefits) and the factors being excluded from priority setting (age, disability, life expectancy). Third, I argue that cost-effectiveness can be achieved within the ACA's constraints, but that doing so will require adopting new approaches to cost-effectiveness and priority setting. By limiting the use of standard cost-effectiveness analysis, the ACA makes the need for workable rivals to cost-effectiveness analysis a pressing practical concern rather than a mere theoretical worry.

  15. Cost-Effective Marine Protection--A Pragmatic Approach.

    Science.gov (United States)

    Oinonen, Soile; Hyytiäinen, Kari; Ahlvik, Lassi; Laamanen, Maria; Lehtoranta, Virpi; Salojärvi, Joona; Virtanen, Jarno

    2016-01-01

    This paper puts forward a framework for probabilistic and holistic cost-effectiveness analysis to provide support in selecting the least-cost set of measures to reach a multidimensional environmental objective. Following the principles of ecosystem-based management, the framework includes a flexible methodology for deriving and populating criteria for effectiveness and costs and analyzing complex ecological-economic trade-offs under uncertainty. The framework is applied in the development of the Finnish Programme of Measures (PoM) for reaching the targets of the EU Marine Strategy Framework Directive (MSFD). The numerical results demonstrate that substantial cost savings can be realized from careful consideration of the costs and multiple effects of management measures. If adopted, the proposed PoM would yield improvements in the state of the Baltic Sea, but the overall objective of the MSFD would not be reached by the target year of 2020; for various environmental and administrative reasons, it would take longer for most measures to take full effect.

  16. Cost-effectiveness of pharmacotherapy to reduce obesity.

    Directory of Open Access Journals (Sweden)

    J Lennert Veerman

    Full Text Available AIMS: Obesity causes a high disease burden in Australia and across the world. We aimed to analyse the cost-effectiveness of weight reduction with pharmacotherapy in Australia, and to assess its potential to reduce the disease burden due to excess body weight. METHODS: We constructed a multi-state life-table based Markov model in Excel in which body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. We use data on effectiveness identified from PubMed searches, on mortality from Australian Bureau of Statistics, on disease costs from the Australian Institute of Health and Welfare, and on drug costs from the Department of Health and Ageing. We evaluate 1-year pharmacological interventions with sibutramine and orlistat targeting obese Australian adults free of obesity-related disease. We use a lifetime horizon for costs and health outcomes and a health sector perspective for costs. Incremental Cost-Effectiveness Ratios (ICERs below A$50 000 per Disability Adjusted Life Year (DALY averted are considered good value for money. RESULTS: The ICERs are A$130 000/DALY (95% uncertainty interval [UI] 93 000-180 000 for sibutramine and A$230 000/DALY (170 000-340 000 for orlistat. The interventions reduce the body weight-related disease burden at the population level by 0.2% and 0.1%, respectively. Modest weight loss during the interventions, rapid post-intervention weight regain and low adherence limit the health benefits. CONCLUSIONS: Treatment with sibutramine or orlistat is not cost-effective from an Australian health sector perspective and has a negligible impact on the total body weight-related disease burden.

  17. Cost-effectiveness of pharmacotherapy to reduce obesity.

    Science.gov (United States)

    Veerman, J Lennert; Barendregt, Jan J; Forster, Megan; Vos, Theo

    2011-01-01

    Obesity causes a high disease burden in Australia and across the world. We aimed to analyse the cost-effectiveness of weight reduction with pharmacotherapy in Australia, and to assess its potential to reduce the disease burden due to excess body weight. We constructed a multi-state life-table based Markov model in Excel in which body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. We use data on effectiveness identified from PubMed searches, on mortality from Australian Bureau of Statistics, on disease costs from the Australian Institute of Health and Welfare, and on drug costs from the Department of Health and Ageing. We evaluate 1-year pharmacological interventions with sibutramine and orlistat targeting obese Australian adults free of obesity-related disease. We use a lifetime horizon for costs and health outcomes and a health sector perspective for costs. Incremental Cost-Effectiveness Ratios (ICERs) below A$50 000 per Disability Adjusted Life Year (DALY) averted are considered good value for money. The ICERs are A$130 000/DALY (95% uncertainty interval [UI] 93 000-180 000) for sibutramine and A$230 000/DALY (170 000-340 000) for orlistat. The interventions reduce the body weight-related disease burden at the population level by 0.2% and 0.1%, respectively. Modest weight loss during the interventions, rapid post-intervention weight regain and low adherence limit the health benefits. Treatment with sibutramine or orlistat is not cost-effective from an Australian health sector perspective and has a negligible impact on the total body weight-related disease burden.

  18. A Layered Decision Model for Cost-Effective System Security

    Energy Technology Data Exchange (ETDEWEB)

    Wei, Huaqiang; Alves-Foss, James; Soule, Terry; Pforsich, Hugh; Zhang, Du; Frincke, Deborah A.

    2008-10-01

    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.

  19. Above Bonneville Passage and Propagation Cost Effectiveness Analysis.

    Energy Technology Data Exchange (ETDEWEB)

    Paulsen, C.M.; Hyman, J.B.; Wernstedt, K.

    1993-05-01

    We have developed several models to evaluate the cost-effectiveness of alternative strategies to mitigate hydrosystem impacts on salmon and steelhead, and applied these models to areas of the Columbia River Basin. Our latest application evaluates the cost-effectiveness of proposed strategies that target mainstem survival (e.g., predator control, increases in water velocity) and subbasin propagation (e.g., habitat improvements, screening, hatchery production increases) for chinook salmon and steelhead stocks, in the portion of the Columbia Basin bounded by Bonneville, Chief Joseph, Dworshak, and Hells Canyon darns. At its core the analysis primarily considers financial cost and biological effectiveness, but we have included other attributes which may be of concern to the region.

  20. Bayesian cost-effectiveness analysis with the R package BCEA

    CERN Document Server

    Baio, Gianluca; Heath, Anna

    2017-01-01

    The book provides a description of the process of health economic evaluation and modelling for cost-effectiveness analysis, particularly from the perspective of a Bayesian statistical approach. Some relevant theory and introductory concepts are presented using practical examples and two running case studies. The book also describes in detail how to perform health economic evaluations using the R package BCEA (Bayesian Cost-Effectiveness Analysis). BCEA can be used to post-process the results of a Bayesian cost-effectiveness model and perform advanced analyses producing standardised and highly customisable outputs. It presents all the features of the package, including its many functions and their practical application, as well as its user-friendly web interface. The book is a valuable resource for statisticians and practitioners working in the field of health economics wanting to simplify and standardise their workflow, for example in the preparation of dossiers in support of marketing authorisation, or acade...

  1. Cost-effectiveness of health research study participant recruitment strategies: a systematic review.

    Science.gov (United States)

    Huynh, Lynn; Johns, Benjamin; Liu, Su-Hsun; Vedula, S Swaroop; Li, Tianjing; Puhan, Milo A

    2014-10-01

    A large fraction of the cost of conducting clinical trials is allocated to recruitment of participants. A synthesis of findings from studies that evaluate the cost and effectiveness of different recruitment strategies will inform investigators in designing cost-efficient clinical trials. To systematically identify, assess, and synthesize evidence from published comparisons of the cost and yield of strategies for recruitment of participants to health research studies. We included randomized studies in which two or more strategies for recruitment of participants had been compared. We focused our economic evaluation on studies that randomized participants to different recruitment strategies. We identified 10 randomized studies that compared recruitment strategies, including monetary incentives (cash or prize), direct contact (letters or telephone call), and medical referral strategies. Only two of the 10 studies compared strategies for recruiting participants to clinical trials. We found that allocating additional resources to recruit participants using monetary incentives or direct contact yielded between 4% and 23% additional participants compared to using neither strategy. For medical referral, recruitment of prostate cancer patients by nurses was cost-saving compared to recruitment by consultant urologists. For all underlying study designs, monetary incentives cost more than direct contact with potential participants, with a median incremental cost per recruitment ratio of Int$72 (Int$-International dollar, a theoretical unit of currency) for monetary incentive strategy compared to Int$28 for direct contact strategy. Only monetary incentives and source of referral were evaluated for recruiting participants into clinical trials. We did not review studies that presented non-monetary cost or lost opportunity cost. We did not adjust for the number of study recruitment sites or the study duration in our economic evaluation analysis. Systematic and explicit reporting of

  2. Cost-effectiveness of Bariatric Surgery in Adolescents With Obesity.

    Science.gov (United States)

    Klebanoff, Matthew J; Chhatwal, Jagpreet; Nudel, Jacob D; Corey, Kathleen E; Kaplan, Lee M; Hur, Chin

    2017-02-01

    Severe obesity affects 4% to 6% of US youth and is increasing in prevalence. Bariatric surgery for the treatment of adolescents with severe obesity is becoming more common, but data on cost-effectiveness are limited. To assess the cost-effectiveness of bariatric surgery for adolescents with obesity using recently published results from the Teen-Longitudinal Assessment of Bariatric Surgery study. A state-transition model was constructed to compare 2 strategies: no surgery and bariatric surgery. In the no surgery strategy, patients remained at their initial body mass index (calculated as weight in kilograms divided by height in meters squared) over time. In the bariatric surgery strategy, patients were subjected to risks of perioperative mortality and complications as well as initial morbidity but also experienced longer-term quality-of-life improvements associated with weight loss. Cohort demographic information-of the 228 patients included, the mean (SD) age was 17 (1.6) years, the mean (range) body mass index was 53 (34-88), and 171 (75.0%) were female-surgery-related outcomes, and base case time horizon (3 years) were based on data from the Teen-Longitudinal Assessment of Bariatric Surgery study. One-way and probabilistic sensitivity analyses were performed. Quality-adjusted life-years (QALYs), total costs (in US dollars adjusted to 2015-year values using the Consumer Price Index), and incremental cost-effectiveness ratios (ICERs). A willingness-to-pay threshold of $100 000 per QALY was used to assess cost-effectiveness. After 3 years, surgery led to a gain of 0.199 QALYs compared with no surgery at an incremental cost of $30 747, yielding an unfavorable ICER of $154 684 per QALY. When the clinical study results were extrapolated to 4 years, the ICER decreased to $114 078 per QALY and became cost-effective by 5 years with an ICER of $91 032 per QALY. Outcomes were robust in most 1-way and probabilistic sensitivity analyses. Bariatric surgery incurs

  3. Effects of cost reflective electricity tariffs in Namibia

    Energy Technology Data Exchange (ETDEWEB)

    2007-04-15

    The power balance in Southern Africa is changing. Namibia faces the choice between increased reliance on imports of electricity or expanding domestic generation. One option is to build a gas fired power plant at Kudu. This plant will have an average generation cost well above the projected import cost. The changing power balance in the region may warrant that Namibia incurs substantial costs to ensure energy security. If Kudu is not built, we project that real end user tariffs will peak in 2010/11 at a level 22 percent higher than in 2006, but then gradually revert towards the 2006 level. The effects of this tariff scenario on the economy should not be dramatic, and we would not recommend to subsidise electricity in this case. This forecast is based on an assumed 67 percent increase the real price of imports. In this and all other scenarios we assume that the unit costs of distribution in Namibia and local surcharges will decline. Namibia has experienced temporary halts in imports of electricity. As the balance in the Southern African power market is changing, the risks of capacity shortages appear to have increased. Frequent power outages could be very costly to the economy, and one may thus argue that Namibia should accept the higher costs of electricity to ensure stable supply. Building Kudu could be one, and possibly the only, viable option to reduce the risks of capacity shortages. The cost of generation at Kudu, if it is built, is uncertain. We have assumed a cost at 44 c/kWh. This can be viewed as an upper bound of the cost range. If Kudu is built at this cost, the end user tariff would have to increase by 85 per cent in real terms over the 2006-2011 period to finance Kudu in full, having factored in projected exports earnings. The real tariff will decline slowly after 2011. This appears a risky scenario, not least for the effects on investments in exports sectors and businesses facing international competition in the Namibian market. If Kudu is built at

  4. Cost-effectiveness of vaccination against herpes zoster and postherpetic neuralgia: a critical review.

    Science.gov (United States)

    Kawai, Kosuke; Preaud, Emmanuelle; Baron-Papillon, Florence; Largeron, Nathalie; Acosta, Camilo J

    2014-03-26

    The objective of this study was to systematically review cost-effectiveness studies of vaccination against herpes zoster (HZ) and postherpetic neuralgia (PHN). We searched MEDLINE and EMBASE databases for eligible studies published prior to November 2013. We extracted information regarding model structure, model input parameters, and study results. We compared the results across studies by projecting the health and economic impacts of vaccinating one million adults over their lifetimes. We identified 15 cost-effectiveness studies performed in North America and Europe. Results ranged from approximately US$10,000 to more than US$100,000 per quality-adjusted life years (QALY) gained. Most studies in Europe concluded that zoster vaccination is likely to be cost-effective. Differences in results among studies are largely due to differing assumptions regarding duration of vaccine protection and a loss in quality of life associated with HZ and to a larger extent, PHN. Moreover, vaccine efficacy against PHN, age at vaccination, and vaccine cost strongly influenced the results in sensitivity analyses. Most studies included in this review shows that vaccination against HZ is likely to be cost-effective. Future research addressing key model parameters and cost-effectiveness studies in other parts of the world are needed. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Privacy Enforcement in a Cost-Effective Smart Grid

    DEFF Research Database (Denmark)

    Mikkelsen, Søren Aagaard

    In this technical report we present the current state of the research conducted during the first part of the PhD period. The PhD thesis “Privacy Enforcement in a Cost-Effective Smart Grid” focuses on ensuring privacy when generating market for energy service providers that develop web services...... and privacy challenges that emerge when designing a system architecture and infrastructure. The resulting architecture is a consumer-centric and agent-based design and uses open Internet-based communication protocols for enabling interoperability while being cost-effective. Finally, the PhD report present...

  6. An experiment to assess the cost-benefits of code inspections in large scale software development

    Science.gov (United States)

    Porter, A.; Siy, H.; Toman, C. A.; Votta, L. G.

    1994-01-01

    This experiment (currently in progress) is designed to measure costs and benefits of different code inspection methods. It is being performed with a real development team writing software for a commercial product. The dependent variables for each code unit's inspection are the elapsed time and the number of defects detected. We manipulate the method of inspection by randomly assigning reviewers, varying the number of reviewers and the number of teams, and, when using more than one team, randomly assigning author repair and non-repair of detected defects between code inspections. After collecting and analyzing the first 17 percent of the data, we have discovered several interesting facts about reviewers, about the defects recorded during reviewer preparation and during the inspection collection meeting, and about the repairs that are eventually made. (1) Only 17 percent of the defects that reviewers record in their preparations are true defects that are later repaired. (2) Defects recorded at the inspection meetings fall into three categories: 18 percent false positives requiring no author repair, 57 percent soft maintenance where the author makes changes only for readability or code standard enforcement, and 25 percent true defects requiring repair. (3) The median elapsed calendar time for code inspections is 10 working days - 8 working days before the collection meeting and 2 after. (4) In the collection meetings, 31 percent of the defects discovered by reviewers during preparation are suppressed. (5) Finally, 33 percent of the true defects recorded are discovered at the collection meetings and not during any reviewer's preparation. The results to date suggest that inspections with two sessions (two different teams) of two reviewers per session (2sX2p) are the most effective. These two-session inspections may be performed with author repair or with no author repair between the two sessions. We are finding that the two-session, two-person with repair (2sX2p

  7. Cost-effectiveness of minimally invasive sacroiliac joint fusion

    Directory of Open Access Journals (Sweden)

    Cher DJ

    2015-12-01

    Full Text Available Daniel J Cher,1 Melissa A Frasco,2 Renée JG Arnold,2,3 David W Polly4,5 1Clinical Affairs, SI-BONE, Inc., San Jose, CA, USA; 2Division of Health Economics and Outcomes Research, Quorum Consulting, Inc., San Francisco, CA, USA; 3Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 4Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA; 5Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA Background: Sacroiliac joint (SIJ disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. Objective: To determine the cost-effectiveness of minimally invasive SIJ fusion. Methods: Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. Results: SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER <$26,000/QALY. Probabilistic analyses showed a high degree of certainty that the maximum ICER for SIJ fusion was less than commonly selected thresholds for acceptability (mean ICER =$13,687, 95% confidence interval $5,162–$28,085. SIJ fusion provided potential cost savings per QALY gained compared to non-surgical treatment after a treatment horizon of greater than 13 years. Conclusion: Compared to traditional non-surgical treatments

  8. Improved cost of energy comparison of permanent magnet generators for large offshore wind turbines

    NARCIS (Netherlands)

    Hart, K.; McDonald, A.; Polinder, H.; Corr, E.; Carroll, J.

    2014-01-01

    This paper investigates geared and direct-drive permanent magnet generators for a typical offshore wind turbine, providing a detailed comparison of various wind turbine drivetrain configurations in order to minimise the Cost of Energy. The permanent magnet generator topologies considered include a d

  9. Improved cost of energy comparison of permanent magnet generators for large offshore wind turbines

    NARCIS (Netherlands)

    Hart, K.; McDonald, A.; Polinder, H.; Corr, E.; Carroll, J.

    2014-01-01

    This paper investigates geared and direct-drive permanent magnet generators for a typical offshore wind turbine, providing a detailed comparison of various wind turbine drivetrain configurations in order to minimise the Cost of Energy. The permanent magnet generator topologies considered include a

  10. Modeling resilience, friability, and cost of an airport affected by the large-scale disruptive event

    NARCIS (Netherlands)

    Janic, M.

    2013-01-01

    This paper deals with modeling resilience, friability, and cost of an airport affected by the largescale disruptive event. These events affecting the airport's operations individually or in combination can be bad weather, failures of particular crucial aiiport and ATC (Air Traffic Control) component

  11. [Comparision of costs of secondary prevention and treatment of stroke--cost-effectiveness analysis].

    Science.gov (United States)

    Ceronja, Ivana; Sosić, Zvonko

    2011-01-01

    Cerebrovascular accident (CVA) is a serious complication of untreated arterial hypertension. The aim of this paper is to compare the cost of secondary prevention and treatment of CVA caused by untreated arterial hypertension. Cost-effectiveness analysis of diagnosis and therapy of arterial hypertension in comparison with CVA treatment. The cost of secondary prevention of CVA per patient per year in 2006. was 1.589,19 kunas, which comes to 15.107,75 kunas in thirty years of treatment (discount factor included), whereas a single CVA treatment was 17.207,54 kunas on average. In every 850 treatments of hypertension (NNT) comes a prevented CVA which is 1.350.811,5 kunas, and is therefore more expensive than a single CVA treatment. Secondary prevention has a long-term protective effect improving the patients' quality of life, inhibiting the potential post-CVA handicap and pre-retirement. Thus, the main advantage of both primary and secondary prevention is in their greater benefit for patients.

  12. Cost-Effectiveness of Decision Support Strategies in Acute Bronchitis.

    Science.gov (United States)

    Michaelidis, Constantinos I; Kern, Melissa S; Smith, Kenneth J

    2015-10-01

    A recent clinical trial suggests that printed (PDS) and computer decision support (CDS) interventions are safe and effective in reducing antibiotic use in acute bronchitis relative to usual care (UC). Our aim was to evaluate the cost-effectiveness of decision support interventions in reducing antibiotic use in acute bronchitis. We conducted a clinical trial-based cost-effectiveness analysis comparing UC, PDS and CDS for management of acute bronchitis. We assumed a societal perspective, 5-year program duration and 30-day time horizon. The U.S. population aged 13-64 years presenting with acute bronchitis in the ambulatory setting. Printed and computer decision support interventions relative to usual care. Cost per antibiotic prescription safely avoided. In the base case, PDS dominated UC and CDS, with lesser total costs (PDS: $2,574, UC: $2,768, CDS: $2,805) and fewer antibiotic prescriptions (PDS: 3.79, UC: 4.60, CDS: 3.95) per patient over 5 years. In one-way sensitivity analyses, PDS dominated UC across all parameter values, except when antibiotics reduced work loss by ≥ 1.9 days or the probability of hospitalization within 30 days was ≥ 0.9 % in PDS (base case: 0.2 %) or ≤ 0.4 % in UC (base case: 1.0 %). The dominance of PDS over CDS was sensitive both to probability of hospitalization and plausible variation in the adjusted odds of antibiotic use in both strategies. A PDS strategy to reduce antibiotic use in acute bronchitis is less costly and more effective than both UC and CDS strategies, although results were sensitive to variation in probability of hospitalization and the adjusted odds of antibiotic use. This simple, low-cost, safe, and effective intervention would be an economically reasonable component of a multi-component approach to address antibiotic overuse in acute bronchitis.

  13. Hepatocellular carcinoma: cost-effectiveness of screening. A systematic review

    Directory of Open Access Journals (Sweden)

    Ruggeri M

    2012-06-01

    Full Text Available Matteo RuggeriFacoltà di Economia, Università Cattolica del Sacro Cuore – sede di Roma, Rome, ItalyAbstract: Hepatocellular carcinoma (HCC is one of the most common tumors worldwide. HCC is a potential target for cancer surveillance (or screening as it occurs in well-defined, at-risk populations. Curative therapy is possible only for small tumors and screening strategy has been recommended by the US, Italian, and other international liver societies and is practiced widely, but its benefits are not clearly established. The objective of this study was to review the available evidence with respect to the cost-effectiveness of key technologies in the prevention HCC. The literature search was conducted with the support of PubMed. Firstly we selected articles by reading the abstracts. Secondly, we read the articles and the revision was further restricted, with the following as inclusion criteria: (1 full economic evaluation of HCC screening programs; (2 comparison between HCC techniques; (3 outcome measures expressed in terms of quality adjusted life years (QALY; (4 full text availability. The initial review of the literature yielded 346 articles. Of those, 288 were excluded at the first stage. Of those excluded, 108 did not meet the target, 106 did not present the cost analysis, 33 did not analyze the treatment of the disease, and in 41 the abstract was not available. Of the 58 included in the first step, seven examined the cost-effectiveness of different HCC screening techniques, seven investigated the cost-effectiveness of HCC screening versus no screening, and one looked at the cost-effectiveness of timing for HCC surveillance and monitoring, while 43 were about HBV vaccination and screening. We included only the seven articles examining the cost-effectiveness of different HCC screening techniques. In general, incidence is the key parameter which determines the cost-effectiveness of HCC screening. Discrepancies in the results exist when

  14. Pipeline cost reduction through effective project management and applied technology

    Energy Technology Data Exchange (ETDEWEB)

    Jenkins, A. [TransCanada Pipeline Ltd., Alberta (Canada); Babuk, T. [Empress International Inc., Westwood, NJ (United States); Mohitpour, M. [Tempsys Pipeline Solutions Inc., Vancouver, BC (Canada); Murray, M.A. [National Energy Board of Canada (Canada)

    2005-07-01

    Pipelines are regarded by many as passive structures with the technology involved in their construction and operation being viewed as relatively simple and stable. If such is the case how can there be much room for cost improvement? In reality, there have been many technological and regulatory innovations required within the pipeline industry to meet the challenges posed by ever increasing consumer demand for hydrocarbons, the effects of aging infrastructure and a need to control operating and maintenance expenditures. The importance of technology management, as a subset of overall project management, is a key element of life cycle cost control. Assurance of public safety and the integrity of the system are other key elements in ensuring a successful pipeline project. The essentials of best practise project management from an owner/ operator's perspective are set out in the paper. Particular attention is paid to the appropriate introduction of new technology, strategic procurement practice and material selection, indicating that capital cost savings of up to 15% are achievable without harming life cycle cost. The value of partnering leading to technical innovation, cost savings and improved profitability for all the participants is described. Partnering also helps avoid duplicated effort through the use of common tools for design, planning schedule tracking and reporting. Investing in appropriate technology development has been a major source of cost reduction in recent years and the impact of a number of these recently introduced technologies in the areas of materials, construction processes and operation and maintenance are discussed in the paper. (author)

  15. Climate targets and cost-effective climate stabilization pathways

    Science.gov (United States)

    Held, H.

    2015-08-01

    Climate economics has developed two main tools to derive an economically adequate response to the climate problem. Cost benefit analysis weighs in any available information on mitigation costs and benefits and thereby derives an "optimal" global mean temperature. Quite the contrary, cost effectiveness analysis allows deriving costs of potential policy targets and the corresponding cost- minimizing investment paths. The article highlights pros and cons of both approaches and then focusses on the implications of a policy that strives at limiting global warming to 2 °C compared to pre-industrial values. The related mitigation costs and changes in the energy sector are summarized according to the IPCC report of 2014. The article then points to conceptual difficulties when internalizing uncertainty in these types of analyses and suggests pragmatic solutions. Key statements on mitigation economics remain valid under uncertainty when being given the adequate interpretation. Furthermore, the expected economic value of perfect climate information is found to be on the order of hundreds of billions of Euro per year if a 2°-policy were requested. Finally, the prospects of climate policy are sketched.

  16. (Correcting misdiagnoses of asthma: a cost effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Vandemheen Katherine

    2011-05-01

    Full Text Available Abstract Background The prevalence of physician-diagnosed-asthma has risen over the past three decades and misdiagnosis of asthma is potentially common. Objective: to determine whether a secondary-screening-program to establish a correct diagnosis of asthma in those who report a physician diagnosis of asthma is cost effective. Method Randomly selected physician-diagnosed-asthmatic subjects from 8 Canadian cities were studied with an extensive diagnostic algorithm to rule-in, or rule-out, a correct diagnosis of asthma. Subjects in whom the diagnosis of asthma was excluded were followed up for 6-months and data on asthma medications and heath care utilization was obtained. Economic analysis was performed to estimate the incremental lifetime costs associated with secondary screening of previously diagnosed asthmatic subjects. Analysis was from the perspective of the Canadian healthcare system and is reported in Canadian dollars. Results Of 540 randomly selected patients with physician diagnosed asthma 150 (28%; 95%CI 19-37% did not have asthma when objectively studied. 71% of these misdiagnosed patients were on some asthma medications. Incorporating the incremental cost of secondary-screening for the diagnosis of asthma, we found that the average cost savings per 100 individuals screened was $35,141 (95%CI $4,588-$69,278. Conclusion Cost savings primarily resulted from lifetime costs of medication use averted in those who had been misdiagnosed.

  17. Cost-effective learning aids for a variety of learning styles

    Energy Technology Data Exchange (ETDEWEB)

    Wyckoff, D.J.

    1993-11-01

    Some people learn easily while others find learning difficult. Trainers need to provide a variety of cost-effective learning experiences to meet the needs of all individuals. There are four techniques that can be used individually, in small groups, or in a large group to achieve the required cost effectiveness and aid the learning process. The first is flash cards, the second in a simple computer board that lights up when correct matches are made. The third technique uses popular game show format wherein objectives are used as answers and trainees come up with the questions. Demonstrating the expected learning behavior is the fourth technique, accomplished by guided practice.

  18. [Cost-effectiveness of breast cancer screening policies in Mexico].

    Science.gov (United States)

    Valencia-Mendoza, Atanacio; Sánchez-González, Gilberto; Bautista-Arredondo, Sergio; Torres-Mejía, Gabriela; Bertozzi, Stefano M

    2009-01-01

    Generate cost-effectiveness information to allow policy makers optimize breast cancer (BC) policy in Mexico. We constructed a Markov model that incorporates four interrelated processes of the disease: the natural history; detection using mammography; treatment; and other competing-causes mortality, according to which 13 different strategies were modeled. Strategies (starting age, % of coverage, frequency in years)= (48, 25, 2), (40, 50, 2) and (40, 50, 1) constituted the optimal method for expanding the BC program, yielding 75.3, 116.4 and 171.1 thousand pesos per life-year saved, respectively. The strategies included in the optimal method for expanding the program produce a cost per life-year saved of less than two times the GNP per capita and hence are cost-effective according to WHO Commission on Macroeconomics and Health criteria.

  19. Theoretical thermodynamics for large molecules: walking the thin line between accuracy and computational cost.

    Science.gov (United States)

    Schwabe, Tobias; Grimme, Stefan

    2008-04-01

    The thermodynamic properties of molecules are of fundamental interest in physics, chemistry, and biology. This Account deals with the developments that we have made in the about last five years to find quantum chemical electronic structure methods that have the prospect of being applicable to larger molecules. The typical target accuracy is about 0.5-1 kcal mol(-1) for chemical reaction and 0.1 kcal mol(-1) for conformational energies. These goals can be achieved when a few physically motivated corrections to first-principles methods are introduced to standard quantum chemical techniques. These do not lead to a significantly increased computational expense, and thus our methods have the computer hardware requirements of the corresponding standard treatments. Together with the use of density-fitting (RI) integral approximations, routine computations on systems with about 100 non-hydrogen atoms (2000-4000 basis functions) can be performed on modern PCs. Our improvements regarding accuracy are basically due to the use of modified second-order perturbation theory to account for many-particle (electron correlation) effects. Such nonlocal correlations are responsible for important parts of the interaction in and between atoms and molecules. A common example is the long-range dispersion interaction that lead to van der Waals complexes, but as shown here also the conventional thermodynamics of large molecules is significantly influenced by intramolecular dispersion effects. We first present the basic theoretical ideas behind our approaches, which are the spin-component-scaled Møller-Plesset perturbation theory (SCS-MP2) and double-hybrid density functionals (DHDF). Furthermore, the effect of the independently developed empirical dispersion correction (DFT-D) is discussed. Together with the use of large atomic orbital basis sets (of at least triple- or quadruple-zeta quality), the accuracy of the new methods is even competitive with computationally very expensive coupled

  20. Optimizing bulk milk dioxin monitoring based on costs and effectiveness.

    Science.gov (United States)

    Lascano-Alcoser, V H; Velthuis, A G J; van der Fels-Klerx, H J; Hoogenboom, L A P; Oude Lansink, A G J M

    2013-07-01

    Dioxins are environmental pollutants, potentially present in milk products, which have negative consequences for human health and for the firms and farms involved in the dairy chain. Dioxin monitoring in feed and food has been implemented to detect their presence and estimate their levels in food chains. However, the costs and effectiveness of such programs have not been evaluated. In this study, the costs and effectiveness of bulk milk dioxin monitoring in milk trucks were estimated to optimize the sampling and pooling monitoring strategies aimed at detecting at least 1 contaminated dairy farm out of 20,000 at a target dioxin concentration level. Incidents of different proportions, in terms of the number of contaminated farms, and concentrations were simulated. A combined testing strategy, consisting of screening and confirmatory methods, was assumed as well as testing of pooled samples. Two optimization models were built using linear programming. The first model aimed to minimize monitoring costs subject to a minimum required effectiveness of finding an incident, whereas the second model aimed to maximize the effectiveness for a given monitoring budget. Our results show that a high level of effectiveness is possible, but at high costs. Given specific assumptions, monitoring with 95% effectiveness to detect an incident of 1 contaminated farm at a dioxin concentration of 2 pg of toxic equivalents/g of fat [European Commission's (EC) action level] costs €2.6 million per month. At the same level of effectiveness, a 73% cost reduction is possible when aiming to detect an incident where 2 farms are contaminated at a dioxin concentration of 3 pg of toxic equivalents/g of fat (EC maximum level). With a fixed budget of €40,000 per month, the probability of detecting an incident with a single contaminated farm at a dioxin concentration equal to the EC action level is 4.4%. This probability almost doubled (8.0%) when aiming to detect the same incident but with a dioxin

  1. How to Get Cost-Effectiveness Analysis Right? The Case of Vaccine Economics in Latin America.

    Science.gov (United States)

    Glassman, Amanda; Cañón, Oscar; Silverman, Rachel

    2016-12-01

    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.

  2. Cost effectiveness of Aedes aegypti control programmes: participatory versus vertical.

    Science.gov (United States)

    Baly, A; Toledo, M E; Boelaert, M; Reyes, A; Vanlerberghe, V; Ceballos, E; Carvajal, M; Maso, R; La Rosa, M; Denis, O; Van der Stuyft, P

    2007-06-01

    We conducted an economic appraisal of two strategies for Aedes aegypti control: a vertical versus a community-based approach. Costs were calculated for the period 2000-2002 in three pilot areas of Santiago de Cuba where a community intervention was implemented and compared with three control areas with routine vertical programme activities. Reduction in A. aegypti foci was chosen as the measure of effectiveness. The pre-intervention number of foci (614 vs. 632) and economical costs for vector control (US$243746 vs. US$263486) were comparable in the intervention and control areas. During the intervention period (2001-2002), a 13% decrease in recurrent costs for the health system was observed. Within the control areas, these recurrent relative costs remained stable. The number of A. aegypti foci in the pilot areas and the control areas fell by 459 and 467, respectively. The community-based approach was more cost effective from a health system perspective (US$964 vs. US$1406 per focus) as well as from society perspective (US$1508 vs. US$1767 per focus).

  3. Update on the management of cirrhosis – focus on cost-effective preventative strategies

    Directory of Open Access Journals (Sweden)

    Neff GW

    2013-04-01

    Full Text Available Guy W Neff,1 Nyingi Kemmer,1 Christopher Duncan,2 Angel Alsina1 1Tampa General Medical Group, Tampa, FL, 2Highline Gastroenterology, Seattle, WA, USA Abstract: Cirrhosis is a chronic liver disease stage that encompasses a variety of etiologies resulting in liver damage. This damage may induce secondary complications such as portal hypertension, esophageal variceal bleeding, spontaneous bacterial peritonitis, and hepatic encephalopathy. Screening for and management of these complications incurs substantial health care costs; thus, determining the most economical and beneficial treatment strategies is essential. This article reviews the economic impact of a variety of prophylactic and treatment regimens employed for cirrhosis-related complications. Prophylactic use of ß-adrenergic blockers for portal hypertension and variceal bleeding appears to be cost-effective, but the most economical regimen for treatment of initial bleeding is unclear given that cost comparisons of pharmacologic and surgical regimens are lacking. In contrast, prophylaxis for spontaneous bacterial peritonitis cannot be recommended. Standard therapy for spontaneous bacterial peritonitis includes antibiotics, and the overall economic impact of these medications depends largely on their direct cost. However, the potential development of bacterial antibiotic resistance and resulting clinical failure should also be considered. Nonabsorbable disaccharides are standard therapies for hepatic encephalopathy; however, given their questionable efficacy, the nonsystemic antibiotic rifaximin may be a more cost-effective, long-term treatment for hepatic encephalopathy, despite its increased direct cost, because of its demonstrated efficacy and prevention of hospitalization. Further studies evaluating the cost burden of cirrhosis and cirrhosis-related complications, including screening costs, the cost of treatment and maintenance therapy, conveyance to liver transplantation, liver

  4. Cost optimizing of large-scale offshore wind farms. Appendix E to J. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-07-01

    This Volume 3 contains reports prepared by SEAS Distribution A.m.b.A. and partly by Risoe National Laboratory. Appendix E: Grid connection. Appendix F: Review of potential offshore sites. Appendix G: Optimisation of wind farm layout. Appendix G.1: Evaluation of Power Production from Three Offshore Wind Farms. Appendix H: Investments, operation and maintenance costs. Appendix I: Authority approvals and environmental investigations. Appendix J: Outline description of demonstration project. Appendix G.1 has been prepared by Risoe National Laboratory. (au)

  5. Trade-off between cost and accuracy in large-scale surface water dynamic modeling

    Science.gov (United States)

    Getirana, Augusto; Peters-Lidard, Christa; Rodell, Matthew; Bates, Paul D.

    2017-06-01

    Recent efforts have led to the development of the local inertia formulation (INER) for an accurate but still cost-efficient representation of surface water dynamics, compared to the widely used kinematic wave equation (KINE). In this study, both formulations are evaluated over the Amazon basin in terms of computational costs and accuracy in simulating streamflows and water levels through synthetic experiments and comparisons against ground-based observations. Varying time steps are considered as part of the evaluation and INER at 60 s time step is adopted as the reference for synthetic experiments. Five hybrid (HYBR) realizations are performed based on maps representing the spatial distribution of the two formulations that physically represent river reach flow dynamics within the domain. Maps have fractions of KINE varying from 35.6 to 82.8%. KINE runs show clear deterioration along the Amazon river and main tributaries, with maximum RMSE values for streamflow and water level reaching 7827 m3 s-1 and 1379 cm near the basin's outlet. However, KINE is at least 25% more efficient than INER with low model sensitivity to longer time steps. A significant improvement is achieved with HYBR, resulting in maximum RMSE values of 3.9-292 m3 s-1 for streamflows and 1.1-28.5 cm for water levels, and cost reduction of 6-16%, depending on the map used. Optimal results using HYBR are obtained when the local inertia formulation is used in about one third of the Amazon basin, reducing computational costs in simulations while preserving accuracy. However, that threshold may vary when applied to different regions, according to their hydrodynamics and geomorphological characteristics.

  6. Comprehensive overview: efficacy, tolerability, and cost-effectiveness of irbesartan

    Directory of Open Access Journals (Sweden)

    Gialama F

    2013-10-01

    Full Text Available Fotini Gialama, Nikos ManiadakisHealth Services Organisation and Management, National School of Public Health, Athens, GreeceBackground: Hypertension represents a major health problem, affecting more than one billion adults worldwide. Irbesartan, an angiotensin II receptor blocker, is considered to be a highly effective treatment in the management of hypertension. The purpose of this review is to evaluate the efficacy, safety and tolerability profile, and cost-effectiveness of treatment with irbesartan in hypertension.Methods: A review of the literature was conducted using the electronic PubMed and Cochrane Library databases and the Health Economic Evaluations Database of search terms relating to irbesartan efficacy, tolerability, and cost-effectiveness, and the results were utilized.Results: Findings from the present analysis show that irbesartan either as monotherapy or in combination with other antihypertensive agents can achieve significant reductions in blood pressure, both systolic and diastolic, compared with alternative treatment options. Irbesartan was also found to have a renoprotective effect independent of its blood pressure-lowering in patients with type 2 diabetes and nephropathy. Furthermore, irbesartan demonstrated an excellent safety and tolerability profile, with either lower or equal adverse events compared with placebo and other alternative treatments. In terms of economic analyses, compared with other antihypertensive therapy alternatives, irbesartan was found to be a preferred option, that is less costly and more effective.Conclusion: The evidence indicates that treating patients with hypertension alone or with type 2 diabetes and nephropathy using irbesartan can control hypertension, prolong life, and reduce costs in relation to existing alternatives.Keywords: irbesartan, tolerability, safety, efficacy, cost-effectiveness, economic evaluation

  7. Cost-effectiveness of hepatitis a vaccination in indonesia

    NARCIS (Netherlands)

    Suwantika, A.A.; Beutels, P.; Postma, M.J.

    2014-01-01

    Objectives: This study aims to assess the cost-effectiveness of hepatitis A vaccination in Indonesia, including an explicit comparison between one-dose and twodose vaccines. Methods: An age-structured cohort model based on a decision tree was developed for the 2012 Indonesia birth cohort. Using the

  8. Cost-effectiveness of hepatitis A vaccination in Indonesia

    NARCIS (Netherlands)

    Suwantika, Auliya A.; Beutels, Philippe; Postma, Maarten J.

    2014-01-01

    Objective: This study aims to assess the cost-effectiveness of hepatitis A immunization in Indonesia, including an explicit comparison between one-dose and two-dose vaccines. Methods: An age-structured cohort model based on a decision tree was developed for the 2012 Indonesia birth cohort. Using the

  9. Cost-effectiveness of varenicline for smoking cessation

    DEFF Research Database (Denmark)

    Keiding, Hans

    2009-01-01

    Smoking cessation therapies are among the most cost-effective preventive healthcare measures. Varenicline is a relatively new drug developed especially for this purpose, and it has been shown to achieve better quit rates than nicotine replacement therapies and the non-nicotine-based drug, bupropion...

  10. The Cost Effectiveness of Hepatitis Immunization for US College Students

    Science.gov (United States)

    Jacobs, R. Jake; Saab, Sammy; Meyerhoff, Allen S.

    2003-01-01

    Hepatitis B immunization is recommended for all American children, and hepatitis A immunization is recommended for children who live in areas with elevated disease rates. Because hepatitis A and B occur most commonly in young adults, the authors examined the cost effectiveness of college-based vaccination. They developed epidemiologic models to…

  11. The Cost-Effectiveness of Atypicals in the UK

    NARCIS (Netherlands)

    Heeg, Bart; Buskens, Erik; Botteman, Marc; Caleo, Sue; Ingham, Mike; Damen, Joep; de Charro, Frank; van Hout, Ben

    2008-01-01

    Background: In 2002, the National Institute for Health and Clinical Excellence (NICE), recommended atypical antipsychotics over conventional ones for first-line schizophrenia treatment, based on their lower risk of extrapyramidal symptoms. Objective: To estimate the incremental cost-effectiveness of

  12. Cost-effectiveness modelling in diagnostic imaging: a stepwise approach

    NARCIS (Netherlands)

    Sailer, A.M.; Zwam, W.H. van; Wildberger, J.E.; Grutters, J.P.C.

    2015-01-01

    Diagnostic imaging (DI) is the fastest growing sector in medical expenditures and takes a central role in medical decision-making. The increasing number of various and new imaging technologies induces a growing demand for cost-effectiveness analysis (CEA) in imaging technology assessment. In this ar

  13. Cost-Effective School Alarm Systems. Security Topics Series.

    Science.gov (United States)

    Kaufer, Steve

    This document outlines considerations in the selection of a cost-effective school-alarm system. Steps in the planning process include: conducting a district needs assessment; gathering input from all staff levels; consulting technical expertise; and selecting a security system that can be integrated with other site needs. It further describes the…

  14. Cost-effectiveness of periconceptional supplementation of folic acid

    NARCIS (Netherlands)

    Postma, MJ; Londeman, J; Veenstra, M; de Walle, HEK; de Jong-van den Berg, LTW

    2002-01-01

    Background: Supplementation of folic acid prior to and in the beginning of pregnancy may prevent neural tube defects (NTDs) in newborns - such as spina bifida - and possibly other congenital malformations. Objective. To estimate cost effectiveness of periconceptional supplementation of folk: acid us

  15. Lifetime health effects and costs of diabetes treatment

    NARCIS (Netherlands)

    L.W. Niessen (Louis Wilhelmus); R. Dijkstra; R.C.W. Hutubessy (Raymond); G.E.H.M. Rutten (Guy); A.F. Casparie (Anton)

    2003-01-01

    textabstractBACKGROUND: This article presents cost-effectiveness analyses of the major diabetes interventions as formulated in the revised Dutch guidelines for diabetes type 2 patients in primary and secondary care. The analyses consider two types of care: diabetes control and the

  16. Cost-effective utilisation of basic biochemical laboratory ...

    African Journals Online (AJOL)

    Cost-effective use of laboratory investigations is vital in primary care. Tahir Pillay, MB ChB, ... He is passionate about strengthening the role of the generalist in healthcare in South Africa. Correspondence to: .... Laboratories can bill for this extra ...

  17. Videoconferencing a Stroke Assessment Training Workshop: Effectiveness, Acceptability, and Cost

    Science.gov (United States)

    Miller, Patricia A.; Huijbregts, Maria; French, Esme; Taylor, Denise; Reinikka, Kirsti; Berezny, Laura; Fry, Sherri; Grunin, Anna; Harvey, Melissa

    2008-01-01

    Introduction: Videoconferencing (VC) is becoming a common method for the delivery of continuing education (CE) to clinicians in remote locations. The purpose of this study was to compare the effectiveness, acceptability, and costs of a full-day training workshop (TW) delivered through two different formats: face-to-face (FTF) and VC. The TW was…

  18. Cost-Effectiveness Affirmative Reading Skills Program, 1984-85.

    Science.gov (United States)

    Gallagher, Michael P.

    The 1984-85 cost-effects study represents the third annual analysis of the components of Cleveland's Affirmative Reading Skills Plan, which offers three instructional strands--developmental (regular reading/language arts), support (additional enrichment, corrective or remedial), and compensatory (instruction for students having reading scores in…

  19. Cost Effectiveness of Current Awareness Sources in the Pharmaceutical Industry

    Science.gov (United States)

    Ashmole, R. F.; And Others

    1973-01-01

    The cost effectiveness of several commercial data bases, journal scanning by information scientists, and the impact of private communication are compared in this study. A previously developed technique for measuring the usefulness of commercial data bases is utilized. (21 references) (Author/KE)

  20. Final report: Compiled MPI. Cost-Effective Exascale Application Development

    Energy Technology Data Exchange (ETDEWEB)

    Gropp, William Douglas [Univ. of Illinois, Urbana-Champaign, IL (United States)

    2015-12-21

    This is the final report on Compiled MPI: Cost-Effective Exascale Application Development, and summarizes the results under this project. The project investigated runtime enviroments that improve the performance of MPI (Message-Passing Interface) programs; work at Illinois in the last period of this project looked at optimizing data access optimizations expressed with MPI datatypes.

  1. [Cost-effectiveness analysis of professional oral hygiene].

    Science.gov (United States)

    Olesov, E E; Shaĭmieva, N I; Kononenko, V I; Bersanov, R U; Monakova, N E

    2014-01-01

    Periodontal status and oral hygiene indexes were studied in 125 young employee of Kurchatov Institute. Oral hygiene values dynamic was assessed after professional oral hygiene in persons with unsatisfactory oral hygiene at baseline examination. When compared with the same values in the absence of professional oral hygiene procedures the results allowed calculating cost-effectiveness rate for biannual professional oral hygiene.

  2. Cost-effectiveness of PET and PET/Computed Tomography

    DEFF Research Database (Denmark)

    Gerke, Oke; Hermansson, Ronnie; Hess, Søren

    2015-01-01

    measure by means of incremental cost-effectiveness ratios when considering the replacement of the standard regimen by a new diagnostic procedure. This article discusses economic assessments of PET and PET/computed tomography reported until mid-July 2014. Forty-seven studies on cancer and noncancer...

  3. Environmental Effects of Large Impacts on Mars

    Science.gov (United States)

    Segura, Teresa L.; Toon, Owen B.; Colaprete, Anthony; Zahnle, Kevin

    2002-12-01

    The martian valley networks formed near the end of the period of heavy bombardment of the inner solar system, about 3.5 billion years ago. The largest impacts produced global blankets of very hot ejecta, ranging in thickness from meters to hundreds of meters. Our simulations indicated that the ejecta warmed the surface, keeping it above the freezing point of water for periods ranging from decades to millennia, depending on impactor size, and caused shallow subsurface or polar ice to evaporate or melt. Large impacts also injected steam into the atmosphere from the craters or from water innate to the impactors. From all sources, a typical 100-, 200-, or 250-kilometers asteroid injected about 2, 9, or 16 meters, respectively, of precipitable water into the atmosphere, which eventually rained out at a rate of about 2 meters per year. The rains from a large impact formed rivers and contributed to recharging aquifers.

  4. Cost Effective Technologies and Renewable Substrates for Biosurfactants’ Production

    Directory of Open Access Journals (Sweden)

    Ibrahim M Banat

    2014-12-01

    Full Text Available Diverse types of microbial surface-active amphiphilic molecules are produced by a range of microbial communities. The extraordinary properties of biosurfactant / bioemulsifier (BS/BE as surface active products allows them to have key roles in various field of applications such as bioremediation, biodegradation, enhanced oil recovery, pharmaceutics, food processing among many others. This leads to a vast number of potential applications of these BS/BE in different industrial sectors. Despite the huge number of reports and patents describing BS and BE applications and advantages, commercialization of these compounds remain difficult, costly and to a large extent irregular. This is mainly due to the usage of chemically synthesized media for growing producing microorganism and in turn the production of preferred quality products. It is important to note that although a number of developments have taken place in the field of biosurfactant industries, large scale production remains economically challenging for many types of these products. This is mainly due to the huge monetary difference between the investment and achievable productivity from the commercial point of view. This review discusses low cost, renewable raw substrates and fermentation technology in BS/BE production processes and their role in reducing the production cost.

  5. Cost effective technologies and renewable substrates for biosurfactants' production.

    Science.gov (United States)

    Banat, Ibrahim M; Satpute, Surekha K; Cameotra, Swaranjit S; Patil, Rajendra; Nyayanit, Narendra V

    2014-01-01

    Diverse types of microbial surface active amphiphilic molecules are produced by a range of microbial communities. The extraordinary properties of biosurfactant/bioemulsifier (BS/BE) as surface active products allows them to have key roles in various field of applications such as bioremediation, biodegradation, enhanced oil recovery, pharmaceutics, food processing among many others. This leads to a vast number of potential applications of these BS/BE in different industrial sectors. Despite the huge number of reports and patents describing BS and BE applications and advantages, commercialization of these compounds remain difficult, costly and to a large extent irregular. This is mainly due to the usage of chemically synthesized media for growing producing microorganism and in turn the production of preferred quality products. It is important to note that although a number of developments have taken place in the field of BS industries, large scale production remains economically challenging for many types of these products. This is mainly due to the huge monetary difference between the investment and achievable productivity from the commercial point of view. This review discusses low cost, renewable raw substrates, and fermentation technology in BS/BE production processes and their role in reducing the production cost.

  6. Knowledge of the Costs of Diagnostic Imaging: A Survey of Physician Trainees at a Large Academic Medical Center.

    Science.gov (United States)

    Vijayasarathi, Arvind; Duszak, Richard; Gelbard, Rondi B; Mullins, Mark E

    2016-11-01

    To study the awareness of postgraduate physician trainees across a variety of specialties regarding the costs of common imaging examinations. During early 2016, we conducted an online survey of all 1,238 physicians enrolled in internships, residencies, and fellowships at a large academic medical center. Respondents were asked to estimate Medicare national average total allowable fees for five commonly performed examinations: two-view chest radiograph, contrast-enhanced CT abdomen and pelvis, unenhanced MRI lumbar spine, complete abdominal ultrasound, and unenhanced CT brain. Responses within ±25% of published amounts were deemed correct. Respondents were also asked about specialty, postgraduate year of training, previous radiology education, and estimated number of imaging examinations ordered per week. A total of 381 of 1,238 trainees returned complete surveys (30.8%). Across all five examinations, only 5.7% (109/1,905) of responses were within the correct ±25% range. A total of 76.4% (291/381) of all respondents incorrectly estimated every examination's cost. Estimation accuracy was not associated with number of imaging examinations ordered per week or year of training. There was no significant difference in cost estimation accuracy between those who participated in medical school radiology electives and those who did not (P = .14). Only 17.5% of trainees considered their imaging cost knowledge adequate. Overall, 75.3% desire integration of cost data into clinical decision support and/or computerized physician order entry systems. Postgraduate physician trainees across all disciplines demonstrate limited awareness of the costs of commonly ordered imaging examinations. Targeted medical school education and integration of imaging cost information into clinical decision support / computerized physician order entry systems seems indicated. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  7. Cost Effective Polymer Solar Cells Research and Education

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Sam-Shajing [Norfolk State Univ, Norfolk, VA (United States)

    2015-10-13

    The technical or research objective of this project is to investigate and develop new polymers and polymer based optoelectronic devices for potentially cost effective (or cost competitive), durable, lightweight, flexible, and high efficiency solar energy conversion applications. The educational objective of this project includes training of future generation scientists, particularly young, under-represented minority scientists, working in the areas related to the emerging organic/polymer based solar energy technologies and related optoelectronic devices. Graduate and undergraduate students will be directly involved in scientific research addressing issues related to the development of polymer based solar cell technology.

  8. Cost-effectiveness of varenicline and three different behavioral treatment formats for smoking cessation.

    Science.gov (United States)

    Javitz, Harold S; Zbikowski, Susan M; Deprey, Mona; McAfee, Timothy A; McClure, Jennifer B; Richards, Julie; Catz, Sheryl L; Jack, Lisa M; Swan, Gary E

    2011-03-01

    There is a lack of evidence of the relative cost-effectiveness of proactive telephone counseling (PTC) and Web-based delivery of smoking cessation services in conjunction with pharmacotherapy. We calculated the differential cost-effectiveness of three behavioral smoking cessation modalities with varenicline treatment in a randomized trial of current smokers from a large health system. Eligible participants were randomized to one of three smoking cessation interventions: Web-based counseling (n=401), PTC (n=402), or combined PTC-Web counseling (n=399). All participants received a standard 12-week course of varenicline. The primary outcome was a 7-day point prevalent nonsmoking at the 6month follow-up. The Web intervention was the least expensive followed by the PTC and PTC-Web groups. Costs per additional 6-month nonsmoker and per additional lifetime quitter were $1,278 and $2,601 for Web, $1,472 and $2,995 for PTC, and $1,617 and $3,291 for PTC-Web. Cost per life-year (LY) and quality-adjusted life-year (QALY) saved were $1,148 and $1,136 for Web, $1,320 and $1,308 for PTC, and $1,450 and $1,437 for PTC-Web. Based on the cost per LY and QALY saved, these interventions are among the most cost-effective life-saving medical treatments. Web, PTC, and combined PTC-Web treatments were all highly cost-effective, with the Web treatment being marginally more cost-effective than the PTC or combined PTC-Web treatments.

  9. Effectiveness, safety and costs of orphan drugs: an evidence-based review.

    Science.gov (United States)

    Onakpoya, Igho J; Spencer, Elizabeth A; Thompson, Matthew J; Heneghan, Carl J

    2015-06-24

    Several orphan drugs have been approved by the European Medicines Agency (EMA) over the past two decades. However, the drugs are expensive, and in some instances, the evidence for effectiveness is not convincing at the time of regulatory approval. Our objective was to evaluate the clinical effectiveness of orphan drugs that have been granted marketing licenses in Europe, determine the annual costs of each drug, compare the costs of branded orphan drugs against their generic equivalents, and explore any relationships between orphan drug disease prevalence and annual costs. We searched the EMA database to identify orphan drugs granted marketing authorisation up to April 2014. Electronic searches were also conducted in PubMed, EMBASE and Google Scholar, to assess data on effectiveness, safety and annual costs. 2 reviewers independently evaluated the levels and quality of evidence, and extracted data. We identified 74 orphan drugs, with 54 (73%) demonstrating moderate quality of evidence. 85% showed significant clinical effects, but serious adverse events were reported in 86.5%. Their annual costs were between £726 and £378,000. There was a significant inverse relationship between disease prevalence and annual costs (p = 0.01); this was largely due to the influence of the ultra-orphan diseases. We could not determine whether the balance between effectiveness and safety influenced annual costs. For 10 drugs where generic alternatives were available, the branded drugs were 1.4 to 82,000 times more expensive. The available evidence suggests that there is inconsistency in the quality of evidence of approved orphan drugs, and there is no clear mechanism for determining their prices. In some cases, far cheaper generic agents appear to be available. A more robust, transparent and standard mechanism for determining annual costs is imperative. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  10. Cost effectiveness of adopted quality requirements in hospital laboratories.

    Science.gov (United States)

    Hamza, Alneil; Ahmed-Abakur, Eltayib; Abugroun, Elsir; Bakhit, Siham; Holi, Mohamed

    2013-01-01

    The present study was designed in quasi-experiment to assess adoption of the essential clauses of particular clinical laboratory quality management requirements based on international organization for standardization (ISO 15189) in hospital laboratories and to evaluate the cost effectiveness of compliance to ISO 15189. The quality management intervention based on ISO 15189 was conceded through three phases; pre - intervention phase, Intervention phase and Post-intervention phase. In pre-intervention phase the compliance to ISO 15189 was 49% for study group vs. 47% for control group with P value 0.48, while the post intervention results displayed 54% vs. 79% for study group and control group respectively in compliance to ISO 15189 and statistically significant difference (P value 0.00) with effect size (Cohen's d) of (0.00) in pre-intervention phase and (0.99) in post - intervention phase. The annual average cost per-test for the study group and control group was 1.80 ± 0.25 vs. 1.97 ± 0.39, respectively with P value 0.39 whereas the post-intervention results showed that the annual average total costs per-test for study group and control group was 1.57 ± 0.23 vs 2.08 ± 0.38, P value 0.019 respectively, with cost-effectiveness ratio of (0.88) in pre -intervention phase and (0.52) in post-intervention phase. The planned adoption of quality management requirements (QMS) in clinical laboratories had great effect to increase the compliance percent with quality management system requirement, raise the average total cost effectiveness, and improve the analytical process capability of the testing procedure.

  11. Cost-Effectiveness of Home Energy Retrofits in Pre-Code Vintage Homes in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Fairey, P.; Parker, D.

    2012-11-01

    This analytical study examines the opportunities for cost-effective energy efficiency and renewable energy retrofits in residential archetypes constructed prior to 1980 (Pre-Code) in fourteen U.S. cities. These fourteen cities are representative of each of the International Energy Conservation Code (IECC) climate zones in the contiguous U.S. The analysis is conducted using an in-house version of EnergyGauge USA v.2.8.05 named CostOpt that has been programmed to perform iterative, incremental economic optimization on a large list of residential energy efficiency and renewable energy retrofit measures. The principle objectives of the study are as follows: to determine the opportunities for cost effective source energy reductions in this large cohort of existing residential building stock as a function of local climate and energy costs; and to examine how retrofit financing alternatives impact the source energy reductions that are cost effectively achievable.

  12. Low-cost Photoacoustic-based Measurement System for Carbon Dioxide Fluxes with the Potential for large-scale Monitoring

    Science.gov (United States)

    Scholz, L. T.; Bierer, B.; Ortiz Perez, A.; Woellenstein, J.; Sachs, T.; Palzer, S.

    2016-12-01

    The determination of carbon dioxide (CO2) fluxes between ecosystems and the atmosphere is crucial for understanding ecological processes on regional and global scales. High quality data sets with full uncertainty estimates are needed to evaluate model simulations. However, current flux monitoring techniques are unsuitable to provide reliable data of a large area at both a detailed level and an appropriate resolution, at best in combination with a high sampling rate. Currently used sensing technologies, such as non-dispersive infrared (NDIR) gas analyzers, cannot be deployed in large numbers to provide high spatial resolution due to their costs and complex maintenance requirements. Here, we propose a novel CO2 measurement system, whose gas sensing unit is made up of low-cost, low-power consuming components only, such as an IR-LED and a photoacoustic detector. The sensor offers a resolution of costs favor the manufacturing in large quantities. This allows the operation of multiple sensors at a reasonable price and thus provides concentration measurements at any desired spatial coverage and at high temporal resolution. With appropriate 3D configuration of the units, vertical and horizontal fluxes can be determined. By applying a closely meshed wireless sensor network, inhomogeneities as well as CO2 sources and sinks in the lower atmosphere can be monitored. In combination with sensors for temperature, pressure and humidity, our sensor paves the way towards the reliable and extensive monitoring of ecosystem-atmosphere exchange rates. The technique can also be easily adapted to other relevant greenhouse gases.

  13. A cost-effective climastrategy; En omkostningseffektiv klimastrategi

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2003-02-01

    As a consequence of the 1997 Kyoto Protocol and the subsequent 1998 EU Burden Sharing Agreement, Denmark is committed to reducing its average annual greenhouse gas emissions in the period 2008-2012 by 21% in relation to the basis year, 1990. Excess emissions in relation to the reduction commitments are expected to be 25 million tonnes CO{sub 2} equivalents per year, corresponding to approximately 30% of expected emissions in the period 2008-2012, if calculations are based on Denmark's legal commitment under the EU Burden Sharing Agreement, which is significantly more than previously estimated. The legal commitment is based on figures not corrected for the especially large import of electricity in the basis year, 1990. At the Council meeting in connection with ratification of the Kyoto Protocol on 4 March 2002, Denmark did however achieve agreement on a political declaration. According to the declaration, Denmark's claim for adjusted electricity imports for the basis year, 1990, will be considered when individual Member State reductions in tonnes are finally determined in 2006. If the claimed correction is fully taken account of, Danish excess emissions will be reduced by 5 million tonnes CO{sub 2} equivalents per year. Flexible mechanisms, i.e. trading in the so-called credits from CO{sub 2} reduction projects in developing countries and in Central and Eastern Europe as well as trading in CO{sub 2} quotas, may contribute to fulfilling Denmark's reduction commitments. This reflects the fact that greenhouse gas emissions are a global problem that must be solved by ensuring the most cost-effective reduction at global level. Furthermore, flexible mechanisms can contribute to developing the countries in question through the transfer of know-how and capital. (ba)

  14. Cost effectiveness of ergonomic redesign of electronic motherboard.

    Science.gov (United States)

    Sen, Rabindra Nath; Yeow, Paul H P

    2003-09-01

    A case study to illustrate the cost effectiveness of ergonomic redesign of electronic motherboard was presented. The factory was running at a loss due to the high costs of rejects and poor quality and productivity. Subjective assessments and direct observations were made on the factory. Investigation revealed that due to motherboard design errors, the machine had difficulty in placing integrated circuits onto the pads, the operators had much difficulty in manual soldering certain components and much unproductive manual cleaning (MC) was required. Consequently, there were high rejects and occupational health and safety (OHS) problems, such as, boredom and work discomfort. Also, much labour and machine costs were spent on repairs. The motherboard was redesigned to correct the design errors, to allow more components to be machine soldered and to reduce MC. This eliminated rejects, reduced repairs, saved US dollars 581495/year and improved operators' OHS. The customer also saved US dollars 142105/year on loss of business.

  15. An Improved, Efficient and Cost Effective Software Inspection Meeting Process

    Directory of Open Access Journals (Sweden)

    Dilawar Ali

    2013-02-01

    Full Text Available Normally, the inspection process is seemed to be just finding defects in software during software development process lifecycle. Software inspection is considered as a most cost effective technique, but if these defects are not properly corrected or handled it would cost you more than double later in the project. This paper focus on the last phase of inspection meeting process showing the importance of Follow-Up Stage in software inspection meeting process. This paper also suggests a set of activities that should be performed during the Rework and Follow-Up Stages so to get inspection meeting results productive and efficient. In this paper we focus on the over the shoulder reviews so to ensure the software quality having less impact on the total software cost.

  16. Hospitalization for pelvic inflammatory disease: a cost-effectiveness analysis.

    Science.gov (United States)

    Smith, Kenneth J; Ness, Roberta B; Roberts, Mark S

    2007-02-01

    Nulliparous women are frequently hospitalized for treatment of pelvic inflammatory disease (PID). The goal of this study was to determine the economic feasibility of hospitalizing adolescents and young women for PID. The authors conducted a Markov decision model, estimating the cost-effectiveness of hospitalization compared with outpatient therapy for mild to moderate PID for adolescents and young women, calculating costs per quality-adjusted life-year (QALY) gained under various assumptions about hospitalization effects on complications. If hospitalization decreases PID complications by 10%, 20%, or 30%, the cost/QALY gained is 145,000 dollars, 67,400 dollars, or 42,400 dollars, respectively, compared with outpatient therapy. Assumptions about hospitalization effects on the development of chronic pelvic pain heavily weight the analysis; costs/QALY gained by hospitalization increase considerably if chronic pain is unaffected. Hospitalization for PID treatment to possibly preserve fertility in nulliparous young women and adolescents is unlikely to be economically reasonable even if substantial improvements in PID complication rates are assumed.

  17. Time Overrun and Cost Effectiveness in the Construction Industry

    Directory of Open Access Journals (Sweden)

    T.Subramani

    2014-06-01

    Full Text Available The project management technique of planning and scheduling using tools and devices are helpful in comparing the project with stipulated cost, time and quality. Resource tracking, Minimize the uncertainty and Cost Effectiveness is focused in this project. The software tool used for planning and scheduling is Primavera project planner enterprise for construction. The study covers three case studies of the process of planning, scheduling the activities and monitoring. A general re sequencing model had been proposed to overcome the delay factor from the critical area, to minimize the delay of the construction and to reduce the time, cost and it also helpful to concentrate on the major areas in the project. Re sequencing model leads the management to cost savings and make entire project success. Resource planning is one aspect, which decides the systematic execution of the project at worksite. This study is to have hands- on experience in an ongoing project, and evaluation of schedule of equipment, staff, Labor and Materials. It helps to plan and evaluate the resources for the Construction of the building project. This study also compares the cost variation due to the delay of the project and re scheduling the project by crashing process. KEYWORDS:

  18. StarTram: Ultra Low Cost Launch For Large Space Architectures

    Science.gov (United States)

    Powell, J.; Maise, G.; Paniagua, J.

    2004-02-01

    The StarTram Maglev system can launch hundreds of thousands of tons of cargo per year to orbit (~1000 times present capability) plus many thousands of passengers. The launch cost is only $30/kilogram of cargo, ~ 1/300 th of present cost. Magnetically levitated spacecraft accelerate to >=8 km/see in an evacuated ground tunnel using superconducting (SC) Maglev technology now operating in Japan for high speed trains. No propellant is used; energy from the electrical grid costs $0.50 per kg of launch weight. After reaching orbital speed, the levitated craft ascend in a curving evacuated launch tube that is magnetically levitated above Earth's surface by the repulsion force between SC cables attached to it and an opposing set of SC cables on the surface. The levitation force is 4 tons/meter of tube length at 20 km altitude, and exceeds the tube weight. High strength Kevlar tethers to the ground prevent vertical and lateral motion. Craft enter the atmosphere at 20 km through an open exit that prevents in-leakage of low density air by high speed gas ejectors and an MHD (Magnetic Hydro Dynamic) pump, and coast to apogee, where a small V burn (~500 m/s) establishes orbit. Deceleration as it enters the atmosphere at 20 km is modest, ~1 g. Peak heating is ~5 KW/cm2 for times of a few seconds before the craft reaches space. The technology for StarTram-C now exists, and no breakthroughs in materials are required. Two possible StarTram systems are compared, one for cargo only, and the second for both passengers and cargo.

  19. Assessing the Cost of Large-Scale Power Outages to Residential Customers.

    Science.gov (United States)

    Baik, Sunhee; Davis, Alexander L; Morgan, M Granger

    2017-06-29

    Residents in developed economies depend heavily on electric services. While distributed resources and a variety of new smart technologies can increase the reliability of that service, adopting them involves costs, necessitating tradeoffs between cost and reliability. An important input to making such tradeoffs is an estimate of the value customers place on reliable electric services. We develop an elicitation framework that helps individuals think systematically about the value they attach to reliable electric service. Our approach employs a detailed and realistic blackout scenario, full or partial (20 A) backup service, questions about willingness to pay (WTP) using a multiple bounded discrete choice method, information regarding inconveniences and economic losses, and checks for bias and consistency. We applied this method to a convenience sample of residents in Allegheny County, Pennsylvania, finding that respondents valued a kWh for backup services they assessed to be high priority more than services that were seen as low priority ($0.75/kWh vs. $0.51/kWh). As more information about the consequences of a blackout was provided, this difference increased ($1.2/kWh vs. $0.35/kWh), and respondents' uncertainty about the backup services decreased (Full: $11 to $9.0, Partial: $13 to $11). There was no evidence that the respondents were anchored by their previous WTP statements, but they demonstrated only weak scope sensitivity. In sum, the consumer surplus associated with providing a partial electric backup service during a blackout may justify the costs of such service, but measurement of that surplus depends on the public having accurate information about blackouts and their consequences. © 2017 Society for Risk Analysis.

  20. Cost-effectiveness of Family-Based Obesity Treatment.

    Science.gov (United States)

    Quattrin, Teresa; Cao, Ying; Paluch, Rocco A; Roemmich, James N; Ecker, Michelle A; Epstein, Leonard H

    2017-09-01

    We translated family-based behavioral treatment (FBT) to treat children with overweight and obesity and their parents in the patient-centered medical home. We reported greater reductions in child and parent weight at 6 and 24 months compared with an attention-controlled information control (IC) group. This article reports the cost-effectiveness of long-term weight change for FBT compared with IC. Ninety-six children 2 to 5 years of age with overweight or obesity and with parents who had a BMI ≥25 were randomly assigned to FBT or IC, and both received diet and activity education (12-month treatment and 12-month follow-up). Weight loss and cost-effectiveness were assessed at 24 months. Intention-to-treat, completers, and sensitivity analyses were performed. The average societal cost per family was $1629 for the FBT and $886 for the IC groups at 24 months. At 24 months, child percent over BMI (%OBMI) change decreased by 2.0 U in the FBT group versus an increase of 4.4 U in the IC group. Parents lost 6.0 vs 0.2 kg at 24 months in the FBT and IC groups, respectively. The incremental cost-effectiveness ratios (ICERs) for children and parents' %OBMI were $116.1 and $83.5 per U of %OBMI, respectively. Parental ICERs were also calculated for body weight and BMI and were $128.1 per 1, and $353.8/ per kilogram, respectively. ICER values for child %OBMI were similar in the intention-to-treat group ($116.1/1 U decrease) compared with completers ($114.3). For families consisting of children and parents with overweight, FBT presents a more cost-effective alternative than an IC group. Copyright © 2017 by the American Academy of Pediatrics.

  1. What can transaction costs tell us about governance in the delivery of large scale HIV prevention programmes in southern India?

    Science.gov (United States)

    Guinness, Lorna

    2011-06-01

    This paper aims to understand the transaction costs implications of two different governance modes for large scale contracting of HIV prevention services to non-governmental organisations (NGOs) in 2 states in India as part of the National AIDS Control Programme between 2001 and 2003. Interviews at purposively selected case study NGOs, contracting agencies and key informants as well as document review were used to compile qualitative data and make comparisons between the states on five themes theoretically proposed to shape transaction costs: institutional environment, informational problems, opportunism, scale of activity and asset specificity (the degree to which investments made specifically for the contract have value elsewhere). The State AIDS Control Society (SACS) in state Y used a management agency to manage the NGO contracts whereas the SACS in state X contracted directly with the NGOs. A high level of uncertainty, endemic corruption and weak information systems served to weaken the contractual relationships in both states. The management agency in state Y enabled the development of a strong NGO network, greater transparency and control over corrupt practises than the contract model in state X. State X's contractual process was further weakened by inadequate human resources. The application of the transaction cost framework to contracting out public services to NGOs identified the key costs associated with the governance of HIV prevention services through NGO contracts in India. A more successful form of relational contract evolved within the network of the contract management agency and the NGOs. This led to improved flows of information and perceived quality, and limited corrupt practises. It is unlikely that the SACS on its own, with broader responsibilities and limited autonomy can achieve the same ends. The management agency approach therefore appears to be both transaction cost reducing and better able to cope with the large scale of these

  2. Cost effectiveness of a protocol using palivizumab in preterm infants

    Directory of Open Access Journals (Sweden)

    Yolanda Hernández-Gago

    2017-03-01

    Full Text Available Objective: The main objective was to evaluate the cost-effectiveness of protocol use of palivizumab in premature established by consensus in our Hospital comparing it based on the recommendations of various Scientific Societies. As a secondary objective risk factors and severity of hospitalized patients attending the established protocol in our Hospital were analyzed. Methods: The study period was 4 seasons with the expanded protocol (retrospective data versus 2 with restricted or agreed protocol (prospective data. The perspective of the study was the Health System, including the costs of hospitalization and palivizumab our center. The calculation of the effectiveness was determined with the admission rate of premature patients stratified by weeks of gestational age <29, <32; and <35. For the analysis of risk factors and severity in patients admitted seasons with the new protocol are collected prospectively clinical data and environmental and social factors. Results: In the range of gestational age <29 years old and <32 greater effectiveness of the extended protocol was not demonstrated against the consensus. Only more effective for EG <35 in the accumulated data and comparing seasons 12/13 and 08/09 to 13/14 for individual data was observed. This range has an associated incremental cost effectiveness ratio of € 53 250,07 (range: € 14 793,39 to € 90 446,47 for singles data and € 50 525,53 (€ 28 688.22 to € 211 575,65 for accumulated. The establishment of this protocol in our center meant an average saving per season € 169 911,51. A cost- effectiveness of the extended protocol appropriate relationship is found if the cost of palivizumab per patient was less than € 1 206,67 (calculated for maximum use of the vial and a higher rate of hospitalization of 9.21%. Children entering the season with the new protocol (season 12/13 and 13/14 are 63.4% in children under 3 months and 90% are term infants who do not belong to any population at

  3. Strengthening Cost-Effectiveness Analysis for Public Health Policy.

    Science.gov (United States)

    Russell, Louise B; Sinha, Anushua

    2016-05-01

    Although the U.S. spends more on medical care than any country in the world, Americans live shorter lives than the citizens of other high-income countries. Many important opportunities to improve this record lie outside the health sector and involve improving the conditions in which Americans live and work: safe design and maintenance of roads, bridges, train tracks, and airports; control of environmental pollutants; occupational safety; healthy buildings; a safe and healthy food supply; safe manufacture of consumer products; a healthy social environment; and others. Faced with the overwhelming array of possibilities, U.S. decision makers need help identifying those that can contribute the most to health. Cost-effectiveness analysis is designed to serve that purpose, but has mainly been used to assess interventions within the health sector. This paper briefly reviews the objective of cost-effectiveness analysis and its methodologic evolution and discusses the issues that arise when it is used to evaluate interventions that fall outside the health sector under three headings: structuring the analysis, quantifying/measuring benefits and costs, and valuing benefits and costs.

  4. [Cost-effectiveness analysis on colorectal cancer screening program].

    Science.gov (United States)

    Huang, Q C; Ye, D; Jiang, X Y; Li, Q L; Yao, K Y; Wang, J B; Jin, M J; Chen, K

    2017-01-10

    Objective: To evaluate the cost-effectiveness of colorectal cancer screening program in different age groups from the view of health economics. Methods: The screening compliance rates, detection rates in different age groups were calculated by using the data from colorectal cancer screening program in Jiashan county, Zhejiang province. The differences in indicator among age groups were analyzed with χ(2) test or trend χ(2) test. The ratios of cost to the number of case were calculated according to cost statistics. Results: The detection rates of immunochemical fecal occult blood test (iFOBT) positivity, advanced adenoma and colorectal cancer and early stage cancer increased with age, while the early diagnosis rates were negatively associated with age. After exclusion the younger counterpart, the cost-effectiveness of individuals aged >50 years could be reduced by 15%-30%. Conclusion: From health economic perspective, it is beneficial to start colorectal cancer screening at age of 50 years to improve the efficiency of the screening.

  5. Cost-effective framework for basic surgical skills training.

    Science.gov (United States)

    Jiang, Deng-Jin; Wen, Chan; Yang, Ai-Jun; Zhu, Zhi-Li; Lei, Yan; Lan, Yang-Jun; Huang, Qing-Yuan; Hou, Xiao-Yu

    2013-06-01

    The importance of basic surgical skills is entirely agreed among surgical educators. However, restricted by ethical issues, finance etc, the basic surgical skills training is increasingly challenged. Increasing cost gives an impetus to the development of cost-effective training models to meet the trainees' acquisition of basic surgical skills. In this situation, a cost-effective training framework was formed in our department and introduced here. Each five students were assigned to a 'training unit'. The training was implemented weekly for 18 weeks. The framework consisted of an early, a transitional, an integrative stage and a surgical skills competition. Corresponding training modules were selected and assembled scientifically at each stage. The modules comprised campus intranet databases, sponge benchtop, nonliving animal tissue, local dissection specimens and simulating reality operations. The training outcomes used direct observation of procedural skills as an assessment tool. The training data of 50 trainees who were randomly selected in each year from 2006 to 2011 year, were retrospectively analysed. An excellent and good rate of the surgical skills is from 82 to 88%, but there is no significant difference among 6 years (P > 0.05). The skills scores of the contestants are markedly higher than those of non-contestants (P < 0.05). The average training cost per trainee is about $21.85-34.08. The present training framework is reliable, feasible, repeatable and cost-effective. The skills competition can promote to improve the surgical skills level of trainees. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

  6. Environmental cost-effectiveness analysis in intertemporal natural resource policy: evaluation of selective fishing gear.

    Science.gov (United States)

    Kronbak, Lone Grønbæk; Vestergaard, Niels

    2013-12-15

    In most decision-making involving natural resources, the achievements of a given policy (e.g., improved ecosystem or biodiversity) are rather difficult to measure in monetary units. To address this problem, the current paper develops an environmental cost-effectiveness analysis (ECEA) to include intangible benefits in intertemporal natural resource problems. This approach can assist managers in prioritizing management actions as least cost solutions to achieve quantitative policy targets. The ECEA framework is applied to a selective gear policy case in Danish mixed trawl fisheries in Kattegat and Skagerrak. The empirical analysis demonstrates how a policy with large negative net benefits might be justified if the intangible benefits are included.

  7. Cost Reduction of Large Eddy Simulation of Airfoils in Turbulent Inflow

    DEFF Research Database (Denmark)

    Gilling, Lasse; Sørensen, Niels; Rethore, Pierre-Elouan

    2009-01-01

    This paper discusses simulations of airfoil flows by use of computational fluid dynamics. In recent work large eddy simulations (LES) of airfoil flows have proved superior to detached eddy simulations (DES); by resolving the inflow turbulence the agreement with experiments is improved. The scope...

  8. Reducing the Runtime Acceptance Costs of Large-Scale Distributed Component-Based Systems

    NARCIS (Netherlands)

    Gonzalez, A.; Piel, E.; Gross, H.G.

    2008-01-01

    Software Systems of Systems (SoS) are large-scale distributed component-based systems in which the individual components are elaborate and complex systems in their own right. Distinguishing characteristics are their short expected integration and deployment time, and the need to modify their archite

  9. Reducing the Runtime Acceptance Costs of Large-Scale Distributed Component-Based Systems

    NARCIS (Netherlands)

    Gonzalez, A.; Piel, E.; Gross, H.G.

    2008-01-01

    Software Systems of Systems (SoS) are large-scale distributed component-based systems in which the individual components are elaborate and complex systems in their own right. Distinguishing characteristics are their short expected integration and deployment time, and the need to modify their

  10. Assessing Cost-Effectiveness in Obesity (ACE-Obesity: an overview of the ACE approach, economic methods and cost results

    Directory of Open Access Journals (Sweden)

    Swinburn Boyd

    2009-11-01

    Full Text Available Abstract Background The aim of the ACE-Obesity study was to determine the economic credentials of interventions which aim to prevent unhealthy weight gain in children and adolescents. We have reported elsewhere on the modelled effectiveness of 13 obesity prevention interventions in children. In this paper, we report on the cost results and associated methods together with the innovative approach to priority setting that underpins the ACE-Obesity study. Methods The Assessing Cost Effectiveness (ACE approach combines technical rigour with 'due process' to facilitate evidence-based policy analysis. Technical rigour was achieved through use of standardised evaluation methods, a research team that assembles best available evidence and extensive uncertainty analysis. Cost estimates were based on pathway analysis, with resource usage estimated for the interventions and their 'current practice' comparator, as well as associated cost offsets. Due process was achieved through involvement of stakeholders, consensus decisions informed by briefing papers and 2nd stage filter analysis that captures broader factors that influence policy judgements in addition to cost-effectiveness results. The 2nd stage filters agreed by stakeholders were 'equity', 'strength of the evidence', 'feasibility of implementation', 'acceptability to stakeholders', 'sustainability' and 'potential for side-effects'. Results The intervention costs varied considerably, both in absolute terms (from cost saving [6 interventions] to in excess of AUD50m per annum and when expressed as a 'cost per child' estimate (from Conclusion The use of consistent methods enables valid comparison of potential intervention costs and cost-offsets for each of the interventions. ACE-Obesity informs policy-makers about cost-effectiveness, health impact, affordability and 2nd stage filters for important options for preventing unhealthy weight gain in children. In related articles cost-effectiveness results and

  11. The Sheffield experiment: the effects of centralising accident and emergency services in a large urban setting

    OpenAIRE

    Simpson, A.; Wardrope, J; Burke, D

    2001-01-01

    Objectives—To assess the effects of centralisation of accident and emergency (A&E) services in a large urban setting. The end points were the quality of patient care judged by time to see a doctor or nurse practitioner, time to admission and the cost of the A&E service as a whole.

  12. The Cost-Effectiveness of Treatment Modalities for Ureteral Stones

    Directory of Open Access Journals (Sweden)

    Justin Ji-Yuen Siu MD

    2016-10-01

    Full Text Available Additional intervention and medical treatment of complications may follow the primary treatment of a ureteral stone. We investigated the cost of the treatment of ureteral stone(s within 45 days after initial intervention by means of retrospective analysis of the National Health Insurance Research Database of Taiwan. All patients of ages ≥20 years diagnosed with ureteral stone(s( International Classification of Diseases, Ninth Revision, Clinical Modification/ICD-9-CM: 592.1 from January 2001 to December 2011 were enrolled. We included a comorbidity code only if the diagnosis appeared in at least 2 separate claims in a patient’s record. Treatment modalities (code included extracorporeal shock-wave lithotripsy (SWL; 98.51, ureteroscopic lithotripsy (URSL; 56.31, percutaneous nephrolithotripsy (PNL; 55.04, (open ureterolithotomy (56.20, and laparoscopy (ie, laparoscopic ureterolithotomy; 54.21. There were 28 513 patients with ureteral stones (13 848 men and 14 665 women in the randomized sample of 1 million patients. The mean cost was 526.4 ± 724.1 United States Dollar (USD. The costs of treatment were significantly increased in patients with comorbidities. The costs of treatment among each primary treatment modalities were 1212.2 ± 627.3, 1146.7 ± 816.8, 2507.4 ± 1333.5, 1533.3 ± 1137.1, 2566.4 ± 2594.3, and 209.8 ± 473.2 USD in the SWL, URSL, PNL, (open ureterolithotomy, laparoscopy (laparoscopic ureterolithotomy, and conservative treatment group, respectively. In conclusion, URSL was more cost-effective than SWL and PNL as a primary treatment modality for ureteral stone(s when the possible additional costs within 45 days after the initial operation were included in the calculation.

  13. Effectiveness and cost-effectiveness of antidepressants in primary care: a multiple treatment comparison meta-analysis and cost-effectiveness model.

    Directory of Open Access Journals (Sweden)

    Joakim Ramsberg

    Full Text Available OBJECTIVE: To determine effectiveness and cost-effectiveness over a one-year time horizon of pharmacological first line treatment in primary care for patients with moderate to severe depression. DESIGN: A multiple treatment comparison meta-analysis was employed to determine the relative efficacy in terms of remission of 10 antidepressants (citalopram, duloxetine escitalopram, fluoxetine, fluvoxamine mirtazapine, paroxetine, reboxetine, sertraline and venlafaxine. The estimated remission rates were then applied in a decision-analytic model in order to estimate costs and quality of life with different treatments at one year. DATA SOURCES: Meta-analyses of remission rates from randomised controlled trials, and cost and quality-of-life data from published sources. RESULTS: The most favourable pharmacological treatment in terms of remission was escitalopram with an 8- to 12-week probability of remission of 0.47. Despite a high acquisition cost, this clinical effectiveness translated into escitalopram being both more effective and having a lower total cost than all other comparators from a societal perspective. From a healthcare perspective, the cost per QALY of escitalopram was €3732 compared with venlafaxine. CONCLUSION: Of the investigated antidepressants, escitalopram has the highest probability of remission and is the most effective and cost-effective pharmacological treatment in a primary care setting, when evaluated over a one year time-horizon. Small differences in remission rates may be important when assessing costs and cost-effectiveness of antidepressants.

  14. Assessment of Vehicle Sizing, Energy Consumption and Cost Through Large Scale Simulation of Advanced Vehicle Technologies

    Energy Technology Data Exchange (ETDEWEB)

    Moawad, Ayman [Argonne National Lab. (ANL), Argonne, IL (United States); Kim, Namdoo [Argonne National Lab. (ANL), Argonne, IL (United States); Shidore, Neeraj [Argonne National Lab. (ANL), Argonne, IL (United States); Rousseau, Aymeric [Argonne National Lab. (ANL), Argonne, IL (United States)

    2016-01-01

    The U.S. Department of Energy (DOE) Vehicle Technologies Office (VTO) has been developing more energy-efficient and environmentally friendly highway transportation technologies that will enable America to use less petroleum. The long-term aim is to develop "leapfrog" technologies that will provide Americans with greater freedom of mobility and energy security, while lowering costs and reducing impacts on the environment. This report reviews the results of the DOE VTO. It gives an assessment of the fuel and light-duty vehicle technologies that are most likely to be established, developed, and eventually commercialized during the next 30 years (up to 2045). Because of the rapid evolution of component technologies, this study is performed every two years to continuously update the results based on the latest state-of-the-art technologies.

  15. Cost and cost-effectiveness of nationwide school-based helminth control in Uganda: intra-country variation and effects of scaling-up.

    Science.gov (United States)

    Brooker, Simon; Kabatereine, Narcis B; Fleming, Fiona; Devlin, Nancy

    2008-01-01

    Estimates of cost and cost-effectiveness are typically based on a limited number of small-scale studies with no investigation of the existence of economies to scale or intra-country variation in cost and cost-effectiveness. This information gap hinders the efficient allocation of health care resources and the ability to generalize estimates to other settings. The current study investigates the intra-country variation in the cost and cost-effectiveness of nationwide school-based treatment of helminth (worm) infection in Uganda. Programme cost data were collected through semi-structured interviews with district officials and from accounting records in six of the 23 intervention districts. Both financial and economic costs were assessed. Costs were estimated on the basis of cost in US$ per schoolchild treated, and an incremental cost-effectiveness ratio (cost in US$ per case of anaemia averted) was used to evaluate programme cost-effectiveness. Sensitivity analysis was performed to assess the effect of discount rate and drug price. The overall economic cost per child treated in the six districts was US$0.54 and the cost-effectiveness was US$3.19 per case of anaemia averted. Analysis indicated that estimates of both cost and cost-effectiveness differ markedly with the total number of children who received treatment, indicating economies of scale. There was also substantial variation between districts in the cost per individual treated (US$0.41-0.91) and cost per anaemia case averted (US$1.70-9.51). Independent variables were shown to be statistically associated with both sets of estimates. This study highlights the potential bias in transferring data across settings without understanding the nature of observed variations.

  16. The Flynn effect in Korea: Large gains

    NARCIS (Netherlands)

    te Nijenhuis, J.; Cho, S.H.; Murphy, R.; Lee, K.H.

    2012-01-01

    Secular gains in IQ test scores have been reported for many Western countries. This is the first study of secular IQ gains in South Korea, using various datasets. The first question is what the size of the Flynn effect in South Korea is. The gains per decade are 7.7 points for persons born between 1

  17. The Flynn effect in Korea: Large gains

    NARCIS (Netherlands)

    te Nijenhuis, J.; Cho, S.H.; Murphy, R.; Lee, K.H.

    2012-01-01

    Secular gains in IQ test scores have been reported for many Western countries. This is the first study of secular IQ gains in South Korea, using various datasets. The first question is what the size of the Flynn effect in South Korea is. The gains per decade are 7.7 points for persons born between

  18. Good practices on cost - effective road infrastructure safety investments.

    Science.gov (United States)

    Yannis, George; Papadimitriou, Eleonora; Evgenikos, Petros; Dragomanovits, Anastasios

    2016-12-01

    The paper presents the findings of a research project aiming to quantify and subsequently classify several infrastructure-related road safety measures, based on the international experience attained through extensive and selected literature review and additionally on a full consultation process including questionnaire surveys addressed to experts and relevant workshops. Initially, a review of selected research reports was carried out and an exhaustive list of road safety infrastructure investments covering all types of infrastructure was compiled. Individual investments were classified according to the infrastructure investment area and the type of investment and were thereafter analysed on the basis of key safety components. These investments were subsequently ranked in relation to their safety effects and implementation costs and on the basis of this ranking, a set of five most promising investments was selected for an in-depth analysis. The results suggest that the overall cost effectiveness of a road safety infrastructure investment is not always in direct correlation with the safety effect and is recommended that cost-benefit ratios and safety effects are always examined in conjunction with each other in order to identify the optimum solution for a specific road safety problem in specific conditions and with specific objectives.

  19. Cost-effectiveness of hepatitis A vaccination in Indonesia.

    Science.gov (United States)

    Suwantika, Auliya A; Beutels, Philippe; Postma, Maarten J

    2014-01-01

    This study aims to assess the cost-effectiveness of hepatitis A immunization in Indonesia, including an explicit comparison between one-dose and two-dose vaccines. An age-structured cohort model based on a decision tree was developed for the 2012 Indonesia birth cohort. Using the model, we made a comparison on the use of two-dose and one-dose vaccines. The model involved a 70-year time horizon with 1-month cycles for children less than 2 years old and annually thereafter. Monte Carlo simulations were used to examine the economic acceptability and affordability of the hepatitis A vaccination. Vaccination would save US$ 3,795,148 and US$ 2,892,920 from the societal perspective, for the two-dose and one-dose vaccine schedules, respectively, in the context of hepatitis A treatment. It also would save 8917 and 6614 discounted quality-adjusted-life-years (QALYs), respectively. With the vaccine price of US$ 3.21 per dose, the implementation of single dose vaccine would yield an incremental cost-effectiveness ratio (ICER) of US$ 4933 per QALY gained versus no vaccination, whereas the two-dose versus one-dose schedule would cost US$ 14 568 per QALY gained. Considering the 2012 gross-domestic-product (GDP) per capita in Indonesia of US$ 3557, the results indicate that hepatitis A vaccination would be a cost-effective intervention, both for the two-dose and one-dose vaccine schedules in isolation, but two-dose vaccination would no longer be cost-effective if one-dose vaccination is a feasible option. Vaccination would be 100% affordable at budgets of US$ 71,408 000 and US$ 37,690,000 for the implementation of the two-dose and one-dose vaccine schedules, respectively. The implementation of hepatitis A vaccination in Indonesia would be a cost-effective health intervention under the market vaccine price. Given the budget limitations, the use of a one-dose-vaccine schedule would be more realistic to be applied than a two-dose schedule. The vaccine price, mortality rate and

  20. Survey and Classification of Large Woody Debris (LWD in Streams Using Generated Low-Cost Geomatic Products

    Directory of Open Access Journals (Sweden)

    Damian Ortega-Terol

    2014-11-01

    Full Text Available Water authorities are required to have a survey of large woody debris (LWD in river channels and to manage this aspect of the stream habitat, making decisions on removing, positioning or leaving LWD in a natural state. The main objective of this study is to develop a new methodology that assists in decision making for sustainable management of river channels by using generated low-cost, geomatic products to detect LWD. The use of low-cost photogrammetry based on the use of economical, conventional, non-metric digital cameras mounted on low-cost aircrafts, together with the use of the latest computational vision techniques and open-source geomatic tools, provides useful geomatic products. The proposed methodology, compared with conventional photogrammetry or other traditional methods, led to a cost savings of up to 45%. This work presents several contributions for the area of free and open source software related to Geographic Information System (FOSSGIS applications to LWD management in streams, while developing a QGIS [1] plugin that characterizes the risk from the automatic calculation of geometrical parameters.

  1. Economic viewpoints in educational effectiveness : Cost-effectiveness analysis of an educational improvement project

    NARCIS (Netherlands)

    Creemers, B; van der Werf, G

    2000-01-01

    Cost-effectiveness analysis is not only important for decision making in educational policy and practice. Also within educational effectiveness research it is important to establish the costs of educational processes in relationship to their effects. The integrated multilevel educational effectivene

  2. Cost-Effectiveness of Maintenance Hemodialysis in Japan.

    Science.gov (United States)

    Takura, Tomoyuki; Nakanishi, Takeshi; Kawanishi, Hideki; Nitta, Kosaku; Akizawa, Tadao; Hiramatsu, Makoto; Kawasaki, Tadayuki; Kukita, Kazutaka; Soejima, Hidehisa; Hirakata, Hideki; Yoshida, Toyohiko; Miyamoto, Takashi; Takahashi, Susumu

    2015-10-01

    The cost-effectiveness according to primary disease or dialysis duration has never been analyzed with respect to maintenance hemodialysis (MHD). Study candidates were > 20 years of age and had received hemodialysis for at least 6 months. Hemodialysis patients were prospectively observed for 36 months, and patient utility was assessed based on the Euro-QOL 5-dimensions (EQ-5D), from which the quality adjusted life years (QALYs) were estimated. Medical costs were calculated based on medical service fees. The cost-effectiveness defined as the incremental cost utility ratio (ICUR) was analyzed from a social perspective. A total of 29 patients (mean age; 59.9 ± 13.1 years) undergoing 437 dialysis sessions were analyzed. Utility based upon the EQ-5D score was 0.75 ± 0.21, and the estimated total medical cost for one year of MHD treatment was 4.52 ± 0.88 US$10 000. ICUR was 6.88 ± 4.47 US$10 000/QALY on average, and when comparing ICUR based on the causes of kidney failure, the value for diabetic nephropathy was found to be higher than that for glomerulonephritis (8.17 ± 6.28 vs. 6.82 ± 4.07). ICUR after 36 months observation increased mainly in the patients below 65 years of age (All; P MHD is a treatment that could improve the socioeconomic state of elderly patients with end-stage kidney disease (ESKD), but the ICUR for diabetic nephropathy was higher than that for glomerulonephritis.

  3. Cost-effective unilateral climate policy design: Size Matters

    Energy Technology Data Exchange (ETDEWEB)

    Boehringer, Christoph; Fischer, Carolyn; Rosendahl, Knut Einar

    2011-07-01

    Given the bleak prospects for a global agreement on mitigating climate change, pressure for unilateral abatement is increasing. A major challenge is emissions leakage. Border carbon adjustments and output-based allocation of emissions allowances can increase effectiveness of unilateral action but introduce distortions of their own. We assess antileakage measures as a function of abatement coalition size. We first develop a partial equilibrium analytical framework to see how these instruments affect emissions within and outside the coalition. We then employ a computable general equilibrium model of international trade and energy use to assess the strategies as the coalition grows. We find that full border adjustments rank first in global cost-effectiveness, followed by import tariffs and output-based rebates. The differences across measures and their overall appeal decline as the abatement coalition grows. In terms of cost, the coalition countries prefer border carbon adjustments; countries outside the coalition prefer output-based rebates.(Author)

  4. Bayesian Variable Selection in Cost-Effectiveness Analysis

    Directory of Open Access Journals (Sweden)

    Miguel A. Negrín

    2010-04-01

    Full Text Available Linear regression models are often used to represent the cost and effectiveness of medical treatment. The covariates used may include sociodemographic variables, such as age, gender or race; clinical variables, such as initial health status, years of treatment or the existence of concomitant illnesses; and a binary variable indicating the treatment received. However, most studies estimate only one model, which usually includes all the covariates. This procedure ignores the question of uncertainty in model selection. In this paper, we examine four alternative Bayesian variable selection methods that have been proposed. In this analysis, we estimate the inclusion probability of each covariate in the real model conditional on the data. Variable selection can be useful for estimating incremental effectiveness and incremental cost, through Bayesian model averaging, as well as for subgroup analysis.

  5. Cost Benefit Analysis: Cost Benefit Analysis for Human Effectiveness Research: Bioacoustic Protection

    Science.gov (United States)

    2007-11-02

    APPENDIX A. ACRONYMS ACCES Attenuating Custom Communication Earpiece System ACEIT Automated Cost estimating Integrated Tools AFSC Air Force...documented in the ACEIT cost estimating tool developed by Tecolote, Inc. The factor used was 14 percent of PMP. 1.3 System Engineering/ Program...The data source is the ASC Aeronautical Engineering Products Cost Factor Handbook which is documented in the ACEIT cost estimating tool developed

  6. Evaluating the cost-effectiveness of preventive zinc supplementation

    OpenAIRE

    Fink, Günther; Heitner, Jesse

    2014-01-01

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

  7. Evaluating the cost-effectiveness of preventive zinc supplementation

    OpenAIRE

    Fink, Günther; Heitner, Jesse

    2014-01-01

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

  8. Modified Transverse Thoracosternotomy and Cost-Effective Reinforced Sternal Closure.

    Science.gov (United States)

    Costa, Joseph; Sonett, Joshua R; D'Ovidio, Frank

    2015-12-01

    The bilateral transverse thoracosternotomy clamshell incision provides excellent exposure to the mediastinal structures in double lung transplantation. The use of a modified transverse sternotomy and a figure of 8 configuration with one monofilament metal wire, along with two longitudinal wires across the sternal division, results in greater stability and equally distributed oblique tension. Our described technique was more cost effective and resulted in no incidence of dehiscence. We present our experience using a modified transverse sternotomy and reinforced sternal closure method.

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

    OpenAIRE

    Clemmensen, Torkil; Vendelø, Morten

    2004-01-01

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

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

    OpenAIRE

    Clemmensen, Torkil; Vendelø, Morten

    2004-01-01

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

  11. Cost-effective wearable sensor to detect EMF

    OpenAIRE

    Paradiso, Joseph A.; Vaucelle, Catherine Nicole; Ishii, Hiroshi

    2009-01-01

    In this paper we present the design of a cost-effective wearable sensor to detect and indicate the strength and other characteristics of the electric field emanating from a laptop display. Our Electromagnetic Field Detector Bracelet can provide an immediate awareness of electric fields radiated from an object used frequently. Our technology thus supports awareness of ambient background emanation beyond human perception. We discuss how detection of such radiation mig...

  12. Data Center Storage Cost-Effective Strategies, Implementation, and Management

    CERN Document Server

    Smith, Hubbert

    2011-01-01

    We overspend on data center storage ! yet, we fall short of business requirements. It's not about the technologies. It's about the proper application of technologies to deliver storage services efficiently and affordably. It's about meeting business requirements dependent on data center storage. Spend less, deliver more. Data Center Storage: Cost-Effective Strategies, Implementation, and Management provides an industry insider's insight on how to properly scope, plan, evaluate, and implement storage technologies to maximize performance, capacity, reliability, and power savings. It provides bus

  13. Cost effectiveness of GHG mitigation options and policy implication

    Energy Technology Data Exchange (ETDEWEB)

    Lim, K. S. [Korea Institute for Industrial Economics and Trade, Seoul (Korea, Republic of)

    1998-04-01

    This paper represents the summary findings and conclusions of several studies implemented about microeconomics and macroeconomics marginal costs of GHG abatement policies. Financial, economic, and, where possible, environmental microeconomics costs of reducing GHGs are estimated by a World Bank team. Six energy-related CO{sub 2} mitigation policy options are applied to estimate the macroeconomics costs of GHG emission reduction, the macroeconomics impacts on the Chinese economy. In terms of policy, conservation is a better option to cope with a restrictive mitigation constraint, assuming a developing country can achieve planned energy-saving targets. Without a CO{sub 2} emission constraint or with less restrictive CO{sub 2} emission constraints, however, the simulation results indicate that a conservation strategy may be less attractive than fuel substitution in a developing country, mainly due to the economic dampening effect of reduced production in the energy sectors. This finding suggests that an often-cited costless or negative-cost energy conservation policy may not be a better option when a less restrictive mitigation target is in force. This does not mean that the potential for energy efficiency improvements in a developing country is not worthwhile, but that the overall macroeconomics impacts should be considered before implementing the policy option. (author). 9 refs., 3 figs., 3 tabs.

  14. Cost and effectiveness of clinical investigation: the state of the art.

    Science.gov (United States)

    Clarke, R M; Mason, B; Leeder, S R

    1980-10-01

    Clinical investigation by means of special technical tests has increased in clinical practice during recent years. Pressures causing this increase are said to include: rapid technological change making many more tests available, clinical uncertainty, peer pressure, greater patient awareness, and concern for diagnostic completeness. Cost factors do not appear to have influenced test-ordering behaviour to any large extent, and those ordering investigations are frequently ignorant of the cost of the test which they are ordering, both to the patient and the community. The relation of clinical investigational activity to quality of outcome of patient care remains largely unestablished. Studies of the possible modification of test-ordering behaviour through educational and institutional policy pressures are reviewed. A rational approach to investigating the effectiveness of techniques designed to encourage the more economic and effective use of investigations is presented in brief on the basis of this review of previously published work.

  15. Monoclonal surface display SELEX for simple, rapid, efficient, and cost-effective aptamer enrichment and identification.

    Science.gov (United States)

    Zhu, Zhi; Song, Yanling; Li, Cong; Zou, Yuan; Zhu, Ling; An, Yuan; Yang, Chaoyong James

    2014-06-17

    A novel method, monoclonal surface display SELEX (MSD-SELEX), has been designed for simple, rapid, efficient, and cost-effective enrichment and identification of aptamers from a library of monoclonal DNA-displaying beads produced via highly parallel single-molecule emulsion PCR. The approach was successfully applied for the identification of high-affinity aptamers that bind specifically to different types of targets, including cancer biomarker protein EpCAM and small toxin molecule aflatoxin B1. Compared to the conventional sequencing-chemical synthesis-screening work flow, MSD-SELEX avoids large-scale DNA sequencing, expensive and time-consuming DNA synthesis, and labor-intensive screening of large populations of candidates, thus offering a new approach for simple, rapid, efficient, and cost-effective aptamer identification for a wide variety of applications.

  16. Potential Cost-Effective Opportunities for Methane Emission Abatement

    Energy Technology Data Exchange (ETDEWEB)

    Warner, Ethan [Joint Inst. for Strategic Energy Analysis, Golden, CO (United States); Steinberg, Daniel [Joint Inst. for Strategic Energy Analysis, Golden, CO (United States); Hodson, Elke [U.S. Department of Energy, Washington, DC (United States); Heath, Garvin [Joint Inst. for Strategic Energy Analysis, Golden, CO (United States)

    2015-08-01

    The energy sector was responsible for approximately 84% of carbon dioxide equivalent (CO2e) greenhouse gas (GHG) emissions in the U.S. in 2012 (EPA 2014a). Methane is the second most important GHG, contributing 9% of total U.S. CO2e emissions. A large portion of those methane emissions result from energy production and use; the natural gas, coal, and oil industries produce approximately 39% of anthropogenic methane emissions in the U.S. As a result, fossil-fuel systems have been consistently identified as high priority sectors to contribute to U.S. GHG reduction goals (White House 2015). Only two studies have recently attempted to quantify the abatement potential and cost associated with the breadth of opportunities to reduce GHG emissions within natural gas, oil, and coal supply chains in the United States, namely the U.S. Environmental Protection Agency (EPA) (2013a) and ICF (2014). EPA, in its 2013 analysis, estimated the marginal cost of abatement for non-CO2 GHG emissions from the natural gas, oil, and coal supply chains for multiple regions globally, including the United States. Building on this work, ICF International (ICF) (2014) provided an update and re-analysis of the potential opportunities in U.S. natural gas and oil systems. In this report we synthesize these previously published estimates as well as incorporate additional data provided by ICF to provide a comprehensive national analysis of methane abatement opportunities and their associated costs across the natural gas, oil, and coal supply chains. Results are presented as a suite of marginal abatement cost curves (MACCs), which depict the total potential and cost of reducing emissions through different abatement measures. We report results by sector (natural gas, oil, and coal) and by supply chain segment - production, gathering and boosting, processing, transmission and storage, or distribution - to facilitate identification of which sectors and supply chain

  17. The clinically-integrated randomized trial: proposed novel method for conducting large trials at low cost

    Directory of Open Access Journals (Sweden)

    Scardino Peter T

    2009-03-01

    Full Text Available Abstract Introduction Randomized controlled trials provide the best method of determining which of two comparable treatments is preferable. Unfortunately, contemporary randomized trials have become increasingly expensive, complex and burdened by regulation, so much so that many trials are of doubtful feasibility. Discussion Here we present a proposal for a novel, streamlined approach to randomized trials: the "clinically-integrated randomized trial". The key aspect of our methodology is that the clinical experience of the patient and doctor is virtually indistinguishable whether or not the patient is randomized, primarily because outcome data are obtained from routine clinical data, or from short, web-based questionnaires. Integration of a randomized trial into routine clinical practice also implies that there should be an attempt to randomize every patient, a corollary of which is that eligibility criteria are minimized. The similar clinical experience of patients on- and off-study also entails that the marginal cost of putting an additional patient on trial is negligible. We propose examples of how the clinically-integrated randomized trial might be applied in four distinct areas of medicine: comparisons of surgical techniques, "me too" drugs, rare diseases and lifestyle interventions. Barriers to implementing clinically-integrated randomized trials are discussed. Conclusion The proposed clinically-integrated randomized trial may allow us to enlarge dramatically the number of clinical questions that can be addressed by randomization.

  18. The cost-effectiveness of a modestly effective HIV vaccine in the United States.

    Science.gov (United States)

    Long, Elisa F; Owens, Douglas K

    2011-08-18

    in the first year). A partially effective HIV vaccine with effectiveness similar to that observed in the RV144 trial would provide large health benefits in the United States and could meet conventionally accepted cost-effectiveness thresholds. Strategies that prioritize key populations are most efficient, but broader strategies provide greater total population health benefit. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. Discounting in the evaluation of the cost-effectiveness of a vaccination programme: A critical review.

    Science.gov (United States)

    Jit, Mark; Mibei, Walter

    2015-07-31

    Discounting future costs and health benefits usually has a large effect on results of cost-effectiveness evaluations of vaccination because of delays between the initial expenditure in the programme and the health benefits from averting disease. Most guidelines currently recommend discounting both costs and health effects at a positive, constant, common rate back to a common point in time. A review of 84 published economic evaluations of vaccines found that most of them apply these recommendations. However, both technical and normative arguments have been presented for discounting health at a different rate to consumption (differential discounting), discounting at a rate that changes over time (non-constant discounting), discounting intra-generational and inter-generational effects at a different rate (two-stage discounting), and discounting the health gains from an intervention to a different discount year from the time of intervention (delayed discounting). These considerations are particularly acute for vaccines, because their effects can occur in a different generation from the one paying for them, and because the time of vaccination, of infection aversion, and of disease aversion usually differ. Using differential, two-stage or delayed discounting in model-based cost-effectiveness evaluations of vaccination raises technical challenges, but mechanisms have been proposed to overcome them.

  20. Cost-effectiveness analysis of a system-based approach for managing neonatal jaundice and preventing kernicterus in Ontario.

    Science.gov (United States)

    Xie, Bin; da Silva, Orlando; Zaric, Greg

    2012-01-01

    To evaluate the incremental cost-effectiveness of a system-based approach for the management of neonatal jaundice and the prevention of kernicterus in term and late-preterm (≥35 weeks) infants, compared with the traditional practice based on visual inspection and selected bilirubin testing. Two hypothetical cohorts of 150,000 term and late-preterm neonates were used to compare the costs and outcomes associated with the use of a system-based or traditional practice approach. Data for the evaluation were obtained from the case costing centre at a large teaching hospital in Ontario, supplemented by data from the literature. The per child cost for the system-based approach cohort was $176, compared with $173 in the traditional practice cohort. The higher cost associated with the system-based cohort reflects increased costs for predischarge screening and treatment and increased postdischarge follow-up visits. These costs are partially offset by reduced costs from fewer emergency room visits, hospital readmissions and kernicterus cases. Compared with the traditional approach, the cost to prevent one kernicterus case using the system-based approach was $570,496, the cost per life year gained was $26,279, and the cost per quality-adjusted life year gained was $65,698. The cost to prevent one kernicterus case using the system-based approach is much lower than previously reported in the literature.

  1. A low-cost large-aperture optical receiver for remote sensing and imaging applications

    Science.gov (United States)

    Hanes, Stephen A.

    2003-03-01

    An inexpensive large aperture (10 m class) receiver for optical wavelength imaging and remote sensing applications is discussed. The design was developed for active (laser illumination) imaging of remote objects using pupil plane measurement techniques, where relatively low optical quality collecting elements can be used. The approach is also well suited for conventional imaging at lower resolutions when light collection capability is of primary importance. The approach relies on a large aperture heliostat consisting of an array of flat mirror segments, like those used in solar collector systems, to collect light from the region of interest. The heliostat segments are tilted in a manner to concentrate the light, by making the light from all segments overlap at a common point, resulting in a region of higher intensity about the size of a segment at the heliostat "focus". A smaller secondary collector, consisting of a concave mirror located at the overlap point, further concentrates the light and forms a pupil image of the heliostat. Additional optics near the pupil image collimate the light for efficient transmission though a narrow band interference filter used to reduce sky background, and focus the light onto a PMT, or other sensor, for detection. Several design approaches for the collimating optics are discussed as well as system performance and limitations.

  2. Postulated weather modification effects of large energy releases

    Energy Technology Data Exchange (ETDEWEB)

    Ramsdell, J.V.; Scott, B.C.; Orgill, M.M.; Renne, D.S.; Hubbard, J.E.; McGinnis, K.A.

    1977-02-01

    Postulated impacts of large energy releases were examined in the light of existing technical information. The magnitudes of direct atmospheric modifications were estimated, and the ecological and economic implications of the modifications were explored. Energy releases from energy centers (10 to 40 power plants at a single site) and individual power plant clusters (1 to 4 power plants) were considered. In the atmosphere the energy will exist initially as increased temperature (sensible heat), moisture (latent heat), and air motion (kinetic energy). Addition of energy could result in increased cloudiness and fog, and changed precipitation patterns. A framework for economic analysis of the impacts of the postulated atmospheric modifications was established on the basis of costs and benefits. Willingness-to-pay was selected as the appropriate measure for valuing each impact. The primary and secondary atmospheric modifications may affect recreation, transportation, and aesthetics as well as agriculture and forestry. Economic values can be placed on some of the effects. However, the willingness of people to pay to gain benefits and avoid damages in many cases can only be determined through extensive surveys. The economic consequences of a given energy release would be highly site specific.

  3. Cost-effectiveness of powered wheelchairs: findings of a study.

    Science.gov (United States)

    Andrich, Renzo; Salatino, Claudia; Converti, Rosa Maria; Saruggia, Maurizio

    2015-01-01

    This study surveyed a sample of 79 wheelchair users who had obtained powered wheelchairs from the National Health Service in an Italian Region in the period 2008-2013. The wheelchair prescriptions had been done on the basis of an assessment protocol agreed with the Local Health Authority. Follow-up interviews were carried out at the users' homes, in order to collect information about the wheelchair use and its effectiveness, usefulness and economic impact. The instruments used in the interviews included an introductory questionnaire (describing the wheelchair use), the QUEST (measuring the user's satisfaction), the PIADS (measuring the psychosocial impact, in terms of perceived changes in ability, adaptability and self-esteem), the FABS/M (detecting environmental facilitators and barriers) and the SCAI (estimating the economic impact). Overall, positive outcomes were detected for most users, especially in relation to their satisfaction and the psychosocial impact. A number of barriers were identified in various settings (at home, in public places, in natural spaces, in public transportation) that sometimes restrict the user mobility and thus may claim for corrective actions. Several environmental factors acting as facilitators were also identified. In relation to the economic impact, the provision of a powered wheelchair generated remarkable savings in social costs for most of the users, on average about 36.000 Euros per person on a projected 5-years span. This estimate results from the comparison between the social cost of the intervention (sum of the costs of all material and human resources involved in the provision and usage of the wheelchair) and the cost of non-intervention (the presumed social cost incurred in case no powered wheelchair had been provided and the user had to carry on with just a manual wheelchair). The study was also an opportunity to develop and try out a follow-up method that proved applicable within service delivery practice.

  4. Chromogenic media for urine cultures can be cost-effective

    Directory of Open Access Journals (Sweden)

    Matjaž J. Retelj

    2007-03-01

    Full Text Available Background: Chromogenic media for diagnostic urinary bacteriology have several advantages over traditional media, such as cysteine-lactose-electrolyte deficient (CLED medium. Chromogenic media allow for easier recognition of mixed growth, save time, reduce workload and provide higher detection rates. However, the cost of chromogenic media is significantly higher compared to CLED and performance of chromogenic media varies depending on the manufacturer. In the present study, performance, turn-around time and cost of Uriselect4 chromogenic medium was compared to CLED.Methods: For performance analysis, 351 midstream urine (MSU samples from September 2005 to December 2005 were directly plated in parallel on Uriselect4 and CLED agar using the calibrated loop technique. Isolates on Uriselect4 were presumptively identified according to the product insert. For cost-effectiveness analysis, we included 1,972 consecutive MSU samples from May 2005 to July 2006. We compared the cost of required materials as well as technologists’ or specialists’ time for each medium examined.Results: No significant differences were found between the isolation rates of urinary pathogens on the studied media. The procedure using chromogenic media for uropathogens is slightly cheaper than the procedure using CLED, considering the proportion of bacteriuria positive samples (50.5 % and the distribution of taxa among isolates (namely Escherichia coli with 59.6 % observed in our laboratory. At the current isolation proportion in MSU samples processed in our laboratory, the average time to reporting results could be decreased by 0.3 days.Conclusions: Use of chromogenic media for urine investigations offers multiple advantages without increasing costs compared to procedures using CLED.

  5. Renal transplantation vs hemodialysis: Cost-effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Perović Saša

    2009-01-01

    Full Text Available Background/Aim. Chronic renal insufficiency (CRI, diabetes, hypertension, autosomal dominant polycystic kidney disease (ADPKD are the main reasons for starting dialysis treatment in patients having kidney function failure. At present, dialysis treatments are performed in about 4,100 patients at 46 institutions in Serbia, out of which 90% are hemodialyses. At end-stage renal disease (ESRD the only correct selection is kidney transplatation. The basic aim of the planned research was to compare ratio of costs and effects (Cost Effectiveness Analysis - CEA of hemodialysis and kidney transplantation in patients at ESRD. Methods. As the main issue of treatment in patients from both groups the life quality measured by the validated McGill Questionary, was used. The study included 150 patients totally, divided into two groups. The study group consisted of 50 patients with kidney transplantation performed at the Clinical Center of Serbia and the control group consisted of 100 patients on hemodialysis at Clinical Center of Serbia, Clinical Hospital Center Zemun, Clinical Hospital Center 'Zvezdara', Clinical Center Kragujevac and Health Center 'Studenica', Kraljevo, comparable with respect to sex, age and length of treatment with the study group. Results. Effect of kidney transplantation in relation to hemodialysis being selection of treatment is expressed in the form of incremental ratio of costs and effects (Incremental Cost-Effectiveness Ratio - ICER. It is clear from the enclosed tables that the strategy of kidney transplantation is far more profitable considering the fact that it represents saving of EUR 132,256.25 per one year of contribution Quality Adjusted Life Years (QALY within the period of 10 years. According to all aspects of live quality (physical symptoms and problems, physical well-being, psychological symptoms, existential well-being and support, difference is statistically important in favor of transplant patents. Conclusion. The costs

  6. Cost-Effectiveness Analysis of Various Methods of Instruction in Developmental Mathematics.

    Science.gov (United States)

    Carman, Robert A.

    This paper examined in a critical fashion the existing applications of cost-effectiveness analysis in education, particularly the study of instructional effectiveness in the community college. Various schemes for measuring costs of instruction such as cost benefit analysis, cost-effectiveness analysis and planning programming budgeting systems…

  7. Intravenous thrombolysis before endovascular therapy for large vessel strokes can lead to significantly higher hospital costs without improving outcomes.

    Science.gov (United States)

    Rai, Ansaar T; Boo, SoHyun; Buseman, Chelsea; Adcock, Amelia K; Tarabishy, Abdul R; Miller, Maurice M; Roberts, Thomas D; Domico, Jennifer R; Carpenter, Jeffrey S

    2017-01-06

    Limited efficacy of IV recombinant tissue plasminogen activator (rt-PA) for large vessel occlusions (LVO) raises doubts about its utility prior to endovascular therapy. To compare outcomes and hospital costs for anterior circulation LVOs (middle cerebral artery, internal carotid artery terminus (ICA-T)) treated with either primary endovascular therapy alone (EV-Only) or bridging therapy (IV+EV)). A single-center retrospective analysis was performed. Clinical and demographic data were collected prospectively and relevant cost data were obtained for each patient in the study. 90 consecutive patients were divided into EV-Only (n=52) and IV+EV (n=38) groups. There was no difference in demographics, stroke severity, or clot distribution. The mean (SD) time to presentation was 5:19 (4:30) hours in the EV-Only group and 1:46 (0:52) hours in the IV+EV group (pIV+EV 31 (81.6%) (p=0.12). Favorable outcome: EV-Only 26 (50%) versus IV+EV 22 (58%) (p=0.45). For patients presenting within 4.5 hours (n=64): Recanalization: EV-Only 21/26 (81%) versus IV+EV 31/38 (81.6%) (p=0.93). Favorable outcome: EV-Only 14/26 (54%) versus IV+EV 22/38 (58%) (p=0.75). There was no significant difference in rates of hemorrhage, mortality, home discharge, or length of stay. A stent retriever was used in 67 cases (74.4%), with similar recanalization, outcomes, and number of passes in the EV-Only and IV+EV groups. The mean (SD) total hospital cost was $33 810 (13 505) for the EV-Only group and $40 743 (17 177) for the IV+EV group (p=0.02). The direct cost was $23 034 (8786) for the EV-Only group and $28 711 (11 406) for the IV+EV group (p=0.007). These significantly higher costs persisted for the subgroup presenting in IV rt-PA administration independently predicted higher hospital costs. IV rt-PA did not improve recanalization, thrombectomy efficacy, functional outcomes, or length of stay. Combined therapy was associated with significantly higher total and direct hospital costs

  8. Single-Seed Casting Large-Size Monocrystalline Silicon for High-Efficiency and Low-Cost Solar Cells

    Directory of Open Access Journals (Sweden)

    Bing Gao

    2015-09-01

    Full Text Available To grow high-quality and large-size monocrystal-line silicon at low cost, we proposed a single-seed casting technique. To realize this technique, two challenges—polycrystalline nucleation on the crucible wall and dislocation multiplication inside the crystal—needed to be addressed. Numerical analysis was used to develop solutions for these challenges. Based on an optimized furnace structure and operating conditions from numerical analysis, experiments were performed to grow monocrystalline silicon using the single-seed casting technique. The results revealed that this technique is highly superior to the popular high-performance multicrystalline and multiseed casting mono-like techniques.

  9. Relevant Costs for Decision in an Effective Controlling System

    Directory of Open Access Journals (Sweden)

    Mihaela TULVINSCHI

    2010-05-01

    Full Text Available Controlling is considered a leading concept in the sense of coordination, planning, control and automation, in order to produce the synthesis necessary in decision making. The purpose of article is to highlight the link between a dynamic accounting system and an effective controlling system. The research method used is based on the idea that the cost analysis in an efficient controlling system involves obtaining accounting information from within the entity which management then uses in decision making. In conclusion, we emphasize that an effective controlling system must provide managers the tools to meet their informational needs.

  10. Development of a Large, Low-Cost, Instant 3D Scanner

    Directory of Open Access Journals (Sweden)

    Jeremy Straub

    2014-05-01

    Full Text Available Three-dimensional scanning serves a large variety of uses. It can be utilized to generate objects for, after possible modification, 3D printing. It can facilitate reverse engineering, replication of artifacts to allow interaction without risking cultural heirlooms and the creation of replacement bespoke parts. The technology can also be used to capture imagery for creating holograms, it can support applications requiring human body imaging (e.g., medical, sports performance, garment creation, security and it can be used to import real-world objects into computer games and other simulations. This paper presents the design of a 3D scanner that was designed and constructed at the University of North Dakota to create 3D models for printing and numerous other uses. It discusses multiple prospective uses for the unit and technology. It also provides an overview of future directions of the project, such as 3D video capture.

  11. Entanglement is a costly life‐history stage in large whales

    DEFF Research Database (Denmark)

    van der Hoop, Julie Marie

    2016-01-01

    Individuals store energy to balance deficits in natural cycles; however, unnatural events can also lead to unbalanced energy budgets. Entanglement in fishing gear is one example of an unnatural but relatively common circumstance that imposes energetic demands of a similar order of magnitude...... and duration of life-history events such as migration and pregnancy in large whales. We present two complementary bioenergetic approaches to estimate the energy associated with entanglement in North Atlantic right whales, and compare these estimates to the natural energetic life history of individual whales...... suggest that when entangled, whales require 3.95 × 109 to 4.08 × 1010 J more energy to swim. Individuals who died from their entanglements performed significantly more work (energy expenditure × time) than those that survived; entanglement duration is therefore critical in determining whales’ survival...

  12. Floating substrate process: Large-area silicon sheet task low-cost solar array project

    Science.gov (United States)

    Garfinkel, M.; Hall, R. N.

    1978-01-01

    Supercooling of silicon-tin alloy melts was studied. Values as high as 78 C at 1100 C and 39 C at 1200 C were observed, corresponding to supersaturation parameter values 0.025 and 0.053 at 1050 C and 1150 C, respectively. The interaction of tin with silane gas streams was investigated over the temperature range 1000 to 1200 C. Single-pass conversion efficiencies exceeding 30% were obtained. The growth habit of spontaneously-nucleated surface growth was determined to be consistent with dendritic and web growth from singly-twinned triangular nucleii. Surface growth of interlocking silicon crystals, thin enough to follow the surface of the liquid and with growth velocity as high as 5 mm/min, was obtained. Large area single-crystal growth along the melt surface was not achieved. Small single-crystal surface growth was obtained which did not propagate beyond a few millimeters.

  13. A cost-effect analysis of an intervention against radon in homes

    Directory of Open Access Journals (Sweden)

    Hein Stigum

    2009-10-01

    Full Text Available Background  Key words  : Radon exposure, lung cancer, cost-effect analysis, attributable risk, models-mathematical: Radon is a radioactive gas that may leak into buildings from the ground. Radon exposure is a risk factor for lung cancer. An intervention against radon exposure in homes may consist of locating homes with high radon exposure (above 200 Bq m-3 and improving these, and of protecting future houses. The purpose of this paper is to calculate the costs and the effects of this intervention. Methods: We performed a cost-effect analysis from the perspective of the society, followed by an uncertainty and sensitivity analysis. The distribution of radon levels in Norwegian homes is lognormal with mean=74.5 Bq/m3, and 7.6% above 200 Bq/m3. Results: The preventable attributable fraction of radon on lung cancer was 3.8% (95% uncertainty interval: 0.6%, 8.3%. In cumulative present values the intervention would cost $238 (145, 310 million and save 892 (133, 1981 lives, each life saved costs $0.27 (0.09, 0.9 million. The cost-effect ratio was sensitive to the radon risk, the radon exposure distribution, and the latency period of lung cancer. Together these three parameters explained 90% of the variation in the cost-effect ratio. Conclusions: Reducing the radon concentration in present and future homes to below 200 Bq/m3 will cost $0.27 (0.09, 0.9 million per life saved. The uncertainty in the estimated cost per life is large, mainly due to uncertainty in the risk of lung cancer from radon. Based on estimates from road construction, the Norwegian society has been willing to pay $1 million to save a life. We therefore conclude that the intervention against radon in homes is justifiable. The willingness to pay is also larger that the upper uncertainty limit of the cost per life. Our conclusion is therefore robust against the uncertainties in the parameters.

  14. Cost-Effectiveness of Interventions to Prevent and Control Diabetes Mellitus: A Systematic Review

    Science.gov (United States)

    Li, Rui; Zhang, Ping; Barker, Lawrence E.; Chowdhury, Farah M.; Zhang, Xuanping

    2010-01-01

    OBJECTIVE To synthesize the cost-effectiveness (CE) of interventions to prevent and control diabetes, its complications, and comorbidities. RESEARCH DESIGN AND METHODS We conducted a systematic review of literature on the CE of diabetes interventions recommended by the American Diabetes Association (ADA) and published between January 1985 and May 2008. We categorized the strength of evidence about the CE of an intervention as strong, supportive, or uncertain. CEs were classified as cost saving (more health benefit at a lower cost), very cost-effective (≤$25,000 per life year gained [LYG] or quality-adjusted life year [QALY]), cost-effective ($25,001 to $50,000 per LYG or QALY), marginally cost-effective ($50,001 to $100,000 per LYG or QALY), or not cost-effective (>$100,000 per LYG or QALY). The CE classification of an intervention was reported separately by country setting (U.S. or other developed countries) if CE varied by where the intervention was implemented. Costs were measured in 2007 U.S. dollars. RESULTS Fifty-six studies from 20 countries met the inclusion criteria. A large majority of the ADA recommended interventions are cost-effective. We found strong evidence to classify the following interventions as cost saving or very cost-effective: (I) Cost saving— 1) ACE inhibitor (ACEI) therapy for intensive hypertension control compared with standard hypertension control; 2) ACEI or angiotensin receptor blocker (ARB) therapy to prevent end-stage renal disease (ESRD) compared with no ACEI or ARB treatment; 3) early irbesartan therapy (at the microalbuminuria stage) to prevent ESRD compared with later treatment (at the macroalbuminuria stage); 4) comprehensive foot care to prevent ulcers compared with usual care; 5) multi-component interventions for diabetic risk factor control and early detection of complications compared with conventional insulin therapy for persons with type 1 diabetes; and 6) multi-component interventions for diabetic risk factor control

  15. Cost-effectiveness of HIV screening for incarcerated pregnant women.

    Science.gov (United States)

    Resch, Stephen; Altice, Frederick L; Paltiel, A David

    2005-02-01

    Antiretroviral therapy (ART) initiated on a prenatal basis in HIV-infected pregnant women is a highly effective method for preventing mother-to-child HIV transmission. We developed a decision analytic model to project the clinical and economic outcomes of alternative HIV screening strategies (voluntary prenatal screening [VPS], routine prenatal screening [RPS], and mandatory newborn screening [MNS]) for a high-risk population of incarcerated pregnant women. Data for the decision model came from the HIV voluntary counseling and testing program at Connecticut's sole correctional facility for women and a comprehensive anonymously linked serosurvey of all inmates who entered the facility during the 2-year period beginning in October 1994. Based on serosurvey results, in the absence of any HIV screening program, 2.5 cases of pediatric HIV infection would be expected per 1000 pregnancies. Multiplied by the discounted lifetime cost per case of $247,000, this translates to a cost of $624 per testing-eligible prison entrant. Entrants were considered eligible if they were pregnant and their HIV status was unknown. MNS would save money, cost $364 per eligible entrant, and simultaneously reduce the rate of infections to 1.1 per 1000 pregnancies. Doing both MNS and RPS is most effective in reducing the rate of new infections (down to 0.2 per 1000 pregnancies). It would, however, increase costs to $430 per eligible entrant. This would result in an incremental cost of $73,603 per additional pediatric HIV case averted when compared with MNS alone. If mandatory newborn testing was not considered a feasible option, RPS would dominate VPS and would be cost-saving compared with no screening. RPS compares favorably with alternative uses of HIV prevention and treatment resources. In correctional facilities where voluntary newborn screening is already in place, our findings show that there remains a small marginal benefit to be realized from switching to RPS. In settings where HIV

  16. Cost-effectiveness analyses of training: a manager?s guide

    OpenAIRE

    O?Malley, Gabrielle; Marseille, Elliot; Weaver, Marcia R

    2013-01-01

    The evidence on the cost and cost-effectiveness of global training programs is sparse. This manager?s guide to cost-effectiveness analysis (CEA) is for professionals who want to recognize and support high quality CEA. It focuses on CEA of training in the context of program implementation or rapid program expansion. Cost analysis provides cost per output and CEA provides cost per outcome. The distinction between these two analyses is essential for making good decisions about value. A hypotheti...

  17. Acceptance of health technology assessment submissions with incremental cost-effectiveness ratios above the cost-effectiveness threshold

    Directory of Open Access Journals (Sweden)

    Griffiths EA

    2015-08-01

    Full Text Available Elizabeth A Griffiths, Janek K Hendrich, Samuel DR Stoddart, Sean CM Walsh HERON™ Commercialization, PAREXEL International, London, UK Objectives: In health technology assessment (HTA agencies where cost-effectiveness plays a role in decision-making, an incremental cost-effectiveness ratio (ICER threshold is often used to inform reimbursement decisions. The acceptance of submissions with ICERs higher than the threshold was assessed across different agencies and across indications, in order to inform future reimbursement submissions. Methods: All HTA appraisals from May 2000 to May 2014 from National Institute for Health and Care Excellence (NICE, Scottish Medicines Consortium (SMC, Pharmaceutical Benefits Advisory Committee (PBAC, and Canadian Agency for Drugs and Technologies in Health (CADTH were assessed. Multiple technology appraisals, resubmissions, vaccination programs, and requests for advice were excluded. Submissions not reporting an ICER, or for which an ICER could not be determined were also excluded. The remaining appraisals were reviewed, and the submitted ICER, recommendation, and reasoning behind the recommendation were extracted. Results: NICE recommended the highest proportion of submissions with ICERs higher than the threshold (34% accepted without restrictions; 20% with restrictions, followed by PBAC (16% accepted without restrictions; 4% with restrictions, SMC (11% accepted without restrictions; 14% accepted with restrictions, and CADTH (0% accepted without restrictions; 26% with restrictions. Overall, the majority of higher-than-threshold ICER submissions were classified into the "malignant disease and immunosuppression" therapeutic category; however, there was no notable variation in acceptance rates by disease area. Reasons for accepting submissions reporting ICERs above the threshold included high clinical benefit over the standard of care, and addressing an unmet therapeutic need. Conclusion: Acceptance of submissions

  18. A Cost- Effective Design of Reversible Programmable Logic Array

    CERN Document Server

    Singla, Pradeep; 10.5120/5619-7911

    2012-01-01

    In the recent era, Reversible computing is a growing field having applications in nanotechnology, optical information processing, quantum networks etc. In this paper, the authors show the design of a cost effective reversible programmable logic array using VHDL. It is simulated on xilinx ISE 8.2i and results are shown. The proposed reversible Programming logic array called RPLA is designed by MUX gate [10] & Feynman gate for 3- inputs, which is able to perform any reversible 3- input logic function or Boolean function. Furthermore the quantized analysis with camparitive finding is shown for the realized RPLA against the existing one. The result shows improvement in the quantum cost and total logical caculation in proposed RPLA.

  19. RTM: Cost-effective processing of composite structures

    Science.gov (United States)

    Hasko, Greg; Dexter, H. Benson

    1991-01-01

    Resin transfer molding (RTM) is a promising method for cost effective fabrication of high strength, low weight composite structures from textile preforms. In this process, dry fibers are placed in a mold, resin is introduced either by vacuum infusion or pressure, and the part is cured. RTM has been used in many industries, including automotive, recreation, and aerospace. Each of the industries has different requirements of material strength, weight, reliability, environmental resistance, cost, and production rate. These requirements drive the selection of fibers and resins, fiber volume fractions, fiber orientations, mold design, and processing equipment. Research is made into applying RTM to primary aircraft structures which require high strength and stiffness at low density. The material requirements are discussed of various industries, along with methods of orienting and distributing fibers, mold configurations, and processing parameters. Processing and material parameters such as resin viscosity, perform compaction and permeability, and tool design concepts are discussed. Experimental methods to measure preform compaction and permeability are presented.

  20. Cost-effective lightweight mirrors for aerospace and defense

    Science.gov (United States)

    Woodard, Kenneth S.; Comstock, Lovell E.; Wamboldt, Leonard; Roy, Brian P.

    2015-05-01

    The demand for high performance, lightweight mirrors was historically driven by aerospace and defense (A&D) but now we are also seeing similar requirements for commercial applications. These applications range from aerospace-like platforms such as small unmanned aircraft for agricultural, mineral and pollutant aerial mapping to an eye tracking gimbaled mirror for optometry offices. While aerospace and defense businesses can often justify the high cost of exotic, low density materials, commercial products rarely can. Also, to obtain high performance with low overall optical system weight, aspheric surfaces are often prescribed. This may drive the manufacturing process to diamond machining thus requiring the reflective side of the mirror to be a diamond machinable material. This paper summarizes the diamond machined finishing and coating of some high performance, lightweight designs using non-exotic substrates to achieve cost effective mirrors. The results indicate that these processes can meet typical aerospace and defense requirements but may also be competitive in some commercial applications.

  1. Reducing Wildlife Damage with Cost-Effective Management Programmes.

    Directory of Open Access Journals (Sweden)

    Cheryl R Krull

    Full Text Available Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control, with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation

  2. Reducing Wildlife Damage with Cost-Effective Management Programmes.

    Science.gov (United States)

    Krull, Cheryl R; Stanley, Margaret C; Burns, Bruce R; Choquenot, David; Etherington, Thomas R

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return.

  3. Use of rice-based oral rehydration solution in a large diarrhoea treatment centre in Bangladesh: in-house production, use and relative cost.

    Science.gov (United States)

    Islam, M A; Mahalanabis, D; Majid, N

    1994-12-01

    Glucose-based oral rehydration salt (ORS) is an appropriate and cost-effective tool to treat diarrhoeal dehydration. In patients with a high purging rate, particularly due to cholera, rice-based ORS has been shown to substantially reduce stool output compared to glucose ORS. However, it is not used in the hospitals or diarrhoea treatment centres largely because of the non-availability of a ready-to-use inexpensive packaged product and because of the problem of cooking. In a large diarrhoea treatment centre in Bangladesh (with an annual ORS consumption of approximately 140,000 litres), we have maintained in-house production of rice ORS and used it routinely for more than 600,000 patients over the last nine years. Semi-literate health workers cook rice ORS and supervise mothers in its use. Rice ORS is less costly (US $0.15 per patient treated compared with US $0.37 for glucose ORS) and is well accepted. It is an attractive alternative to glucose ORS in many fixed facility treatment centres in countries where rice is a staple and cholera is endemic. The process of its in-house preparation and use is described in this report which may assist hospitals wishing to use rice ORS in treating diarrhoea patients. Availability of a low cost ready-to-use rice ORS packet (which needs no cooking) with adequate shelf-life will increase its use at fixed facilities.

  4. Echo-based screening of rheumatic heart disease in children: a cost-effectiveness Markov model.

    Science.gov (United States)

    Zachariah, Justin P; Samnaliev, Mihail

    2015-06-01

    To project the cost-effectiveness of population-based echo screening to prevent rheumatic heart disease (RHD) consequences. RHD is a leading cause of cardiovascular mortality and morbidity during adolescence and young adulthood in low- and middle-per capita income settings. Echocardiography-based screening approaches can dramatically expand the number of children identified at risk of progressive RHD. Cost-effectiveness analysis can inform public health agencies and payers about the net economic benefit of such large-scale population-based screening. A Markov model was constructed comparing a no-screen to echo screen approach. The echo screen program was modeled as a 2-staged screen of a cohort of 11-year-old children with initial short screening performed by dedicated technicians and follow-up complete echo by cardiologists. Penicillin RHD prophylaxis was modeled to only reduce rheumatic fever recurrence-related exacerbation. Quality-adjusted life years (QALYs) and societal costs (in 2010 Australian dollars) associated with each approach were estimated. One-way, two-way and probabilistic sensitivity analyses were performed on RHD prevalence and transition probabilities; echocardiography test characteristics; and societal level costs including supplies, transportation, and labor. The incremental costs and QALYs of the screen compared to no screen strategy were -$432 (95% CI = -$1357 to $575) and 0.007 (95% CI = -0.0101 to 0.0237), respectively. The joint probability that the screen was both less costly and more effective exceeded 80%. Sensitivity analyses suggested screen strategy dominance depends mostly on the probability of transitioning out of sub-clinical RHD. Two-stage echo RHD screening and secondary prophylaxis may achieve modestly improved outcomes at lower cost compared to clinical detection and deserves closer attention from health policy stakeholders.

  5. Large scale production of carbon nanotube arrays on the sphere surface from liquefied petroleum gas at low cost

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Liquefied petroleum gas (LPG), a cheap industrial material, is used as carbon source to produce carbon nanotube (CNT) arrays on ceramic spherical surface on a large scale in the floating catalyst process. The ceramic spheres provide huge surface area and good mobility, leading to the mass production of CNT arrays continuously. The arrays obtained from the surface are of good alignment, and the purity is as high as 97.5%. With the decrease of the growth temperature, CNTs in the array form with small-diameter of about 13 nm can be obtained. Therefore, with the industrial fuel as carbon source and the ceramic sphere as substrate, CNT arrays can easily be produced on large scale at low cost.

  6. 大型工程项目的造价数学建模过程仿真%Simulation of Cost Mathematical Modeling Process of Large Engineering Project

    Institute of Scientific and Technical Information of China (English)

    张勇飞

    2014-01-01

    In engineering cost management system, we need to proceed mathematical modeling for large engineering project cost to realize the overall planning and to cut down expenses. In the course of traditional project cost mathematical modeling ,we have adopted the variable cost fluctuation prediction method and regarded engineering economic cost data sequence as a set of nonlinear time series, and also we have adopted the Lyapunov index prediction algorithm to forecast the cost volatility. While the traditional algorithm cannot effectively consider the complex uncertain factors of the renovation projects, and then the accuracy is not high, it cannot effectively satisfy the principle of maintaining the minimization of the present cost value and the maximization of state indicator within the life span. A mathemati⁃cal model for the simulation of large engineering project cost is proposed based on principal component analysis and cross equalization. From analysis of the cost constraint relationship of large scale construction project, we can get the production quality-efficiency-cost control model of the large engineering project;by using the method of principal component analysis to reconstruct the optimization problem of construction project cost forecasting, we can get the cost constraints multi-objective close degree mathematical model for large-scale construction;based on the principle of cross equalization, according to the cumulative contribution degree of the variance, and using the method of time series, we estimate the time series for engineering budget growth index;and combining Lyapunov index prediction algorithm, the improvement for the design of the project cost mathematical modeling and cost calculation method can be achieved. The simulation experiment results show that the model has higher precision, and smaller mean square error. With it we can save project cost by 23%for building of the same quality, with the merits of improving construction quality as

  7. Optimization of large area solar cells for low cost space application

    Science.gov (United States)

    Matthei, K. W.; Zemmrich, D. K.; Webb, M.

    1981-01-01

    The development of large-area solar cell manufacturing techniques for production of up to 10 kW/month of cells for use on the Shuttle Power Extension Package is detailed. Design goals for the cells were 14% efficiency at 135.3 mW/sq cm AM0 illumination for a 10 ohm-cm BSF/reflector cell, or 12.8% for a 2 ohm-cm BSR cell. Use of terrestrial cell technology to produce CVD SiO2 dielectric insulators for 3-in. ingot cells yielded satisfactory contact integrity. Fused silica coverings with thicknesses of 0.004 in. have allowed exploration of conventional and wraparound cell configurations due to inherent flexibilities of the frosted covers. One production run can now handle 108 3-in. wafers for the wraparound form or 216 in one-sided contact evaporations, with both processes taking 70 mins. Current contact grid designs for space use production permits average efficiencies of 12.8%.

  8. Prospective study on cost-effectiveness of home-based motor assessment in Parkinson's disease.

    Science.gov (United States)

    Cubo, E; Mariscal, N; Solano, B; Becerra, V; Armesto, D; Calvo, S; Arribas, J; Seco, J; Martinez, A; Zorrilla, L; Heldman, D

    2017-02-01

    Introduction Treatment adjustments in Parkinson's disease (PD) are in part dependent on motor assessments. The aim of this study was to evaluate the cost-effectiveness of home-based motor monitoring plus standard in-office visits versus in-office visits alone in patients with advanced PD. Methods The procedures consisted of a prospective, one-year follow-up, randomized, case-control study. A total of 40 patients with advanced PD were randomized into two groups: 20 patients underwent home-based motor monitoring by using wireless motion sensor technology, while the other 20 patients had in-office visits. Motor and non-motor symptom severities, quality of life, neuropsychiatric symptoms, and comorbidities were assessed every four months. Direct costs were assessed using a standardized questionnaire. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). Results Both groups of PD patients were largely comparable in their clinical and demographic variables at baseline; however, there were more participants using levodopa-carbidopa intestinal gel in the home-based motor monitoring group. There was a trend for lower Unified Parkinson's Disease Rating Scale functional status (UPDRS II) scores in the patients monitored at home compared to the standard clinical follow-up ( p = 0.06). However, UPDRS parts I, III, IV and quality-adjusted life-years scores were similar between both groups. Home-based motor monitoring was cost-effective in terms of improvement of functional status, motor severity, and motor complications (UPDRS II, III; IV subscales), with an ICER/UPDRS ranging from €126.72 to €701.31, respectively. Discussion Home-based motor monitoring is a tool which collects cost-effective clinical information and helps augment health care for patients with advanced PD.

  9. Determinants and Effects of Logistics Costs in Container Ports: The Transaction Cost Economics Perspective

    National Research Council Canada - National Science Library

    Hyuk-soo Cho

    2014-01-01

    .... Based on country-level analysis, this study is designed to investigate empirically internal capabilities and external environments of logistics costs and traffic volumes in individual container ports...

  10. Technology strategy for cost-effective drilling and intervention; Technology Target Areas; TTA4 - Cost effective drilling and intervention

    Energy Technology Data Exchange (ETDEWEB)

    2007-07-01

    The main goals of the OG21 initiative are to (1) develop new technology and knowledge to increase the value creation of Norwegian oil and gas resources and (2) enhance the export of Norwegian oil and gas technology. The OG21 Cost-effective Drilling and Intervention (CEDI) Technology Target Area (TTA) has identified some key strategic drilling and well intervention needs to help meet the goals of OG21. These key strategic drilling and well intervention needs are based on a review of present and anticipated future offshore-Norway drilling and well intervention conditions and the Norwegian drilling and well intervention industry. A gap analysis has been performed to assess the extent to which current drilling and well intervention research and development and other activities will meet the key strategic needs. Based on the identified strategic drilling and well intervention needs and the current industry res each and development and other activities, the most important technology areas for meeting the OG21 goals are: environment-friendly and low-cost exploration wells; low-cost methods for well intervention/sidetracks; faster and extended-reach drilling; deep water drilling, completion and intervention; offshore automated drilling; subsea and sub-ice drilling; drilling through basalt and tight carbonates; drilling and completion in salt formation. More specific goals for each area: reduce cost of exploration wells by 50%; reduce cost for well intervention/sidetracks by 50%; increase drilling efficiency by 40%; reduce drilling cost in deep water by 40 %; enable offshore automated drilling before 2012; enable automated drilling from seabed in 2020. Particular focus should be placed on developing new technology for low-cost exploration wells to stem the downward trends in the number of exploration wells drilled and the volume of discovered resources. The CEDI TTA has the following additional recommendations: The perceived gaps in addressing the key strategic drilling and

  11. New tools for cost-effective delivery of breast imaging.

    Science.gov (United States)

    Kolb, Gerald R

    2002-01-01

    Breast imaging has a deserved reputation as a very difficult financial proposition for hospitals. Regulation, low reimbursement, costly new technologies and staff shortages all combine to create an operational environment that is difficult, at best. While it may not be possible for every hospital to make breast imaging profitable, it is the obligation of every hospital to make this and all service lines as cost-effective as possible. While the typical care episode in a hospital will include several different services or procedures, the breast-imaging patient is typically in the department or breast center for a single procedure. Consequently, all of the administrative and facility costs of the patient encounter must be borne by the reimbursement for the single procedure. Breast imaging involves relatively expensive technology and highly-trained, and costly, technologists in its delivery. The costs of these inputs are relatively fixed; therefore material improvement can only be realized through the redesign of process. Analysis of the process of care delivery is critical to any discussion of the economics of breast imaging. Breast imaging can basically be divided into two categories: screening mammography and diagnostic procedures. This is a very important distinction, because screening mammography requires only general supervision, while the balance of breast imaging requires the direct supervision of the physician. Decoupling the physician from the examination allows the organization of screening delivery programs in highly efficient, high-throughput systems. On the diagnostic side of breast imaging, the primary economic enhancement that can be realized is from the delivery of more than one procedure during the patient visit. Mammography has high fixed costs (technology and technologist) and, where high fixed costs are found, profitability is determined by process and volume. Where process can be optimized to a level that will allow a positive return for each

  12. Examining the cost-effectiveness of early dental visits.

    Science.gov (United States)

    Lee, Jessica Y; Bouwens, Thomas J; Savage, Matthew F; Vann, William F

    2006-01-01

    The subject of early dental visits as an integral dimension of anticipatory guidance and the related supporting scientific evidence for this concept is a critical and timely issue for the dental profession. The purpose of this paper was to review the scientific evidence and rationale for early dental visits. In theory, early dental visits can prevent disease and reduce costs. During the age 1 dental visit, there is strong emphasis on prevention and parents are given: (1) counseling on infant oral hygiene; (2) home and office-based fluoride therapies; (3) dietary counseling; and (4) information relative to oral habits and dental injury prevention. There is evidence that the early preventive visits can reduce the need for restorative and emergency care, therefore reducing dentally related costs among high-risk children. Preschool Medicaid children who had an early preventive dental visit by age 1 were more likely to use subsequent preventive services and experienced less dentally related costs. These finding have significant policy implications, and more research is needed to examine this effect in a low-risk population.

  13. Economic evaluation of universal 7-valent pneumococcal conjugate vaccination in Taiwan: A cost-effectiveness analysis

    Directory of Open Access Journals (Sweden)

    David Bin Chia Wu

    2013-03-01

    Conclusion: Taking herd effect and indirect costs into account, PCV7 vaccination is cost-effective in Taiwan. Further pharmacoeconomic model should include herd effect in CEA of infectious disease research.

  14. Low cost solution-based materials processing methods for large area OLEDs and OFETs

    Science.gov (United States)

    Jeong, Jonghwa

    In Part 1, we demonstrate the fabrication of organic light-emitting devices (OLEDs) with precisely patterned pixels by the spin-casting of Alq3 and rubrene thin films with dimensions as small as 10 mum. The solution-based patterning technique produces pixels via the segregation of organic molecules into microfabricated channels or wells. Segregation is controlled by a combination of weak adsorbing characteristics of aliphatic terminated self-assembled monolayers (SAMs) and by centrifugal force, which directs the organic solution into the channel or well. This novel patterning technique may resolve the limitations of pixel resolution in the method of thermal evaporation using shadow masks, and is applicable to the fabrication of large area displays. Furthermore, the patterning technique has the potential to produce pixel sizes down to the limitation of photolithography and micromachining techniques, thereby enabling the fabrication of high-resolution microdisplays. The patterned OLEDs, based upon a confined structure with low refractive index of SiO2, exhibited higher current density than an unpatterned OLED, which results in higher electroluminescence intensity and eventually more efficient device operation at low applied voltages. We discuss the patterning method and device fabrication, and characterize the morphological, optical, and electrical properties of the organic pixels. In part 2, we demonstrate a new growth technique for organic single crystals based on solvent vapor assisted recrystallization. We show that, by controlling the polarity of the solvent vapor and the exposure time in a closed system, we obtain rubrene in orthorhombic to monoclinic crystal structures. This novel technique for growing single crystals can induce phase shifting and alteration of crystal structure and lattice parameters. The organic molecules showed structural change from orthorhombic to monoclinic, which also provided additional optical transition of hypsochromic shift from

  15. Cost Effective System Modeling of Active Micro- Module Solar Tracker

    Directory of Open Access Journals (Sweden)

    Md. Faisal Shuvo

    2014-01-01

    Full Text Available The increasing interests in using renewable energies are coming from solar thermal energy and solar photovoltaic systems to the micro production of electricity. Usually we already have considered the solar tracking topology in large scale applications like power plants and satellite but most of small scale applications don’t have any solar tracker system, mainly because of its high cost and complex circuit design. From that aspect, this paper confab microcontroller based one dimensional active micro-module solar tracking system, in which inexpensive LDR is used to generate reference voltage to operate microcontroller for functioning the tracking system. This system provides a fast response of tracking system to the parameters like change of light intensity as well as temperature variations. This micro-module model of tracking system can be used for small scale applications like portable electronic devices and running vehicles.

  16. Factors Effect Direct Cost of Hospital Foodservices and Approximate Cost Analyze

    Directory of Open Access Journals (Sweden)

    Fatma Çelik

    2006-01-01

    Full Text Available The aim of this study was to investigate the cost of foodservice for the university hospital by taking into account of the criteria’s of well diet balanced using information technology. The data explain cost of food were obtained from input, output of hospital food barn that processed by hospital information system for 1995, 2000-2004 years. All details for calculating the net expenditure of food and direct cost of nutrition services were obtained from hospital information system that records all data on line. The energy and nutrient values of daily food served were calculated using the output of hospital food barn by the computer software that was developed. It was found that, our hospital catering system supplied a daily food ration of 2728 kcal and 98,1 gr protein/person in 2004.It has found that the cost of food was increased 10 times from 1995 to 2004. The expenditure of food groups that used in the hospital was 58.96% percent in the total cost of all nutrition services. The big part (28.92% of food expenditure was red meat and pulses. It has been thought that the daily approximate food cost for per person was 3,15 YTL. The total approximate cost could be estimated by adding the cost of staffs and the various managing expenditures to the approximate food cost. These data would be used to make the hospital foodservices private.In conclusion, to be successful in managing hospital food services depends on regular inspection and to take all costs under control daily. To present the results of cost analysis for hospitals will increase the quality of foodservices and will be possible to compare with the others.

  17. Effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs

    NARCIS (Netherlands)

    F. Karapinar-Çarkit (Fatma); S.D. Borgsteede (Sander); J. Zoer (Jan); T.C.G. Egberts (Toine); P.M.L.A. van den Bemt (Patricia); M.W. van Tulder (Maurits)

    2012-01-01

    textabstractBACKGROUND: Medication reconciliation aims to correct discrepancies in medication use between health care settings and to check the quality of pharmacotherapy to improve effectiveness and safety. In addition, medication reconciliation might also reduce costs. OBJECTIVE: To evaluate the

  18. Review of the cost effectiveness of pharmacogenetic-guided treatment of hypercholesterolaemia.

    Science.gov (United States)

    Sorich, Michael J; Wiese, Michael D; O'Shea, Rebekah L; Pekarsky, Brita

    2013-05-01

    Hypercholesterolaemia is a highly prevalent condition that has major health and cost implications for society. Pharmacotherapy is an important and effective treatment modality for hypercholesterolaemia, with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors ('statins') the most commonly used class of drugs. Over the past decade, there has been intensive research to identify pharmacogenetic markers to guide treatment of hypercholesterolaemia. This study aimed to review the evidence of incremental cost, effect and cost effectiveness of pharmacogenetic-guided treatment of hypercholesterolaemia. Three cost-effectiveness analyses (CEAs) were identified that studied the value of screening for genotypes of angiotensin I converting enzyme (ACE), cholesteryl ester transfer protein (CETP), and kinesin family member 6 (KIF6) prior to initiating statin therapy. For all three CEAs, a major limitation identified was the reproducibility of the evidence supporting the clinical effect of screening for the pharmacogenetic marker. Associated issues included the uncertain value of pharmacogenetic markers over or in addition to existing approaches for monitoring lipid levels, and the lack of evidence to assess the effectiveness of alternative therapeutic options for individuals identified as poor responders to statin therapy. Finally, the economic context of the market for diagnostic tests (is it competitive or is there market power?) and the practicality of large-scale screening programmes to inform prescribing in a complex and varied market may limit the generalizability of the results of the specific CEAs to policy outcomes. The genotype of solute carrier organic anion transporter family member 1B1 (SLCO1B1) has recently been associated with increased risk of muscle toxicity with statin therapy and the review identified that exploration of cost effectiveness of this pharmacogenetic marker is likely warranted.

  19. Complementary and alternative medicine use and cost in functional bowel disorders: A six month prospective study in a large HMO

    Directory of Open Access Journals (Sweden)

    Drossman Douglas A

    2008-07-01

    Full Text Available Abstract Background Functional Bowel Disorders (FBD are chronic disorders that are difficult to treat and manage. Many patients and doctors are dissatisfied with the level of improvement in symptoms that can be achieved with standard medical care which may lead them to seek alternatives for care. There are currently no data on the types of Complementary and Alternative Medicine (CAM used for FBDs other than Irritable Bowel Syndrome (IBS, or on the economic costs of CAM treatments. The aim of this study is to determine prevalence, types and costs of CAM in IBS, functional diarrhea, functional constipation, and functional abdominal pain. Methods 1012 Patients with FBD were recruited through a health care maintenance organization and followed for 6 months. Questionnaires were used to ascertain: Utilization and expenditures on CAM, symptom severity (IBS-SS, quality of life (IBS-QoL, psychological distress (BSI and perceived treatment effectiveness. Costs for conventional medical care were extracted from administrative claims. Results CAM was used by 35% of patients, at a median yearly cost of $200. The most common CAM types were ginger, massage therapy and yoga. CAM use was associated with female gender, higher education, and anxiety. Satisfaction with physician care and perceived effectiveness of prescription medication were not associated with CAM use. Physician referral to a CAM provider was uncommon but the majority of patients receiving this recommendation followed their physician's advice. Conclusion CAM is used by one-third of FBD patients. CAM use does not seem to be driven by dissatisfaction with conventional care. Physicians should discuss CAM use and effectiveness with their patients and refer patients if appropriate.

  20. Development and Manufacture of Cost Effective Composite Drill Pipe

    Energy Technology Data Exchange (ETDEWEB)

    James C. Leslie; James C. Leslie, II; Lee Truong; James T. Heard

    2006-09-29

    This technical report presents the engineering research, process development and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report presents progress made from October 1, 2005 through September 30, 2006 and contains the following discussions: Qualification Testing; Prototype Development and Testing of ''Smart Design'' Configuration; Field Test Demonstration; Development of Ultra-Short Radius Composite Drill Pipe (USR-CDP); and Development of Smart USR-CDP.

  1. Cost-effective wound management: a survey of 1717 nurses.

    Science.gov (United States)

    Newton, Heather

    2017-06-22

    Delivering high-quality wound care requires a mix of knowledge and skills, which nurses aim to update by attending educational events such as conferences and study days. This article describes the data obtained from 30 educational study days, which took place across England, Scotland and Wales. It will explore nurses' knowledge in relation to the cost-effectiveness and clinical efficacy of current wound care practices, based on the answers of 1717 delegates that attended the events. It will also outline the results in relation to reducing expenditure on wound dressings and the importance of performing an accurate wound assessment.

  2. Privacy Enforcement in a Cost-Effective Smart Grid

    DEFF Research Database (Denmark)

    Mikkelsen, Søren Aagaard

    In this technical report we present the current state of the research conducted during the first part of the PhD period. The PhD thesis “Privacy Enforcement in a Cost-Effective Smart Grid” focuses on ensuring privacy when generating market for energy service providers that develop web services...... for the residential domain in the envisaged smart grid. The PhD project is funded and associated to the EU project “Energy Demand Aware Open Services for Smart Grid Intelligent Automation” (Smart HG) and therefore introduces the project on a system-level. Based on this, we present some of the integration, security...

  3. Cost-Effective Helicopter Options for Partner Nations

    Science.gov (United States)

    2015-01-01

    elevation feature MGTOW maximum gross takeoff weight MOB main operating base MoD Ministry of Defense MoI Ministry of Interior nm nautical miles NSRW...we provided a main operat- ing base ( MOB ) or forward operating base (FOB) from which operations would be conducted. In these instances, the...RAND RR141z1-2.2 MOB /FOB MOB /FOB X Y Z LZs Alternate LZs 23 nmPrimary LZ Bor der Bor der 120º 120º 10 Cost-Effective Helicopter Options for Partner

  4. DEVELOPMENT AND MANUFACTURE OF COST EFFECTIVE COMPOSITE DRILL PIPE

    Energy Technology Data Exchange (ETDEWEB)

    James C. Leslie; James C. Leslie II; Lee Truong; James T. Heard; Peter Manekas

    2005-03-18

    This technical report presents the engineering research, process development and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report presents progress made from October 1, 2003 through September 30, 2004 and contains the following discussions: (1) Direct Electrical Connection for Rotary Shoulder Tool Joints; (2) Conductors for inclusion in the pipe wall (ER/DW-CDP); (3) Qualify fibers from Zoltek; (4) Qualify resin from Bakelite; (5) First commercial order for SR-CDP from Integrated Directional Resources (SR-CDP); and (6) Preparation of papers for publication and conference presentations.

  5. The redundant target effect is affected by modality switch costs

    DEFF Research Database (Denmark)

    Gondan, Matthias; Lange, K.; Rösler, F.;

    2004-01-01

    , possibly due to multisensory interactions. In random stimulus sequences, reaction times are slower when the stimulus is preceded by a stimulus of a different modality (modality switch effect [MSE]). Simple reaction time redundant target experiments with auditory-visual, visual-tactile, and auditory......-tactile stimulus combinations were run to determine whether the RTE may be partly explained by MSEs because bimodal stimuli do not require a modality switch. In all three modality pairings, significant MSEs and RTEs were observed. However, the RTE was still significant after reaction times were corrected...... for the MSE, supporting the hypothesis that coactivation occurs independently of modality switch costs....

  6. Cost effectiveness of rural development programme instruments in denmark

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Jacobsen, Lars Bo; Madsen, Bjarne

    2011-01-01

    support (e.g. 10 million €/year) for the respective instruments, and in turn assess the geographically distributed effects on farm income and employment, on production, value-added and employment in related upstream and downstream industries, on income and employment in the municipalities, and on a number......The objective of this study is to investigate the cost-effectiveness of selected instruments of the Danish Rural Development Programme 2007-2013, which constitutes the Danish implementation of the EU Rural Development Programme under Pillar Two of the Common Agricultural Policy. The Programme aims...... (micro-based “National Accounts” for municipalities, municipality economic model) and national level (national economic model), which enables analysis at a fairly detailed geographical level and hence to evaluate the spatially distributed effects of the considered policy instruments, while at the same...

  7. Cost effectiveness of rural development programme instruments in denmark

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Jacobsen, Lars Bo; Madsen, Bjarne

    2011-01-01

    The objective of this study is to investigate the cost-effectiveness of selected instruments of the Danish Rural Development Programme 2007-2013, which constitutes the Danish implementation of the EU Rural Development Programme under Pillar Two of the Common Agricultural Policy. The Programme aims...... (micro-based “National Accounts” for municipalities, municipality economic model) and national level (national economic model), which enables analysis at a fairly detailed geographical level and hence to evaluate the spatially distributed effects of the considered policy instruments, while at the same...... time incorporating economic interactions between different geographical areas, via inter-regional trade, commuting and influences via prices and wages. In order to make results for different policy instruments comparable, we use the simulation models to assess the effects of a given amount of public...

  8. In-Office Application of Fluoride Gel or Varnish: Cost-Effectiveness and Expected Value of Perfect Information Analysis.

    Science.gov (United States)

    Schwendicke, Falk; Stolpe, Michael

    2017-01-01

    Application of fluoride gel/varnish (FG/FV) reduces caries increments but generates costs. Avoiding restorative treatments by preventing caries might compensate for these costs. We assessed the cost-effectiveness of dentists applying FG/FV in office and the expected value of perfect information (EVPI). EVPI analyses estimate the economic value of having perfect knowledge, assisting research resource allocation. A mixed public-private-payer perspective in Germany was adopted. A population of 12-year-olds was followed over their lifetime, with caries increments modelled using wide intervals to reflect the uncertainty of caries risk. Biannual application of FV/FG until age 18 years was compared to no fluoride application. Effectiveness parameters and their uncertainty were derived from systematic reviews. The health outcome was caries increment (decayed, missing, or filled teeth; DMFT). Cost calculations were based on fee catalogs or microcosting, including costs for individual-prophylactic fluoridation and, for FG, an individualized tray, plus material costs. Microsimulations, sensitivity, and EVPI analyses were performed. On average and applied to a largely low-risk population, no application of fluoride was least costly but also least effective (EUR 230; 11 DMFT). FV was more costly and effective (EUR 357; 7 DMFT). FG was less effective than FV and also more costly when using individualized trays. FV was the best choice for payers willing to invest EUR 39 or more per avoided DMFT. This cost-effectiveness will differ in different settings/countries or if FG/FV is applied by other care professionals. The EVPI was mainly driven by the individual's caries risk, as FV/FG were significantly more cost-effective in high-risk populations than in low-risk ones. Future studies should focus on caries risk prediction. © 2017 S. Karger AG, Basel.

  9. Cost-effectiveness of opportunistic screening and minimal contact psychotherapy to prevent depression in primary care patients

    NARCIS (Netherlands)

    J.M. van den Berg (Merlijn); F. Smit (Filip); T. Vos (Theo); P.H.M. van Baal (Pieter)

    2011-01-01

    textabstractBackground: Depression causes a large burden of disease worldwide. Effective prevention has the potential to reduce that burden considerably. This study aimed to investigate the cost-effectiveness of minimal contact psychotherapy, based on Lewinsohn's 'Coping with depression' course, tar

  10. The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study.

    Directory of Open Access Journals (Sweden)

    Dongfeng Gu

    2015-08-01

    Full Text Available Hypertension is China's leading cardiovascular disease risk factor. Improved hypertension control in China would result in result in enormous health gains in the world's largest population. A computer simulation model projected the cost-effectiveness of hypertension treatment in Chinese adults, assuming a range of essential medicines list drug costs.The Cardiovascular Disease Policy Model-China, a Markov-style computer simulation model, simulated hypertension screening, essential medicines program implementation, hypertension control program administration, drug treatment and monitoring costs, disease-related costs, and quality-adjusted life years (QALYs gained by preventing cardiovascular disease or lost because of drug side effects in untreated hypertensive adults aged 35-84 y over 2015-2025. Cost-effectiveness was assessed in cardiovascular disease patients (secondary prevention and for two blood pressure ranges in primary prevention (stage one, 140-159/90-99 mm Hg; stage two, ≥160/≥100 mm Hg. Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure. One-way and probabilistic sensitivity analyses explored ranges of antihypertensive drug effectiveness and costs, monitoring frequency, medication adherence, side effect severity, background hypertension prevalence, antihypertensive medication treatment, case fatality, incidence and prevalence, and cardiovascular disease treatment costs. Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices. Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int$] in 2015 were considered cost-effective. Treating hypertensive adults with prior

  11. A systematic review of repetitive functional task practice with modelling of resource use, costs and effectiveness.

    Science.gov (United States)

    French, B; Leathley, M; Sutton, C; McAdam, J; Thomas, L; Forster, A; Langhorne, P; Price, C; Walker, A; Watkins, C

    2008-07-01

    gained, RFTP is cost-effective so long as the net cost per patient is less than 1963 pounds. This result showed some sensitivity to the assumptions made for the model. The cost-effectiveness of RFTP tends to stem from the relatively modest cost associated with this intervention. The evidence suggests that some form of RFTP can be effective in improving lower limb function at any time after stroke, but that the duration of intervention effect is unclear. There is as yet insufficient good-quality evidence to make any firm recommendations for upper limb interventions. If task-specific training is used, adverse effects should be monitored. While the effectiveness of RFTP is relatively modest, this sort of intervention appears to be cost-effective. Owing to the large number of ongoing trials, this review should be updated within 2 years and any future review should include a comparison against alternative treatments. Further research should evaluate RFTP upper limb interventions and in particular constraint-induced movement therapy, address practical ways of delivering RFTP interventions, be directed towards the evaluation of suitable methods to maintain functional gain, and be powered to detect whether RFTP interventions are cost-effective.

  12. Better informing decision making with multiple outcomes cost-effectiveness analysis under uncertainty in cost-disutility space.

    Directory of Open Access Journals (Sweden)

    Nikki McCaffrey

    Full Text Available Comparing multiple, diverse outcomes with cost-effectiveness analysis (CEA is important, yet challenging in areas like palliative care where domains are unamenable to integration with survival. Generic multi-attribute utility values exclude important domains and non-health outcomes, while partial analyses-where outcomes are considered separately, with their joint relationship under uncertainty ignored-lead to incorrect inference regarding preferred strategies.The objective of this paper is to consider whether such decision making can be better informed with alternative presentation and summary measures, extending methods previously shown to have advantages in multiple strategy comparison.Multiple outcomes CEA of a home-based palliative care model (PEACH relative to usual care is undertaken in cost disutility (CDU space and compared with analysis on the cost-effectiveness plane. Summary measures developed for comparing strategies across potential threshold values for multiple outcomes include: expected net loss (ENL planes quantifying differences in expected net benefit; the ENL contour identifying preferred strategies minimising ENL and their expected value of perfect information; and cost-effectiveness acceptability planes showing probability of strategies minimising ENL.Conventional analysis suggests PEACH is cost-effective when the threshold value per additional day at home (1 exceeds $1,068 or dominated by usual care when only the proportion of home deaths is considered. In contrast, neither alternative dominate in CDU space where cost and outcomes are jointly considered, with the optimal strategy depending on threshold values. For example, PEACH minimises ENL when 1=$2,000 and 2=$2,000 (threshold value for dying at home, with a 51.6% chance of PEACH being cost-effective.Comparison in CDU space and associated summary measures have distinct advantages to multiple domain comparisons, aiding transparent and robust joint comparison of costs and

  13. Estimating the cost-effectiveness of lifestyle intervention programmes to prevent diabetes based on an example from Germany: Markov modelling

    Directory of Open Access Journals (Sweden)

    Neumann Anne

    2011-11-01

    Full Text Available Abstract Background Type 2 diabetes mellitus (T2D poses a large worldwide burden for health care systems. One possible tool to decrease this burden is primary prevention. As it is unethical to wait until perfect data are available to conclude whether T2D primary prevention intervention programmes are cost-effective, we need a model that simulates the effect of prevention initiatives. Thus, the aim of this study is to investigate the long-term cost-effectiveness of lifestyle intervention programmes for the prevention of T2D using a Markov model. As decision makers often face difficulties in applying health economic results, we visualise our results with health economic tools. Methods We use four-state Markov modelling with a probabilistic cohort analysis to calculate the cost per quality-adjusted life year (QALY gained. A one-year cycle length and a lifetime time horizon are applied. Best available evidence supplies the model with data on transition probabilities between glycaemic states, mortality risks, utility weights, and disease costs. The costs are calculated from a societal perspective. A 3% discount rate is used for costs and QALYs. Cost-effectiveness acceptability curves are presented to assist decision makers. Results The model indicates that diabetes prevention interventions have the potential to be cost-effective, but the outcome reveals a high level of uncertainty. Incremental cost-effectiveness ratios (ICERs were negative for the intervention, ie, the intervention leads to a cost reduction for men and women aged 30 or 50 years at initiation of the intervention. For men and women aged 70 at initiation of the intervention, the ICER was EUR27,546/QALY gained and EUR19,433/QALY gained, respectively. In all cases, the QALYs gained were low. Cost-effectiveness acceptability curves show that the higher the willingness-to-pay threshold value, the higher the probability that the intervention is cost-effective. Nonetheless, all curves are

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

    Science.gov (United States)

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

    2010-12-22

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

  15. Effectiveness and cost-effectiveness of the pharmacological treatment of Alzheimer's disease and vascular dementia.

    Science.gov (United States)

    Versijpt, Jan

    2014-01-01

    Until an effective and especially disease-modifying treatment for Alzheimer's disease (AD) and vascular dementia (VaD) is available, the currently available pharmacological therapeutic arsenal aims at merely improving symptomatology. Health economic data make an important contribution to the planning of healthcare services and the estimation of the cost of drug reimbursement. As such, both for cholinesterase inhibitors and, to a lesser extent, for memantine it can be claimed that the direct cost of the drug itself is eclipsed by the cost savings associated with delaying institutionalization or delaying the time of progression into a more severe disease state. The present manuscript reviews several factors contributing to the costs of dementia, gives an overview of available studies claiming both the effectiveness and cost-effectiveness of current dementia treatments, and highlights strengths and weaknesses of the aforementioned studies.

  16. Clinical effectiveness and cost-effectiveness of Internet- vs. group-based cognitive behavior therapy for social anxiety disorder: 4-year follow-up of a randomized trial.

    Science.gov (United States)

    Hedman, Erik; El Alaoui, Samir; Lindefors, Nils; Andersson, Erik; Rück, Christian; Ghaderi, Ata; Kaldo, Viktor; Lekander, Mats; Andersson, Gerhard; Ljótsson, Brjánn

    2014-08-01

    Social anxiety disorder (SAD) is common, debilitating and associated with high societal costs. The disorder can be effectively treated with Internet-based cognitive behavior therapy (ICBT), but no previous study has investigated the long-term clinical or health economic effects of ICBT for SAD in comparison to an evidence-based control treatment. The aim of the study was to investigate the clinical effectiveness and cost-effectiveness of ICBT compared to cognitive behavioral group therapy (CBGT) four years post-treatment. We conducted a 4-year follow-up study of participants who had received ICBT or CBGT for SAD within the context of a randomized controlled non-inferiority trial. The cost-effectiveness analyses were conducted taking a societal perspective. Participants in both treatment groups made large improvements from baseline to 4-year follow-up on the primary outcome measure (d = 1.34-1.48) and the 95% CI of the mean difference on the primary outcome was well within the non-inferiority margin. ICBT and CBGT were similarly cost-effective and both groups reduced their indirect costs. We conclude that ICBT for SAD yields large sustainable effects and is at least as long-term effective as CBGT. Intervention costs of both treatments are offset by net societal cost reductions in a short time. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Valuation of road safety effects in cost-benefit analysis.

    Science.gov (United States)

    Wijnen, Wim; Wesemann, Paul; de Blaeij, Arianne

    2009-11-01

    Cost-benefit analysis is a common method for evaluating the social economic impact of transport projects, and in many of these projects the saving of human lives is an issue. This implies, within the framework of cost-benefit analysis, that a monetary value should be attached to saving human lives. This paper discusses the 'Value of a Statistical Life' (VoSL), a concept that is often used for monetising safety effects, in the context of road safety. Firstly, the concept of 'willingness to pay' for road safety and its relation to the VoSL are explained. The VoSL approach will be compared to other approaches to monetise safety effects, in particular the human capital approach and 'quality adjusted life years'. Secondly, methods to estimate the VoSL and their applicability to road safety will be discussed. Thirdly, the paper reviews the VoSL estimates that have been found in scientific research and compares them with the values that are used in policy evaluations. Finally, a VoSL study in the Netherlands will be presented as a case study, and its applicability in policy evaluation will be illustrated.

  18. Cost-Effectiveness Analysis in Practice: Interventions to Improve High School Completion

    Science.gov (United States)

    Hollands, Fiona; Bowden, A. Brooks; Belfield, Clive; Levin, Henry M.; Cheng, Henan; Shand, Robert; Pan, Yilin; Hanisch-Cerda, Barbara

    2014-01-01

    In this article, we perform cost-effectiveness analysis on interventions that improve the rate of high school completion. Using the What Works Clearinghouse to select effective interventions, we calculate cost-effectiveness ratios for five youth interventions. We document wide variation in cost-effectiveness ratios between programs and between…

  19. A comparison of estimates of cost-effectiveness of alternative fuels and vehicles for reducing emissions

    Energy Technology Data Exchange (ETDEWEB)

    Hadder, G.R.

    1995-11-01

    The cost-effectiveness ratio (CER) is a measure of the monetary value of resources expended to obtain reductions in emissions of air pollutants. The CER can lead to selection of the most effective sequence of pollution reduction options. Derived with different methodologies and technical assumptions, CER estimates for alternative fuel vehicles (AFVs) have varied widely among pervious studies. In one of several explanations of LCER differences, this report uses a consistent basis for fuel price to re-estimate CERs for AFVs in reduction of emissions of criteria pollutants, toxics, and greenhouse gases. The re-estimated CERs for a given fuel type have considerable differences due to non-fuel costs and emissions reductions, but the CERs do provide an ordinal sense of cost-effectiveness. The category with CER less than $5,000 per ton includes compressed natural gas and ed Petroleum gas vehicles; and E85 flexible-fueled vehicles (with fuel mixture of 85 percent cellulose-derived ethanol in gasoline). The E85 system would be much less attractive if corn-derived ethanol were used. The CER for E85 (corn-derived) is higher with higher values placed on the reduction of gas emissions. CER estimates are relative to conventional vehicles fueled with Phase 1 California reformulated gasoline (RFG). The California Phase 2 RFG program will be implemented before significant market penetration by AFVs. CERs could be substantially greater if they are calculated incremental to the Phase 2 RFG program. Regression analysis suggests that different assumptions across studies can sometimes have predictable effects on the CER estimate of a particular AFV type. The relative differences in cost and emissions reduction assumptions can be large, and the effect of these differences on the CER estimate is often not predictable. Decomposition of CERs suggests that methodological differences can make large contributions to CER differences among studies.

  20. Assessment of effectiveness and cost-effectiveness of HPV testing in primary screening for cervical

    Directory of Open Access Journals (Sweden)

    Willich, Stefan N.

    2007-09-01

    % of the HPV strategies were found to be cost-effective, whereas in comparison with one-, three-, and five-yearly PAP screening, the percentage of overall cost-effective HPV strategies was 83%, 55%, and 92%, respectively. Results for annual screening intervals are based on the assumption of complete screening compliance, which has to be further evaluated in decision analyses in the future adapting to the German health care setting. Discussion: Including HPV testing in screening procedures for cervical carcinoma could lead to a reduction in false positive results. Doing so would involve one of the following approaches: a combining the HPV test with cytology, or b using cytology as triage in HPV-positive women. The most appropriate interval between screening tests and the best age to start or stop screening remains to be determined. At this point a formal health economic decision analyses may help in resolving those questions, additionally incorporating compliance and adherence within different screening scenarios. Conclusion: Considering medical evidence weighing the question whether HPV testing should be implemented into screening routine may not be if but how to do so. Open questions remain in setting the length of optimal screening intervals, the age range in which to screen, and the combination or sequence of existing cytology and HPV testing. Answers to those questions will be gathered in the very near future through large international clinical trials. Cost-effectiveness of implementing HPV testing is likely to exist in the management of borderline or unclear smears in triage treatment as well as in certain scenarios of primary screening within the German health care setting.

  1. Large Scale Triboelectric Nanogenerator and Self-Powered Pressure Sensor Array Using Low Cost Roll-to-Roll UV Embossing

    Science.gov (United States)

    Dhakar, Lokesh; Gudla, Sudeep; Shan, Xuechuan; Wang, Zhiping; Tay, Francis Eng Hock; Heng, Chun-Huat; Lee, Chengkuo

    2016-02-01

    Triboelectric nanogenerators (TENGs) have emerged as a potential solution for mechanical energy harvesting over conventional mechanisms such as piezoelectric and electromagnetic, due to easy fabrication, high efficiency and wider choice of materials. Traditional fabrication techniques used to realize TENGs involve plasma etching, soft lithography and nanoparticle deposition for higher performance. But lack of truly scalable fabrication processes still remains a critical challenge and bottleneck in the path of bringing TENGs to commercial production. In this paper, we demonstrate fabrication of large scale triboelectric nanogenerator (LS-TENG) using roll-to-roll ultraviolet embossing to pattern polyethylene terephthalate sheets. These LS-TENGs can be used to harvest energy from human motion and vehicle motion from embedded devices in floors and roads, respectively. LS-TENG generated a power density of 62.5 mW m-2. Using roll-to-roll processing technique, we also demonstrate a large scale triboelectric pressure sensor array with pressure detection sensitivity of 1.33 V kPa-1. The large scale pressure sensor array has applications in self-powered motion tracking, posture monitoring and electronic skin applications. This work demonstrates scalable fabrication of TENGs and self-powered pressure sensor arrays, which will lead to extremely low cost and bring them closer to commercial production.

  2. Large Scale Triboelectric Nanogenerator and Self-Powered Pressure Sensor Array Using Low Cost Roll-to-Roll UV Embossing.

    Science.gov (United States)

    Dhakar, Lokesh; Gudla, Sudeep; Shan, Xuechuan; Wang, Zhiping; Tay, Francis Eng Hock; Heng, Chun-Huat; Lee, Chengkuo

    2016-02-24

    Triboelectric nanogenerators (TENGs) have emerged as a potential solution for mechanical energy harvesting over conventional mechanisms such as piezoelectric and electromagnetic, due to easy fabrication, high efficiency and wider choice of materials. Traditional fabrication techniques used to realize TENGs involve plasma etching, soft lithography and nanoparticle deposition for higher performance. But lack of truly scalable fabrication processes still remains a critical challenge and bottleneck in the path of bringing TENGs to commercial production. In this paper, we demonstrate fabrication of large scale triboelectric nanogenerator (LS-TENG) using roll-to-roll ultraviolet embossing to pattern polyethylene terephthalate sheets. These LS-TENGs can be used to harvest energy from human motion and vehicle motion from embedded devices in floors and roads, respectively. LS-TENG generated a power density of 62.5 mW m(-2). Using roll-to-roll processing technique, we also demonstrate a large scale triboelectric pressure sensor array with pressure detection sensitivity of 1.33 V kPa(-1). The large scale pressure sensor array has applications in self-powered motion tracking, posture monitoring and electronic skin applications. This work demonstrates scalable fabrication of TENGs and self-powered pressure sensor arrays, which will lead to extremely low cost and bring them closer to commercial production.

  3. Cost Effectiveness Analysis of Antibiotic Used among Sepsis Patients in Hospital in Bandung

    Directory of Open Access Journals (Sweden)

    Cherry Rahayu

    2013-06-01

    Full Text Available The aim of this study was to determine the antibiotic combination group that were the most effective in cost (cost effectiveness used as sepsis with respiratory infections treatment at one of hospital in Bandung. Observational study was conducted by retrospective data. Data were collected from medical record from inpatients sepsis with respiratory infection and received empirical therapy cefotaxime-metronidazole or cefotaxime-erythromycin. Direct medical cost is collected from empirical antibiotic costs, costs of medical treatment, medical expenses, hospitalization costs, and administrative costs. The results of Incremental Cost Effectiveness Ratio (ICER showed that ratio of direct medical cost and survived patients is 3.301.090,00 IDR for cefotaxime-metronidazole that compared to other empirical antibiotic, and 2.227.366,89 IDR for cefotaxime-erythromycin. It can be conclude that the combination of cefotaxime-erythromycin is more cost effective than cefotaxime-metronidazole.

  4. Analysis of the Effect of Employee Costs on Company Performance

    Directory of Open Access Journals (Sweden)

    Željko Požega

    2010-07-01

    Full Text Available The goal of every economic entity is to accomplish an optimal system of compensation management and to reach maximum returns through optimal employee investment, raising their motivation and knowledge as well as developing their abilities and skills. In order to reach this goal of maximizing company performance it is necessary to systematically approach the management of human resources within a certain economic entity and to create the fairest material and non-material reward and punishment system by using compensation management methods. This in turn will bring about a positive working atmosphere in the company, where employees will rapidly and easily adjust to changes, interact and co-operate with one another at a high level. This research, which studies the effect of employee costs on company performance, is divided into three chapters. The first chapter provides a brief theoretical overview of the importance of compensation management in human resources administration and reaching business efficiency, i.e. the different possibilities of creating a reward and punishment system in a company which aims to organise an optimal working atmosphere. The second chapter demonstrates the applied methodology and illustrates the information from different companies, which has been used in this research and analysis. The information comprises statistical data of employee costs, income, profits and losses from a sample of companies from the Republic of Croatia in 2008. The third part deals with the analysis and interpretation of the research results which show the effect of employee costs on the income and company performance, also expressed per employee. The goal of this research is to test the hypothesis that companies with higher employee cost, i.e. with higher investment in human resources, on average obtain a higher income and a higher profit per employee and are more efficient and more successful on the market. From the given hypothesis, one can

  5. Development of a Cost Effective Power Generation System: An Overview

    Directory of Open Access Journals (Sweden)

    Shiv Prakash Bihari

    2016-03-01

    Full Text Available This paper presents an overview on development of cost effective power generation system and motivates for development of a model for hybrid system with wind to investigate the combined operation of wind with different sources to cater to wind’s stochastic nature for imbalance minimization and optimal operation. Development of model for trading power in competitive electricity market and development of strategies for trading in electricity markets (wind energy and reserves markets to investigate the effects of real time pricing tariffs on electricity market operation has been illustrated in this paper. Dynamic modelling related studies to investigate the wind generator’s kinetic energy for primary frequency support using simulink and simulation studies on doubly fed induction generator to study its capability during small disturbances / fluctuations on power system have been described.

  6. Different screening strategies (single or dual for the diagnosis of suspected latent tuberculosis: a cost effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Rook Graham

    2010-02-01

    Full Text Available Abstract Background Previous health economic studies recommend either a dual screening strategy [tuberculin skin test (TST followed by interferon-γ-release assay (IGRA] or a single one [IGRA only] for latent tuberculosis infection (LTBI, the former largely based on claims that it is more cost-effective. We sought to examine that conclusion through the use of a model that accounts for the additional costs of adverse drug reactions and directly compares two commercially available versions of the IGRA: the Quantiferon-TB-Gold-In-Tube (QFT-GIT and T-SPOT.TB. Methods A LTBI screening model directed at screening contacts was used to perform a cost-effectiveness analysis, from a UK healthcare perspective, taking into account the risk of isoniazid-related hepatotoxicity and post-exposure TB (2 years post contact using the TST, QFT-GIT and T-SPOT.TB IGRAs. Results Examining costs alone, the TST/IGRA dual screening strategies (TST/T-SPOT.TB and TST/QFT-GIT; £162,387 and £157,048 per 1000 contacts, respectively cost less than their single strategy counterparts (T-SPOT.TB and QFT-GIT; £203,983 and £202,921 per 1000 contacts which have higher IGRA test costs and greater numbers of persons undergoing LTBI treatment. However, IGRA alone strategies direct healthcare interventions and costs more accurately to those that are truly infected. Subsequently, less contacts need to be treated to prevent an active case of TB (T-SPOT.TB and QFT-GIT; 61.7 and 69.7 contacts in IGRA alone strategies. IGRA single strategies also prevent more cases of post-exposure TB. However, this greater effectiveness does not outweigh the lower incremental costs associated with the dual strategies. Consequently, when these costs are combined with effectiveness, the IGRA dual strategies are more cost-effective than their single strategy counterparts. Comparing between the IGRAs, T-SPOT.TB-based strategies (single and dual; £39,712 and £37,206 per active TB case prevented

  7. Health benefits and cost-effectiveness of a hybrid screening strategy for colorectal cancer.

    Science.gov (United States)

    Dinh, Tuan; Ladabaum, Uri; Alperin, Peter; Caldwell, Cindy; Smith, Robert; Levin, Theodore R

    2013-09-01

    Colorectal cancer (CRC) screening guidelines recommend screening schedules for each single type of test except for concurrent sigmoidoscopy and fecal occult blood test (FOBT). We investigated the cost-effectiveness of a hybrid screening strategy that was based on a fecal immunological test (FIT) and colonoscopy. We conducted a cost-effectiveness analysis by using the Archimedes Model to evaluate the effects of different CRC screening strategies on health outcomes and costs related to CRC in a population that represents members of Kaiser Permanente Northern California. The Archimedes Model is a large-scale simulation of human physiology, diseases, interventions, and health care systems. The CRC submodel in the Archimedes Model was derived from public databases, published epidemiologic studies, and clinical trials. A hybrid screening strategy led to substantial reductions in CRC incidence and mortality, gains in quality-adjusted life years (QALYs), and reductions in costs, comparable with those of the best single-test strategies. Screening by annual FIT of patients 50-65 years old and then a single colonoscopy when they were 66 years old (FIT/COLOx1) reduced CRC incidence by 72% and gained 110 QALYs for every 1000 people during a period of 30 years, compared with no screening. Compared with annual FIT, FIT/COLOx1 gained 1400 QALYs/100,000 persons at an incremental cost of $9700/QALY gained and required 55% fewer FITs. Compared with FIT/COLOx1, colonoscopy at 10-year intervals gained 500 QALYs/100,000 at an incremental cost of $35,100/QALY gained but required 37% more colonoscopies. Over the ranges of parameters examined, the cost-effectiveness of hybrid screening strategies was slightly more sensitive to the adherence rate with colonoscopy than the adherence rate with yearly FIT. Uncertainties associated with estimates of FIT performance within a program setting and sensitivities for flat and right-sided lesions are expected to have significant impacts on the cost-effectiveness

  8. The cost-effectiveness of screening and treatment for hepatitis C in prisons in England and Wales: a cost-utility analysis.

    Science.gov (United States)

    Sutton, A J; Edmunds, W J; Sweeting, M J; Gill, O N

    2008-11-01

    Prisoners have a high prevalence of hepatitis C virus (HCV) infection compared with the general population in England and Wales and in many locations throughout the world. This is because of large numbers of injecting drug users that engage in behaviours likely to transmit HCV being present within prison populations. It is, therefore, suggested that prison may be an appropriate location for HCV screening and treatment to be administered. Using cost-utility analysis, this study considers the costs and benefits of administering a single round of screening on reception into prison to all individuals followed by possible later screening in the community and comparing this to individuals who may only be tested and treated in the community at a later date. The cost/QALY of one round of prison testing and treatment was found to be 54,852 pounds sterling, although probabilistic sensitivity analysis showed extensive uncertainty about this estimate. One-way sensitivity analysis revealed the importance of the parameters describing the progression of chronic HCV and the discount rates. While the results presented here at baseline would suggest that screening and treatment for HCV in prisons is not cost-effective, these results are subject to much uncertainty. The importance of the rates describing the progression of chronic HCV on the cost-effectiveness of this intervention has been demonstrated and this suggests that future work should be undertaken to gain further insight into the rates that individuals progress to the later stages of chronic HCV infection.

  9. Assessing the Battery Cost at Which Plug-In Hybrid Medium-Duty Parcel Delivery Vehicles Become Cost-Effective

    Energy Technology Data Exchange (ETDEWEB)

    Ramroth, L. A.; Gonder, J. D.; Brooker, A. D.

    2013-04-01

    The National Renewable Energy Laboratory (NREL) validated diesel-conventional and diesel-hybrid medium-duty parcel delivery vehicle models to evaluate petroleum reductions and cost implications of hybrid and plug-in hybrid diesel variants. The hybrid and plug-in hybrid variants are run on a field data-derived design matrix to analyze the effect of drive cycle, distance, engine downsizing, battery replacements, and battery energy on fuel consumption and lifetime cost. For an array of diesel fuel costs, the battery cost per kilowatt-hour at which the hybridized configuration becomes cost-effective is calculated. This builds on a previous analysis that found the fuel savings from medium duty plug-in hybrids more than offset the vehicles' incremental price under future battery and fuel cost projections, but that they seldom did so under present day cost assumptions in the absence of purchase incentives. The results also highlight the importance of understanding the application's drive cycle specific daily distance and kinetic intensity.

  10. Silicon-on-ceramic process: Silicon sheet growth and device development for the large-area silicon sheet task of the low-cost solar array project

    Science.gov (United States)

    Whitehead, A. B.; Zook, J. D.; Grung, B. L.; Heaps, J. D.; Schmit, F.; Schuldt, S. B.; Chapman, P. W.

    1981-01-01

    The technical feasibility of producing solar cell quality sheet silicon to meet the DOE 1986 cost goal of 70 cents/watt was investigated. The silicon on ceramic approach is to coat a low cost ceramic substrate with large grain polycrystalline silicon by unidirectional solidification of molten silicon. Results and accomplishments are summarized.

  11. Large employers that have lived through transformation say payment reform alone won't cut costs and reengineer care.

    Science.gov (United States)

    Sepúlveda, Martín J; Darling, Helen

    2012-09-01

    As payment reform in health care gathers momentum, employers, as major payers, endorse the effort to move away from volume-driven payment to incentivizing and rewarding the delivery of better health care at lower cost. In this commentary we discuss large employers' perspectives on three particular challenges that payment reform alone, as important as it is, may not be sufficient to address: high health care prices, inefficient and complex systems, and an outdated work environment ill designed to meet the pressing goals of better health care at lower cost. We believe that policies that support health care organizations in redesigning work processes will be essential to reducing prices and simplifying interactions in care delivery. We also believe that health care organizations will need to redesign their compensation systems to align their employees' pay with improvements in performance. To that end, we describe the major transformation that IBM underwent in the 1990s to position itself to compete in a radically changed computer marketplace. We also offer several policy recommendations to support health care organizations in making the necessary changes.

  12. Costs of Illness Due to Cholera, Costs of Immunization and Cost-Effectiveness of an Oral Cholera Mass Vaccination Campaign in Zanzibar

    Science.gov (United States)

    Schaetti, Christian; Weiss, Mitchell G.; Ali, Said M.; Chaignat, Claire-Lise; Khatib, Ahmed M.; Reyburn, Rita; Duintjer Tebbens, Radboud J.; Hutubessy, Raymond

    2012-01-01

    Background The World Health Organization (WHO) recommends oral cholera vaccines (OCVs) as a supplementary tool to conventional prevention of cholera. Dukoral, a killed whole-cell two-dose OCV, was used in a mass vaccination campaign in 2009 in Zanzibar. Public and private costs of illness (COI) due to endemic cholera and costs of the mass vaccination campaign were estimated to assess the cost-effectiveness of OCV for this particular campaign from both the health care provider and the societal perspective. Methodology/Principal Findings Public and private COI were obtained from interviews with local experts, with patients from three outbreaks and from reports and record review. Cost data for the vaccination campaign were collected based on actual expenditure and planned budget data. A static cohort of 50,000 individuals was examined, including herd protection. Primary outcome measures were incremental cost-effectiveness ratios (ICER) per death, per case and per disability-adjusted life-year (DALY) averted. One-way sensitivity and threshold analyses were conducted. The ICER was evaluated with regard to WHO criteria for cost-effectiveness. Base-case ICERs were USD 750,000 per death averted, USD 6,000 per case averted and USD 30,000 per DALY averted, without differences between the health care provider and the societal perspective. Threshold analyses using Shanchol and assuming high incidence and case-fatality rate indicated that the purchase price per course would have to be as low as USD 1.2 to render the mass vaccination campaign cost-effective from a health care provider perspective (societal perspective: USD 1.3). Conclusions/Significance Based on empirical and site-specific cost and effectiveness data from Zanzibar, the 2009 mass vaccination campaign was cost-ineffective mainly due to the relatively high OCV purchase price and a relatively low incidence. However, mass vaccination campaigns in Zanzibar to control endemic cholera may meet criteria for cost-effectiveness

  13. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Wyoming

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Wyoming. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Wyoming.

  14. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for South Dakota

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in South Dakota. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in South Dakota.

  15. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for West Virginia

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in West Virginia. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in West Virginia.

  16. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Texas

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Texas. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Texas.

  17. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Wisconsin

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Wisconsin. Moving to the 2015 IECC from the 2006 IECC base code is cost-effective for residential buildings in all climate zones in Wisconsin.

  18. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Utah

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Utah. Moving to the 2015 IECC from the 2012 Utah State Code base code is cost-effective for residential buildings in all climate zones in Utah.

  19. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Tennessee

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Tennessee. Moving to the 2015 IECC from the 2006 IECC base code is cost-effective for residential buildings in all climate zones in Tennessee.

  20. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Rhode Island

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Rhode Island. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Rhode Island.

  1. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Oklahoma

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Oklahoma. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Oklahoma.

  2. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Vermont

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Vermont. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Vermont.

  3. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Pennsylvania

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Pennsylvania. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Pennsylvania.

  4. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for South Carolina

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in South Carolina. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in South Carolina.

  5. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Virginia

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Virginia. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Virginia.

  6. Cost effectiveness analysis of strategies for tuberculosis control in developing countries

    NARCIS (Netherlands)

    K. Floyd (Katherine); C. Dye; R.M.P.M. Baltussen (Rob)

    2005-01-01

    textabstractOBJECTIVE: To assess the costs and health effects of tuberculosis control interventions in Africa and South East Asia in the context of the millennium development goals. DESIGN: Cost effectiveness analysis based on an epidemiological model. SETTING: Analyses undertaken

  7. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Illinois

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Illinois. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Illinois.

  8. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Mississippi

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Mississippi. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Mississippi.

  9. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Colorado

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Colorado. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Colorado.

  10. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Missouri

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Missouri. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Missouri.

  11. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Nevada

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Nevada. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Nevada.

  12. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Idaho

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Idaho. Moving to the 2015 IECC from the 2015 Idaho State Code base code is cost-effective for residential buildings in all climate zones in Idaho.

  13. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Montana

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Montana. Moving to the 2015 IECC from the 2014 Montana State Code base code is cost-effective for residential buildings in all climate zones in Montana.

  14. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Delaware

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Delaware. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Delaware.

  15. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Louisiana

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Louisiana. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Louisiana.

  16. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Kansas

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Kansas. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Kansas.

  17. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Minnesota

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Minnesota. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Minnesota.

  18. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for New Mexico

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in New Mexico. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in New Mexico.

  19. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Indiana

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V.; Zhao, Mingjie; Taylor, Zachary T.; Poehlman, Eric A.

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Indiana. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Indiana.

  20. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Arkansas

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Arkansas. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Arkansas.