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Sample records for cost utility analysis

  1. Cost-utility analysis of thrombolytic therapy

    NARCIS (Netherlands)

    M.L. Simoons (Maarten); J. Vos (Jeroen); L.L. Martens (Leonardus Lambertus)

    1991-01-01

    textabstractAn analysis of the cost-effectiveness of thrombolytic therapy was performed, based on 3- to 5-year follow-up data, from 533 patients randomized to receive conventional therapy or intracoronary streptokinase. At the 3-year follow-up, mortality was 22% in the former group and 14% after thr

  2. Cost analysis of energy storage systems for electric utility applications

    Energy Technology Data Exchange (ETDEWEB)

    Akhil, A. [Sandia National Lab., Albuquerque, NM (United States); Swaminathan, S.; Sen, R.K. [R.K. Sen & Associates, Inc., Bethesda, MD (United States)

    1997-02-01

    Under the sponsorship of the Department of Energy, Office of Utility Technologies, the Energy Storage System Analysis and Development Department at Sandia National Laboratories (SNL) conducted a cost analysis of energy storage systems for electric utility applications. The scope of the study included the analysis of costs for existing and planned battery, SMES, and flywheel energy storage systems. The analysis also identified the potential for cost reduction of key components.

  3. Evaluating water quality investments using cost utility analysis.

    Science.gov (United States)

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

    2008-09-01

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

  4. A cost-utility analysis of psychoanalysis versus psychoanalytic psychotherapy.

    Science.gov (United States)

    Berghout, Caspar C; Zevalkink, Jolien; Hakkaart-van Roijen, Leona

    2010-01-01

    Despite the considerable and growing body of research about the clinical effectiveness of long-term psychoanalytic treatment, relatively little attention has been paid to economic evaluations, particularly with reference to the broader range of societal effects. In this cost-utility study, we examined the incremental cost-effectiveness ratio (ICER) of psychoanalysis versus psychoanalytic psychotherapy. Incremental costs and effects were estimated by means of cross-sectional measurements in a cohort design (psychoanalysis, n = 78; psychoanalytic psychotherapy, n = 104). Quality-adjusted life-years (QALYs) were estimated for each treatment strategy using the SF-6D. Total costs were calculated from a societal perspective (treatment costs plus other societal costs) and discounted at 4 percent. Psychoanalysis was more costly than psychoanalytic psychotherapy, but also more effective from a health-related quality of life perspective. The ICER--that is, the extra costs to gain one additional QALY by delivering psychoanalysis instead of psychoanalytic psychotherapy--was estimated at 52,384 euros per QALY gained. Our findings show that the cost-utility ratio of psychoanalysis relative to psychoanalytic psychotherapy is within an acceptable range. More research is needed to find out whether cost-utility ratios vary with different types of patients. We also encourage cost-utility analyses comparing psychoanalytic treatment to other forms of (long-term) treatment.

  5. 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.

  6. An educational review of the statistical issues in analysing utility data for cost-utility analysis.

    Science.gov (United States)

    Hunter, Rachael Maree; Baio, Gianluca; Butt, Thomas; Morris, Stephen; Round, Jeff; Freemantle, Nick

    2015-04-01

    The aim of cost-utility analysis is to support decision making in healthcare by providing a standardised mechanism for comparing resource use and health outcomes across programmes of work. The focus of this paper is the denominator of the cost-utility analysis, specifically the methodology and statistical challenges associated with calculating QALYs from patient-level data collected as part of a trial. We provide a brief description of the most common questionnaire used to calculate patient level utility scores, the EQ-5D, followed by a discussion of other ways to calculate patient level utility scores alongside a trial including other generic measures of health-related quality of life and condition- and population-specific questionnaires. Detail is provided on how to calculate the mean QALYs per patient, including discounting, adjusting for baseline differences in utility scores and a discussion of the implications of different methods for handling missing data. The methods are demonstrated using data from a trial. As the methods chosen can systematically change the results of the analysis, it is important that standardised methods such as patient-level analysis are adhered to as best as possible. Regardless, researchers need to ensure that they are sufficiently transparent about the methods they use so as to provide the best possible information to aid in healthcare decision making.

  7. Cost-Utility Analysis of a Cardiac Telerehabilitation Program

    DEFF Research Database (Denmark)

    Kidholm, Kristian; Rasmussen, Maja Kjær; Andreasen, Jan Jesper

    2016-01-01

    was higher in the intervention group, but the difference was not statistically significant. The incremental CU ratio was more than (sic)400,000 per QALY gained. Conclusions: Even though the rehabilitation activities increased, the program does not appear to be cost-effective. The intervention itself...... was not costly (less than (sic)500), and increasing the number of patients may show reduced costs of the devices and make the CTR more cost-effective. Telerehabilitation can increase participation, but the intervention, in its current form, does not appear to be cost-effective.......Background: Cardiac rehabilitation can reduce mortality of patients with cardiovascular disease, but a frequently low participation rate in rehabilitation programs has been found globally. The objective of the Teledialog study was to assess the cost-utility (CU) of a cardiac telerehabilitation (CTR...

  8. Cost-utility analysis: Current methodological issues and future perspectives

    Directory of Open Access Journals (Sweden)

    Mark J C Nuijten

    2011-06-01

    Full Text Available The use of cost-effectiveness as final criterion in the reimbursement process for listing of new pharmaceuticals can be questioned from a scientific and policy point of view. There is a lack of consensus on main methodological issues and consequently we may question the appropriateness of the use of cost-effectiveness data in health care decision-making. Another concern is the appropriateness of the selection and use of an incremental cost-effectiveness threshold (Cost/QALY. In this review, we focus mainly on only some key methodological concerns relating to discounting, the utility concept, cost assessment and modelling methodologies. Finally we will consider the relevance of some other important decision criteria, like social values and equity.

  9. Cost-Utility Analysis of a Cardiac Telerehabilitation Program

    DEFF Research Database (Denmark)

    Kidholm, Kristian; Rasmussen, Maja Kjær; Andreasen, Jan Jesper

    2016-01-01

    was not costly (less than (sic)500), and increasing the number of patients may show reduced costs of the devices and make the CTR more cost-effective. Telerehabilitation can increase participation, but the intervention, in its current form, does not appear to be cost-effective.......Background: Cardiac rehabilitation can reduce mortality of patients with cardiovascular disease, but a frequently low participation rate in rehabilitation programs has been found globally. The objective of the Teledialog study was to assess the cost-utility (CU) of a cardiac telerehabilitation (CTR......) program. The aim of the intervention was to increase the patients' participation in the CTR program. At discharge, an individualized 3-month rehabilitation plan was formulated for each patient. At home, the patients measured their own blood pressure, pulse, weight, and steps taken for 3 months. Materials...

  10. A cost-utility analysis of psychoanalysis versus psychoanalytic psychotherapy

    NARCIS (Netherlands)

    Berghout, C.C.; Zevalkink, D.J.; Hakkaart-van Roijen, L.

    2010-01-01

    Objectives: Despite the considerable and growing body of research about the clinical effectiveness of long-term psychoanalytic treatment, relatively little attention has been paid to economic evaluations, particularly with reference to the broader range of societal effects. In this cost-utility

  11. A cost-utility analysis of psychoanalysis versus psychoanalytic psychotherapy

    NARCIS (Netherlands)

    Berghout, C.C.; Zevalkink, D.J.; Hakkaart-van Roijen, L.

    2010-01-01

    Objectives: Despite the considerable and growing body of research about the clinical effectiveness of long-term psychoanalytic treatment, relatively little attention has been paid to economic evaluations, particularly with reference to the broader range of societal effects. In this cost-utility stud

  12. 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

  13. Cost utility analysis of diagnostic method of syphilis

    Directory of Open Access Journals (Sweden)

    Viroj Wiwanitkit

    2008-04-01

    Full Text Available Presently, the diagnosis of syphilis is dependent mainly on serological tests. The most widely used screening tests for syphilis are the VDRL and the rapid plasma reagin (RPR and for confirmation, the fluorescent treponemal antibody (FTA and the treponema pallidum hemagglutination (TPHA tests. The four alternative modes for diagnosis of syphilis can be a VDRL + FTA, b VDRL + TPHA, c RPR + FTA and d RPR + TPHA. Here the author reports an evaluation of cost utility of these tests in medical practice. It is shown that the cost per accurate diagnosis with VDRL + TPH is the least expensive choice. Therefore, this alternative is the best method for serological diagnosis for syphilis, based on medical laboratory economics principles

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

    NARCIS (Netherlands)

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

    2000-01-01

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

  15. [Value of cost-utility analysis; evidence-based policy making].

    Science.gov (United States)

    Buskens, E

    2004-05-29

    In this issue of the Journal a review on the present state of science regarding cost-utility analysis is presented. The article can be regarded as a laudable enumeration of the points of academic discussion still associated with cost-utility analyses. Indeed, various schools of researchers with different positions on specific points contribute to these discussions. However, it would be incorrect to conclude that cost-utility analyses are therefore not useful. If performed according to current insights and clearly presented, they are transparent and can be assessed and reproduced. Thus they can contribute to a scientific underpinning of policy decisions. Notably, the alternative of 'opinion'-based policy making should be kept in mind when assessing cost-utility analyses.

  16. Cost-utility analysis of prehospital spine immobilization recommendations for penetrating trauma.

    Science.gov (United States)

    Garcia, Arturo; Liu, Terrence H; Victorino, Gregory P

    2014-02-01

    The American College of Surgeons' Committee on Trauma's recent prehospital trauma life support recommendations against prehospital spine immobilization (PHSI) after penetrating trauma are based on a low incidence of unstable spine injuries after penetrating injuries. However, given the chronic and costly nature of devastating spine injuries, the cost-utility of PHSI is unclear. Our hypothesis was that the cost-utility of PHSI in penetrating trauma precludes routine use of this prevention strategy. A Markov model based cost-utility analysis was performed from a society perspective of a hypothetical cohort of 20-year-old males presenting with penetrating trauma and transported to a US hospital. The analysis compared PHSI with observation alone. The probabilities of spine injuries, costs (US 2010 dollars), and utility of the two groups were derived from published studies and public data. Incremental effectiveness was measured in quality-adjusted life-years. Subset analyses of isolated head and neck injuries as well as sensitivity analyses were performed to assess the strength of the recommendations. Only 0.2% of penetrating trauma produced unstable spine injury, and only 7.4% of the patients with unstable spine injury who underwent spine stabilization had neurologic improvement. The total lifetime per-patient cost was $930,446 for the PHSI group versus $929,883 for the nonimmobilization group, with no difference in overall quality-adjusted life-years. Subset analysis demonstrated that PHSI for patients with isolated head or neck injuries provided equivocal benefit over nonimmobilization. PHSI was not cost-effective for patients with torso or extremity penetrating trauma. Despite increased incidence of unstable spine injures produced by penetrating head or neck injuries, the cost-benefit of PHSI in these patients is equivocal, and further studies may be needed before omitting PHSI in patients with penetrating head and neck injuries. Economic and value-based evaluation

  17. Cost-Utility Analysis of Screening Strategies for Diabetic Retinopathy in Korea.

    Science.gov (United States)

    Kim, Sang-Won; Kang, Gil-Won

    2015-12-01

    This study involved a cost-utility analysis of early diagnosis and treatment of diabetic retinopathy depending on the screening strategy used. The four screening strategies evaluated were no screening, opportunistic examination, systematic fundus photography, and systematic examination by an ophthalmologists. Each strategy was evaluated in 10,000 adults aged 40 yr with newly diagnosed diabetes mellitus (hypothetical cohort). The cost of each strategy was estimated in the perspective of both payer and health care system. The utility was estimated using quality-adjusted life years (QALY). Incremental Cost Effectiveness Ratio (ICER) for the different screening strategies was analyzed. After exclusion of the weakly dominating opportunistic strategy, the ICER of systematic photography was 57,716,867 and that of systematic examination by ophthalmologists was 419,989,046 from the perspective of the healthcare system. According to the results, the systematic strategy is preferable to the opportunistic strategy from the perspective of both a payer and a healthcare system. Although systematic examination by ophthalmologists may have higher utility than systematic photography, it is associated with higher cost. The systematic photography is the best strategy in terms of cost-utility. However systematic examination by ophthalmologists can also be a suitable policy alternative, if the incremental cost is socially acceptable.

  18. Medicare long-term CPAP coverage policy: a cost-utility analysis.

    Science.gov (United States)

    Billings, Martha E; Kapur, Vishesh K

    2013-10-15

    CPAP is an effective treatment for OSA that may reduce health care utilization and costs. Medicare currently reimburses the costs of long-term CPAP therapy only if the patient is adherent during a 90-day trial. If not, Medicare requires a repeat polysomnogram (PSG) and another trial which seems empirically not cost-effective. We modeled the cost-effectiveness of current Medicare policy compared to an alternative policy (clinic-only) without the adherence criterion and repeat PSG. Cost-utility and cost-effectiveness analysis. U.S. Medicare Population. N/A. N/A. We created a decision tree modeling (1) clinic only follow-up vs. (2) current Medicare policy. Costs were assigned based on Medicare reimbursement rates in 2012. Sensitivity analyses were conducted to test our assumptions. We estimated cumulative costs, overall adherence, and QALY gained for a 5-year time horizon from the perspective of Medicare as the payer. Current Medicare policy is more costly than the clinic-only policy but has higher net adherence and improved utility. Current Medicare policy compared to clinic-only policy costs $30,544 more per QALY. Current CMS policy promotes early identification of those more likely to adhere to CPAP therapy by requiring strict adherence standards. The policy effect is to deny coverage to those unlikely to use CPAP long-term and prevent wasted resources. Future studies are needed to measure long-term adherence in an elderly population with and without current adherence requirements to verify the cost-effectiveness of a policy change.

  19. A note on the nature of utility in time and health and implications for cost utility analysis.

    Science.gov (United States)

    Buckingham, Ken J; Devlin, Nancy Joy

    2009-01-01

    Time Trade-Off (TTO) valuations of health are widely used in economic evaluation of health care. Current approaches to eliciting TTO values, and their use in economic evaluation, rest on specific assumptions about the way utility relates to time and health. Both the assumptions themselves and evidence of violations of them are discussed in the literature - yet the issues appear not to be widely appreciated by those using and applying TTO in economic evaluation. This paper adds to that literature by demonstrating both the requirements of TTO and violations of these assumptions in terms of the underlying indifference curve maps and utility functions. The advantage of this approach is that it demonstrates very clearly a number of fundamental problems for the way TTO values are currently elicited and used in cost utility analysis. In essence, it is extremely unwise to assume that the current 'tariffs' of TTO values, such as those widely used in cost utility analysis to inform health sector decisions in many countries can be applied irrespective of the duration of the health states to which they are assigned. The estimates of QALYs that result will, quite often, simply be wrong. We conclude by pointing to a number of possible solutions.

  20. Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil

    Directory of Open Access Journals (Sweden)

    Carlos R. Maia

    2015-01-01

    Full Text Available Objective:To perform a cost-utility analysis on the treatment of attention deficit hyperactivity disorder (ADHD with methylphenidate immediate-release (MPH-IR in children and adolescents from Brazil.Method:A Markov model was constructed to compare MPH-IR vs. no treatment. A 24-week naturalistic study was conducted to collect transition probabilities and utility data. Effectiveness was expressed as quality-adjusted life-years (QALY, and costs reported in 2014 international dollars (I$. The perspective was the Brazilian Unified Health System as payer, and the time horizon was 6 years.Results:Of 171 patients, 73 provided information at baseline, and 56 at week 24. Considering the MPH-IR monthly cost of I$ 38, the incremental cost-effectiveness ratio (ICER of treatment was I$ 9,103/QALY for children and I$ 11,883/QALY for adolescents. In two-way sensitivity analysis, considering one Gross National Product per capita (I$ 11,530 as willingness-to-pay, a cost of no-treatment lower than I$ 45/month would render MPH-IR a cost-saving strategy.Discussion:MPH-IR treatment of children and adolescents is cost-effective for ADHD patients from the Brazilian public health system perspective. Both patients and the healthcare system might benefit from such a strategy.Trial registration number:NCT01705613.

  1. Cost-Utility Analysis: Sartorius Flap versus Negative Pressure Therapy for Infected Vascular Groin Graft Managment.

    Science.gov (United States)

    Chatterjee, Abhishek; Macarios, David; Griffin, Leah; Kosowski, Tomasz; Pyfer, Bryan J; Offodile, Anaeze C; Driscoll, Daniel; Maddali, Sirish; Attwood, John

    2015-11-01

    Sartorius flap coverage and adjunctive negative pressure wound therapy (NPWT) have been described in managing infected vascular groin grafts with varying cost and clinical success. We performed a cost-utility analysis comparing sartorius flap with NPWT in managing an infected vascular groin graft. A literature review compiling outcomes for sartorius flap and NPWT interventions was conducted from peer-reviewed journals in MEDLINE (PubMed) and EMBASE. Utility scores were derived from expert opinion and used to estimate quality-adjusted life years (QALYs). Medicare current procedure terminology and diagnosis-related groups codes were used to assess the costs for successful graft salvage with the associated complications. Incremental cost-effectiveness was assessed at $50,000/QALY, and both univariate and probabilistic sensitivity analyses were conducted to assess robustness of the conclusions. Thirty-two studies were used pooling 384 patients (234 sartorius flaps and 150 NPWT). NPWT had better clinical outcomes (86.7% success rate, 0.9% minor complication rate, and 13.3% major complication rate) than sartorius flap (81.6% success rate, 8.0% minor complication rate, and 18.4% major complication rate). NPWT was less costly ($12,366 versus $23,516) and slightly more effective (12.06 QALY versus 12.05 QALY) compared with sartorius flap. Sensitivity analyses confirmed the robustness of the base case findings; NPWT was either cost-effective at $50,000/QALY or dominated sartorius flap in 81.6% of all probabilistic sensitivity analyses. In our cost-utility analysis, use of adjunctive NPWT, along with debridement and antibiotic treatment, for managing infected vascular groin graft wounds was found to be a more cost-effective option when compared with sartorius flaps.

  2. Primary Prevention of Pediatric Abusive Head Trauma: A Cost Audit and Cost-Utility Analysis

    Science.gov (United States)

    Friedman, Joshua; Reed, Peter; Sharplin, Peter; Kelly, Patrick

    2012-01-01

    Objectives: To obtain comprehensive, reliable data on the direct cost of pediatric abusive head trauma in New Zealand, and to use this data to evaluate the possible cost-benefit of a national primary prevention program. Methods: A 5 year cohort of infants with abusive head trauma admitted to hospital in Auckland, New Zealand was reviewed. We…

  3. Allocating health care: cost-utility analysis, informed democratic decision making, or the veil of ignorance?

    Science.gov (United States)

    Goold, S D

    1996-01-01

    Assuming that rationing health care is unavoidable, and that it requires moral reasoning, how should we allocate limited health care resources? This question is difficult because our pluralistic, liberal society has no consensus on a conception of distributive justice. In this article I focus on an alternative: Who shall decide how to ration health care, and how shall this be done to respect autonomy, pluralism, liberalism, and fairness? I explore three processes for making rationing decisions: cost-utility analysis, informed democratic decision making, and applications of the veil of ignorance. I evaluate these processes as examples of procedural justice, assuming that there is no outcome considered the most just. I use consent as a criterion to judge competing processes so that rationing decisions are, to some extent, self-imposed. I also examine the processes' feasibility in our current health care system. Cost-utility analysis does not meet criteria for actual or presumed consent, even if costs and health-related utility could be measured perfectly. Existing structures of government cannot creditably assimilate the information required for sound rationing decisions, and grassroots efforts are not representative. Applications of the veil of ignorance are more useful for identifying principles relevant to health care rationing than for making concrete rationing decisions. I outline a process of decision making, specifically for health care, that relies on substantive, selected representation, respects pluralism, liberalism, and deliberative democracy, and could be implemented at the community or organizational level.

  4. Cost-utility analysis of stenting versus endarterectomy in the International Carotid Stenting Study.

    Science.gov (United States)

    Morris, Stephen; Patel, Nishma V; Dobson, Joanna; Featherstone, Roland L; Richards, Toby; Luengo-Fernandez, Ramon; Rothwell, Peter M; Brown, Martin M

    2016-06-01

    The International Carotid Stenting Study was a multicenter randomized trial in which patients with symptomatic carotid artery stenosis were randomly allocated to treatment by carotid stenting or endarterectomy. Economic evidence comparing these treatments is limited and inconsistent. We compared the cost-effectiveness of stenting versus endarterectomy using International Carotid Stenting Study data. We performed a cost-utility analysis estimating mean costs and quality-adjusted life years per patient for both treatments over a five-year time horizon based on resource use data and utility values collected in the trial. Costs of managing stroke events were estimated using individual patient data from a UK population-based study (Oxford Vascular Study). Mean costs per patient (95% CI) were US$10,477 ($9669 to $11,285) in the stenting group (N = 853) and $9669 ($8835 to $10,504) in the endarterectomy group (N = 857). There were no differences in mean quality-adjusted life years per patient (3.247 (3.160 to 3.333) and 3.228 (3.150 to 3.306), respectively). There were no differences in adjusted costs between groups (mean incremental costs for stenting versus endarterectomy $736 (95% CI -$353 to $1826)) or adjusted outcomes (mean quality-adjusted life years gained -0.010 (95% CI -0.117 to 0.097)). The incremental net monetary benefit for stenting versus endarterectomy was not significantly different from zero at the maximum willingness to pay for a quality-adjusted life year commonly used in the UK. Sensitivity analyses showed little uncertainty in these findings. Economic considerations should not affect whether patients with symptomatic carotid stenosis undergo stenting or endarterectomy. © 2016 World Stroke Organization.

  5. Utilization of recycled asphalt concrete with warm mix asphalt and cost-benefit analysis.

    Science.gov (United States)

    Oner, Julide; Sengoz, Burak

    2015-01-01

    The asphalt paving industries are faced with two major problems. These two important challenges are generated with an increase in demand for environmentally friendly paving mixtures and the problem of rapidly rising raw materials. Recycling of reclaimed asphalt pavement (RAP) is a critical necessity to save precious aggregates and reduce the use of costly bitumen. Warm Mix Asphalt (WMA) technology provides not only the option of recycling asphalt pavement at a lower temperature than the temperature maintained in hot mixtures but also encourages the utilization of RAP and therefore saves energy and money. This paper describes the feasibility of utilizing three different WMA additives (organic, chemical and water containing) at recommended contents with different percentages of RAP. The mechanical properties and cost-benefit analysis of WMA containing RAP have been performed and compared with WMA without RAP. The results indicated that, 30%, 10% and 20% can be accepted as an optimum RAP addition related to organic, chemical and water containing additives respectively and organic additive with 30% RAP content has an appreciable increase in tensile strength over the control mix. It was also concluded that the RAP with WMA technology is the ability to reduce final cost compared to HMA and WMA mixtures.

  6. Utilization of recycled asphalt concrete with warm mix asphalt and cost-benefit analysis.

    Directory of Open Access Journals (Sweden)

    Julide Oner

    Full Text Available The asphalt paving industries are faced with two major problems. These two important challenges are generated with an increase in demand for environmentally friendly paving mixtures and the problem of rapidly rising raw materials. Recycling of reclaimed asphalt pavement (RAP is a critical necessity to save precious aggregates and reduce the use of costly bitumen. Warm Mix Asphalt (WMA technology provides not only the option of recycling asphalt pavement at a lower temperature than the temperature maintained in hot mixtures but also encourages the utilization of RAP and therefore saves energy and money. This paper describes the feasibility of utilizing three different WMA additives (organic, chemical and water containing at recommended contents with different percentages of RAP. The mechanical properties and cost-benefit analysis of WMA containing RAP have been performed and compared with WMA without RAP. The results indicated that, 30%, 10% and 20% can be accepted as an optimum RAP addition related to organic, chemical and water containing additives respectively and organic additive with 30% RAP content has an appreciable increase in tensile strength over the control mix. It was also concluded that the RAP with WMA technology is the ability to reduce final cost compared to HMA and WMA mixtures.

  7. Budget impact and cost-utility analysis of universal infant rotavirus vaccination in Spain.

    Science.gov (United States)

    Imaz, Iñaki; Rubio, Beltrán; Cornejo, Ana M; González-Enríquez, Jesús

    2014-04-01

    Rotavirus is not included in the Spanish mass infant vaccination schedule but has also not been economically evaluated for its inclusion. We analysed cost-utility of the universal infant rotavirus vaccination using RotaTeq® versus no vaccination in Spain. We also carried out a budget impact analysis and determined the effect on results of different variables introduced in the model. A deterministic Markov model was built considering loss of quality of life for children and their parents, and introducing direct and indirect costs updated to 2011. The introduction of the vaccination using RotaTeq® as a universal infant vaccination would increase the annual health care budget in 10.43 million euro and would result in a gain of an additional Quality Adjusted Life Year at a cost of 280,338€ from the healthcare system perspective and 210,167€ from the societal perspective. The model was stable to variable modifications. To sum up, according to our model and estimates, the introduction of a universal infant rotavirus vaccination with RotaTeq® in Spain would cause a large impact on the health care budget and would not be efficient unless significant variations in vaccine price, vaccine efficacy and/or utilities took place. Copyright © 2013 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Philip M Clarke

    2010-02-01

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

  9. Using Stochastic Frontier Analysis to Analyze Adjustment Costs and Investment Utilization

    DEFF Research Database (Denmark)

    Olsen, Jakob Vesterlund; Henningsen, Arne

    Based on a theoretical microeconomic model, we develop an empirical framework for analyzing the size and the timing of adjustment costs and investment utilization. We show that adjustment costs and investment utilization result in technical inefficiency, because adjustments require the use of add...... influence technical efficiency, as well as the effect of current and past investments on adjustment costs and investment utilization. These results are robust to different model specifications and different ways of measuring capital....... of current and past investments on technical efficiency, which we interpret as adjustment costs and temporary incomplete investment utilization. We apply this methodology to a large panel data set of Danish pig producers with 9,281 observations between 1996 and 2008. The results show that investments have......Based on a theoretical microeconomic model, we develop an empirical framework for analyzing the size and the timing of adjustment costs and investment utilization. We show that adjustment costs and investment utilization result in technical inefficiency, because adjustments require the use...

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

    Science.gov (United States)

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

    2004-10-11

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

  11. A framework and review of customer outage costs: Integration and analysis of electric utility outage cost surveys

    Energy Technology Data Exchange (ETDEWEB)

    Lawton, Leora; Sullivan, Michael; Van Liere, Kent; Katz, Aaron; Eto, Joseph

    2003-11-01

    A clear understanding of the monetary value that customers place on reliability and the factors that give rise to higher and lower values is an essential tool in determining investment in the grid. The recent National Transmission Grid Study recognizes the need for this information as one of growing importance for both public and private decision makers. In response, the U.S. Department of Energy has undertaken this study, as a first step toward addressing the current absence of consistent data needed to support better estimates of the economic value of electricity reliability. Twenty-four studies, conducted by eight electric utilities between 1989 and 2002 representing residential and commercial/industrial (small, medium and large) customer groups, were chosen for analysis. The studies cover virtually all of the Southeast, most of the western United States, including California, rural Washington and Oregon, and the Midwest south and east of Chicago. All variables were standardized to a consistent metric and dollar amounts were adjusted to the 2002 CPI. The data were then incorporated into a meta-database in which each outage scenario (e.g., the lost of electric service for one hour on a weekday summer afternoon) is treated as an independent case or record both to permit comparisons between outage characteristics and to increase the statistical power of analysis results. Unadjusted average outage costs and Tobit models that estimate customer damage functions are presented. The customer damage functions express customer outage costs for a given outage scenario and customer class as a function of location, time of day, consumption, and business type. One can use the damage functions to calculate outage costs for specific customer types. For example, using the customer damage functions, the cost experienced by an ''average'' customer resulting from a 1 hour summer afternoon outage is estimated to be approximately $3 for a residential customer, $1

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

    Directory of Open Access Journals (Sweden)

    Krog AH

    2017-06-01

    Full Text Available Anne Helene Krog,1,2 Mehdi Sahba,3 Erik M Pettersen,4 Torbjørn Wisløff,5,6 Jon O Sundhagen,2 Syed SH Kazmi2 1Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 2Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, 3Department of Vascular Surgery, Østfold Central Hospital, Kalnes, 4Department of Vascular Surgery, Sørlandet Hospital HF, Kristiansand, 5Department of Health Management and Health Economics, University of Oslo, 6Norwegian Institute of Public Health, Oslo, Norway Objectives: Laparoscopic aortobifemoral bypass has become an established treatment option for symptomatic aortoiliac obstructive disease at dedicated centers. Minimally invasive surgical techniques like laparoscopic surgery have often been shown to reduce expenses and increase patients’ health-related quality of life. The main objective of our study was to measure quality-adjusted life years (QALYs and costs after totally laparoscopic and open aortobifemoral bypass. Patients and methods: This was a within trial analysis in a larger ongoing randomized controlled prospective multicenter trial, Norwegian Laparoscopic Aortic Surgery Trial. Fifty consecutive patients suffering from symptomatic aortoiliac occlusive disease suitable for aortobifemoral bypass surgery were randomized to either totally laparoscopic (n=25 or open surgical procedure (n=25. One patient dropped out of the study before surgery. We measured health-related quality of life using the EuroQol (EQ-5D-5L questionnaire at 4 different time points, before surgery and for 6 months during follow-up. We calculated the QALYs gained by using the area under the curve for both groups. Costs were calculated based on prices for surgical equipment, vascular prosthesis and hospital stay. Results: We found a significantly higher increase in QALYs after laparoscopic vs open aortobifemoral bypass surgery, with a difference of 0.07 QALYs, (p=0

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

    NARCIS (Netherlands)

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

    2001-01-01

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

  14. Managing female urinary incontinence: A regional prospective analysis of cost-utility ratios (curs and effectiveness

    Directory of Open Access Journals (Sweden)

    Elisabetta Costantini

    2014-06-01

    Full Text Available Introduction: To evaluate the cost-utility of incontinence treatments, particularly anticholinergic therapy, by examining costs and quality-adjusted life years. Materials and methods: A prospective cohort study of women who were consecutively referred by general practitioners (GPs to the Urology Department because of urinary incontinence. The primary outcome was evaluation of the cost-utility of incontinence treatments (surgery, medical therapy and physiotherapy for stress and/or urgency incontinence by examining costs and quality-adjusted life years. Results: 137 consecutive female patients (mean age 60.6 ± 11.6; range 36-81 were enrolled and stratified according to pathologies: SUI and UUI. Group A: SUI grade II-III: 43 patients who underwent mid-urethral sling (MUS; Group B: SUI grade I-II 57 patients who underwent pelvic floor muscle exercise and Group C: UUI: 37 patients who underwent antimuscarinic treatment with 5 mg solifenacin daily. The cost utility ratio (CUR was estimated as saving more than €1200 per QALY for surgery and physiotherapy and as costing under € 100 per QALY for drug therapy. Conclusions: This study shows that appropriate diagnosis and treatment of a patient with incontinence lowers National Health Service costs and improves the benefits of treatment and quality of life.

  15. Testicular self-examination and testicular cancer: a cost-utility analysis.

    Science.gov (United States)

    Aberger, Michael; Wilson, Bradley; Holzbeierlein, Jeffrey M; Griebling, Tomas L; Nangia, Ajay K

    2014-12-01

    The United States Preventive Services Task Force (USPSTF) has recommended against testicular self-examinations (TSE) or clinical examination for testicular cancer screening. However, in this recommendation there was no consideration of the significant fiscal cost of treating advanced disease versus evaluation of benign disease. In this study, a cost-utility validation for TSE was performed. The cost of treatment for an advanced-stage testicular tumor (both seminomatous and nonseminomatous) was compared to the cost of six other scenarios involving the clinical assessment of a testicular mass felt during self-examination (four benign and two early-stage malignant). Medicare reimbursements were used as an estimate for a national cost standard. The total treatment cost for an advanced-stage seminoma ($48,877) or nonseminoma ($51,592) equaled the cost of 313-330 benign office visits ($156); 180-190 office visits with scrotal ultrasound ($272); 79-83 office visits with serial scrotal ultrasounds and labs ($621); 6-7 office visits resulting in radical inguinal orchiectomy for benign pathology ($7,686) or 2-3 office visits resulting in treatment and surveillance of an early-stage testicular cancer ($17,283: seminoma, $26,190: nonseminoma). A large number of clinical evaluations based on the TSE for benign disease can be made compared to the cost of one missed advanced-stage tumor. An average of 2.4 to 1 cost benefit ratio was demonstrated for early detected testicular cancer versus advanced-stage disease.

  16. Cost-utility analysis of treating out of hospital cardiac arrests in Jerusalem.

    Science.gov (United States)

    Ginsberg, Gary M; Kark, Jeremy D; Einav, Sharon

    2015-01-01

    Out-of-hospital cardiac arrest (OHCA) initiates a chain of responses including emergency medical service mobilization and medical treatment, transfer and admission first to a hospital Emergency Department (ED) and then usually to an intensive care unit and ward. Costly pre- and in-hospital care may be followed by prolonged post discharge expenditure on treatment of patients with severe neurological sequelae. We assessed the cost-effectiveness of treatment of OHCA by calculating the cost per Disability Adjusted Life Year (DALY) averted. We studied 3355 consecutive non-traumatic OHCAs (2005-2010) in Jerusalem, Israel, supplemented by hospital utilization data extracted from patient files (n = 570) and post-discharge follow-up (n = 196). Demographic, utilization and economic data were incorporated into a spreadsheet model to calculate the cost-utility ratio. Advanced life support was administered to 2264 of the 3355 OHCAs (67.5%) and 1048 (45.6%) patients were transferred to the ED. Of 676 (20.1%) patients who survived the ED and were admitted, there were 206 (6.1%) survivors to discharge, among them only 113 (3.4%) neurologically intact. Total cost ($39,100,000) per DALY averted (1353) was $28,864. The current package of OHCA interventions in Jerusalem appears to be very cost-effective as the cost per averted DALY of $28,864 is less than the Gross Domestic Product per capita ($33,261). This paper provides a basis for studying the effects of potential interventions that can be evaluated in terms of their incremental costs per averted DALY for treatment of OHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  17. Cost-utility analysis of abatacept in rheumatoid arthritis in Italy

    Directory of Open Access Journals (Sweden)

    Simona de Portu

    2008-01-01

    Full Text Available Objective: a substantial number of patients with rheumatoid arthritis (RA have an insufficient or unsustained response to Tumor Necrosis Factor-α antagonists (anti-TNFs. The aim of the present study was to estimate the cost-utility of abatacept, a new selective T-cell co-stimulation modulator, in patients with moderately to severely active RA and an insufficient response or intolerance to anti-TNFs in the Italian setting. Methods: a probabilistic patient level simulation model was developed to estimate long-term costs and health outcomes of abatacept versus anti-TNFs (etanercept, adalimumab, infliximab in RA patients. The model predicted patients’ HAQ (Health Assessment Questionnaire scores over time based on the initial response to treatment (% change in HAQ score at six months. Responding patients continued treatment with a reduced rate of HAQ progression until long-term treatment failure. Health-state utilities and use of health care resources (excluding RA therapies were assumed to depend on HAQ scores. The model used data from a Phase III clinical trial of abatacept in patients with inadequate response to anti-TNFs (Abatacept Trial in Treatment of anti-TNF Inadequate Responders [ATTAIN] and various secondary data sources. The study was performed using the National Health Service (NHS perspective. Cost-utility of abatacept vs other anti-TNFs was derived in terms of incremental cost per quality-adjusted life-year (QALY gained based on a lifetime horizon with costs expressed in Euros. Single-way sensitivity analyses were performed on key parameters. Costs and health effects were discounted at 3% annually. Results: abatacept therapy was estimated to yield 1.18 additional QALYs per patient (5.02 abatacept vs 3.84 anti-TNFs at an incremental cost of € 21,996.41 based on a 20 years time horizon. Cost per QALY gained was € 18,567.24. These results were robust to variation of key model parameters and are well within the usual cost-utility

  18. Cost-utility analysis of direct VAD versus double bridges to heart transplantation in patients with refractory heart failure.

    Science.gov (United States)

    Chang, Hsiao-Huang; Chen, Po-Lin; Chen, I-Ming; Kuo, Tzu-Ting; Weng, Zen-Chung; Huang, Pei-Jung; Wu, Nai-Yuan; Cheng, Ching-Li

    2017-09-25

    This study compared the cost-utility of direct ventricular assist device (VAD) versus double bridges, extracorporeal membrane oxygenation (ECMO) before VAD, to heart transplantation in patients with refractory heart failure. From a health payer perspective, a Markov model was developed. The cycle length was one month and the time horizon was a lifetime. Probabilities and direct cost data were calculated from a nationwide claim database. Utility inputs were adopted from published sources. The utility was expressed as quality adjusted life years (QALYs). Both costs and utility were discounted by an annual rate of 3%. Deterministic and probabilistic sensitivity analyses were performed to test the stability of the model. The direct VAD group had less life time costs (USD 95,910] v. USD 129,516) but higher life time QALYs than the double bridges group (1.73 vs. 0.89). The sensitivity analysis revealed that the direct VAD group consistently had lower cost and higher QALYs during all variations in model parameters. The probability that direct VAD was cost-effective exceeded 75% at any levels of willing-to-pay. From a health-insurance payer perspective, direct VAD bridge to heart transplantation appeared to be more cost-effective than double bridges in patients with refractory heart failure. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  19. Utility of CT angiography in cervical spine trauma: analysis of radiation and cost

    Directory of Open Access Journals (Sweden)

    Waqas Shuaib

    2014-12-01

    head and neck can reduce costs and decrease unnecessary exposure to radiation and contrast medium.---------------------------------------Cite this article as:Shuaib W, Khan AA, Mehta AS, Vijayasarathi A, Hidalgo J. Utility of CT angiography in cervical spine trauma: analysis of radiation and cost. Int J Cancer Ther Oncol 2014; 2(4:02043. DOI: 10.14319/ijcto.0204.3

  20. Cost-Effectiveness and Cost-Utility Analysis of Ingenol Mebutate Versus Diclofenac 3% and Imiquimod 5% in the Treatment of Actinic Keratosis in Spain.

    Science.gov (United States)

    Elías, I; Ortega-Joaquín, N; de la Cueva, P; Del Pozo, L J; Moreno-Ramírez, D; Boada, A; Aguilar, M; Mirada, A; Mosquera, E; Gibbons, C; Oyagüez, I

    2016-01-01

    To perform a cost-effectiveness and cost-utility analysis of ingenol mebutate in the treatment of actinic keratosis in Spain. We used an adapted Markov model to simulate outcomes in a cohort of patients (mean age, 73 years) with actinic keratosis over a 5-year period. The comparators were diclofenac 3% and imiquimod 5%. The analysis was performed from the perspective of the Spanish National Health System based on direct costs (2015 retail price plus value added tax less the mandatory discount). A panel of experts estimated resources, taking unit costs from national databases. An annual discount rate of 3% was applied. Deterministic and probabilistic sensitivity analyses were performed. The effectiveness of ingenol mebutate-with 0.192 and 0.129 more clearances gained in treatments for face and scalp lesions and trunk and extremity lesions, respectively-was superior to diclofenac's. The total costs of treatment with ingenol mebutate were lower at € 551.50 (face and scalp) and € 622.27 (trunk and extremities) than the respective costs with diclofenac (€ 849.11 and € 844.93). The incremental cost-effectiveness and cost-utility ratios showed that ingenol mebutate was a dominant strategy vs diclofenac. Ingenol mebutate also proved to be more effective than imiquimod, based on 0.535 and 0.503 additional clearances, and total costs of € 551.50 and € 527.89 for the two drugs, respectively. The resulting incremental cost-effectiveness ratio was € 728.64 per clearance gained with ingenol mebutate vs imiquimod. Ingenol mebutate was a dominant treatment option vs diclofenac and was efficient vs imiquimod (i.e., more effective at a higher cost, achieving an incremental cost-utility ratio of<€30000/quality-adjusted life-years). Copyright © 2016 AEDV. Published by Elsevier España, S.L.U. All rights reserved.

  1. A cost-utility analysis of adding a bivalent or quadrivalent HPV vaccine to the Irish cervical screening programme.

    LENUS (Irish Health Repository)

    Dee, Anne

    2010-04-01

    Cervical cancer is a leading cause of death worldwide, and in Ireland it is the ninth most commonly diagnosed cancer in women. Almost 100% of these cancers are caused by human papillomavirus (HPV) infection. Two newly developed vaccines against HPV infection have become available. This study is a cost-utility analysis of the HPV vaccine in Ireland, and it compares the cost-effectiveness profiles of the two vaccines.

  2. Cost-Benefit Analysis of Green Infrastructures on Community Stormwater Reduction and Utilization: A Case of Beijing, China

    Science.gov (United States)

    Liu, Wen; Chen, Weiping; Feng, Qi; Peng, Chi; Kang, Peng

    2016-12-01

    Cost-benefit analysis is demanded for guiding the plan, design and construction of green infrastructure practices in rapidly urbanized regions. We developed a framework to calculate the costs and benefits of different green infrastructures on stormwater reduction and utilization. A typical community of 54,783 m2 in Beijing was selected for case study. For the four designed green infrastructure scenarios (green space depression, porous brick pavement, storage pond, and their combination), the average annual costs of green infrastructure facilities are ranged from 40.54 to 110.31 thousand yuan, and the average of the cost per m3 stormwater reduction and utilization is 4.61 yuan. The total average annual benefits of stormwater reduction and utilization by green infrastructures of the community are ranged from 63.24 to 250.15 thousand yuan, and the benefit per m3 stormwater reduction and utilization is ranged from 5.78 to 11.14 yuan. The average ratio of average annual benefit to cost of four green infrastructure facilities is 1.91. The integrated facilities had the highest economic feasibility with a benefit to cost ratio of 2.27, and followed by the storage pond construction with a benefit to cost ratio of 2.14. The results suggested that while the stormwater reduction and utilization by green infrastructures had higher construction and maintenance costs, their comprehensive benefits including source water replacements benefits, environmental benefits and avoided cost benefits are potentially interesting. The green infrastructure practices should be promoted for sustainable management of urban stormwater.

  3. Including health economic analysis in pilot studies: lessons learned from a cost-utility analysis within the PROSPECTIV pilot study

    Directory of Open Access Journals (Sweden)

    Richéal M. Burns

    2017-07-01

    Full Text Available PurposeTo assess feasibility and health economic benefits and costs as part of a pilot study for a nurse-led, psychoeducational intervention (NPLI for prostate cancer in order to understand the potential for cost effectiveness as well as contribute to the design of a larger scale trial.MethodsMen with stable prostate cancer post-treatment were recruited from two cancer centres in the UK. Eighty-three men were randomised to the NLPI plus usual care or usual care alone (UCA (42 NLPI and 41 UCA; the NLPI plus usual care was delivered in the primary-care setting (the intervention and included an initial face-to-face consultation with a trained nurse, with follow-up tailored to individual needs. The study afforded the opportunity to undertake a short-term within pilot analysis. The primary outcome measure for the economic evaluation was quality of life, as measured by the EuroQol five dimensions questionnaire (EQ-5D (EQ-5D-5L instrument. Costs (£2014 assessed included health-service resource use, out-of-pocket expenses and losses from inability to undertake usual activities.ResultsTotal and incremental costs varied across the different scenarios assessed, with mean cost differences ranging from £173 to £346; incremental effect, as measured by the change in utility scores over the duration of follow-up, exhibited wide confidence intervals highlighting inconclusive effectiveness (95% CI: -0.0226; 0.0438. The cost per patient of delivery of the intervention would be reduced if rolled out to a larger patient cohort.ConclusionsThe NLPI is potentially cost saving depending on the scale of delivery; however, the results presented are not considered generalisable.

  4. Cost-effectiveness in the management of Dupuytren's contracture. A Canadian cost-utility analysis of current and future management strategies.

    Science.gov (United States)

    Baltzer, H; Binhammer, P A

    2013-08-01

    In Canada, Dupuytren's contracture is managed with partial fasciectomy or percutaneous needle aponeurotomy (PNA). Injectable collagenase will soon be available. The optimal management of Dupuytren's contracture is controversial and trade-offs exist between the different methods. Using a cost-utility analysis approach, our aim was to identify the most cost-effective form of treatment for managing Dupuytren's contracture it and the threshold at which collagenase is cost-effective. We developed an expected-value decision analysis model for Dupuytren's contracture affecting a single finger, comparing the cost-effectiveness of fasciectomy, aponeurotomy and collagenase from a societal perspective. Cost-effectiveness, one-way sensitivity and variability analyses were performed using standard thresholds for cost effective treatment ($50 000 to $100 000/QALY gained). Percutaneous needle aponeurotomy was the preferred strategy for managing contractures affecting a single finger. The cost-effectiveness of primary aponeurotomy improved when repeated to treat recurrence. Fasciectomy was not cost-effective. Collagenase was cost-effective relative to and preferred over aponeurotomy at $875 and $470 per course of treatment, respectively. In summary, our model supports the trend towards non-surgical interventions for managing Dupuytren's contracture affecting a single finger. Injectable collagenase will only be feasible in our publicly funded healthcare system if it costs significantly less than current United States pricing.

  5. A utility/cost analysis of breast cancer risk prediction algorithms

    Science.gov (United States)

    Abbey, Craig K.; Wu, Yirong; Burnside, Elizabeth S.; Wunderlich, Adam; Samuelson, Frank W.; Boone, John M.

    2016-03-01

    Breast cancer risk prediction algorithms are used to identify subpopulations that are at increased risk for developing breast cancer. They can be based on many different sources of data such as demographics, relatives with cancer, gene expression, and various phenotypic features such as breast density. Women who are identified as high risk may undergo a more extensive (and expensive) screening process that includes MRI or ultrasound imaging in addition to the standard full-field digital mammography (FFDM) exam. Given that there are many ways that risk prediction may be accomplished, it is of interest to evaluate them in terms of expected cost, which includes the costs of diagnostic outcomes. In this work we perform an expected-cost analysis of risk prediction algorithms that is based on a published model that includes the costs associated with diagnostic outcomes (true-positive, false-positive, etc.). We assume the existence of a standard screening method and an enhanced screening method with higher scan cost, higher sensitivity, and lower specificity. We then assess expected cost of using a risk prediction algorithm to determine who gets the enhanced screening method under the strong assumption that risk and diagnostic performance are independent. We find that if risk prediction leads to a high enough positive predictive value, it will be cost-effective regardless of the size of the subpopulation. Furthermore, in terms of the hit-rate and false-alarm rate of the of the risk prediction algorithm, iso-cost contours are lines with slope determined by properties of the available diagnostic systems for screening.

  6. Assessing the value for money of pharmaceuticals in New Zealand--PHARMAC's approach to cost-utility analysis.

    Science.gov (United States)

    Grocott, Rachel; Metcalfe, Scott; Alexander, Paul; Werner, Rachel

    2013-07-12

    Cost-utility analysis (CUA) is a form of economic analysis that has been used by PHARMAC for nearly 20 years. It is also used by many health funding and assessment agencies internationally. So what is CUA and why is it so important? This article describes the process involved in undertaking CUA, including critical appraisal of clinical evidence; transforming the evidence to estimate quality-adjusted life years (QALYs); estimating costs; and how this information is combined to obtain an output that can be used to inform decision-making. The article also describes how PHARMAC uses CUA to prioritise pharmaceuticals for funding in New Zealand.

  7. Preliminary report on a cost-utility analysis of revascularization by percutaneous coronary intervention for ischemic heart disease.

    Science.gov (United States)

    Takura, Tomoyuki; Tachibana, Kouichi; Isshiki, Takaaki; Sumitsuji, Satoru; Kuroda, Tadashi; Mizote, Isamu; Ide, Seiko; Nanto, Shinsuke

    2017-04-01

    Few socioeconomic studies have so far reported on revascularization for stable ischemic heart disease in Japan. This study aimed to validate the sensitivity of the health-related quality of life (HRQOL) scale for determining the pathology and medical technology to be used and to validate the application of a cost-utility analysis model. We studied 32 patients who had undergone percutaneous coronary intervention (PCI) (mean age 67.9 ± 7.3 years). For HRQOL, utility and quality of life (QOL) were examined using the EuroQol 5 Dimension (EQ-5D) and EuroQol Visual Analogue Scale (EQ-VAS), respectively. The changes in the utility index before and after PCI were compared between the PCI and coronary angiography (CAG) groups to determine the sensitivity of the EQ-5D that was used to calculate quality-adjusted life years (QALY). Additionally, to estimate the cost-utility of PCI 120 months after the procedure, we analyzed our study results and the results of previous reports using the Markov chain model. The utility index was found to improve in the PCI group (0.08 ± 0.15), whereas it decreased in the CAG group (-0.02 ± 0.11) (p = 0.049). The estimated result of the cost-utility analysis as the increase in utility above baseline level was the expected value, that is, 70,000 US$/QALY. Our findings suggest that QALY may be valid as a utility index in the clinical and economic evaluation of PCI in Japan.

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

    Science.gov (United States)

    Fusco, Francesco; Turchetti, Giuseppe

    2016-01-01

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

  9. Cost-utility analysis of interventions to reduce the burden of cervical cancer in Israel.

    Science.gov (United States)

    Ginsberg, Gary M

    2013-11-22

    Using World health Organization, CHOosing Interventions that are Cost Effective (WHO-CHOICE) methodology, cost-utility ratios were calculated for various interventions (Papanicolaou [Pap] smear, human papillomavirus [HPV]-DNA testing, visual inspection with acetic acid [VIA] and vaccination against HPV) at various frequencies to reduce the burden of cervical cancer and condyloma (in the case of the HPV vaccination) in Israel, which has a low prevalence of cervical cancer. All of the screening and/or vaccine interventions were very cost-effective. Attempts should be made to raise compliancy with Pap smears from the current opportunistic 12.1% per annum to screen everyone aged 20-64 once every 5 years in combination with HPV-DNA testing for persons aged 30-64 both before and/or after HPV vaccination is introduced. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in Israel" Vaccine Volume 31, Supplement 8, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Electrical utility generating system reliability analysis code, SYSREL. Social cost studies program

    Energy Technology Data Exchange (ETDEWEB)

    Hub, K.; Conley, L.; Buehring, W.; Rowland, B.; Stephenson, M.

    1975-09-01

    The system reliability code, SYSREL, is a system planning tool that can be used to assess the reliability and economic performance of alternative expansion patterns of electric utility generation systems. Given input information such as capacity, forced-outage rate, number of weeks of annual scheduled maintenance, and economic data for individual units along with the expected load characteristics, the code produces estimates of the mean time between system failures, required reserve capacity to meet a specified system-failure-frequency criterion, expected energy generation from each unit, and system energy cost. The categories of calculations performed by the code are maintenance scheduling, reliability, capacity requirement, energy production allocation, and energy cost. The code is designed to examine alternative generating units and system expansion patterns based on the constraints and general economic conditions imposed by the investigator. The computer running time to execute a study is short and many system alternatives can be examined at a relatively low cost. The report contains a technical description of the code, list of input data requirements, program listing, sample execution, and parameter studies. (auth)

  11. Cost-Utility Analysis of Mycophenolate Mofetil versus Azathioprine Based Regimens for Maintenance Therapy of Proliferative Lupus Nephritis

    Directory of Open Access Journals (Sweden)

    Robert Nee

    2015-01-01

    Full Text Available Background/Aims. We aimed to examine the cost-effectiveness of mycophenolate mofetil (MMF and azathioprine (AZA as maintenance therapy for patients with Class III and Class IV lupus nephritis (LN, from a United States (US perspective. Methods. Using a Markov model, we conducted a cost-utility analysis from a societal perspective over a lifetime horizon. The modeled population comprised patients with proliferative LN who received maintenance therapy with MMF (2 gm/day versus AZA (150 mg/day for 3 years. Risk estimates of clinical events were based on a Cochrane meta-analysis while costs and utilities were retrieved from other published sources. Outcome measures included costs, quality-adjusted life-years (QALY, incremental cost-effectiveness ratios (ICER, and net monetary benefit. Results. The base-case model showed that, compared with AZA strategy, the ICER for MMF was $2,630,592/QALY at 3 years. Over the patients’ lifetime, however, the ICER of MMF compared to AZA was $6,454/QALY. Overall, the ICER results from various sensitivity and subgroup analyses did not alter the conclusions of the model simulation. Conclusions. In the short term, an AZA-based regimen confers greater value than MMF for the maintenance therapy of proliferative LN. From a lifelong perspective, however, MMF is cost-effective compared to AZA.

  12. Cost-Utility Analysis of Daily Versus Intermittent Inhaled Corticosteroids in Mild-Persistent Asthma

    Science.gov (United States)

    Rodriguez-Martinez, Carlos E.; Nino, Gustavo; Castro-Rodriguez, Jose A.

    2017-01-01

    Summary Introduction Despite the many benefits that have been demonstrated by the continuous administration of inhaled corticosteroids (ICS) in persistent asthma, a new strategy for mild-asthma is emerging, consisting of using intermittent or as-needed ICS treatment in conjunction with short-acting beta2 agonists in response to symptoms. However, no previous studies have reported an economic evaluation comparing these two therapeutic strategies. Methods A Markov-type model was developed in order to estimate costs and health outcomes of a simulated cohort of pediatric patients with persistent asthma treated over a 12-month period. Effectiveness parameters were obtained from a systematic review of the literature. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The main outcome was the variable “quality-adjusted life-years” (QALYs). Results For the base-case analysis, the model showed that compared to intermittent ICS, daily therapy with ICS had lower costs (US $437.02 vs. 585.03 and US$704.62 vs. 749.81 average cost per patient over 12 months for school children and preschoolers, respectively), and the greatest gain in QALYs (0.9629 vs. 0.9392 QALYs and 0.9238 vs. 0.9130 QALYS for school children and preschoolers, respectively), resulting in daily therapy being considered dominant. Conclusions The present analysis shows that compared to intermittent therapy, daily therapy with ICS for treating pediatric patients with recurrent wheezing and mild persistent asthma is a dominant strategy (more cost effective), because it showed a greater gain in QALYs with lower total treatment costs. Pediatr Pulmonol. PMID:24965279

  13. Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation : cost utility analysis alongside a randomised controlled trial

    NARCIS (Netherlands)

    Hout, van den W.B.; Peul, W.C.; Koes, B.W.; Brand, R.; Kievit, J.; Thomeer, R.T.W.M.

    2008-01-01

    Objective: To determine whether the faster recovery after early surgery for sciatica compared with prolonged conservative care is attained at reasonable costs. Design: Cost utility analysis alongside a randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with sciati

  14. Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial.

    NARCIS (Netherlands)

    Hout, W.B. van den; Peul, W.C.; Koes, B.W.; Brand, R.; Kievit, J.; Thomeer, R.T.

    2008-01-01

    OBJECTIVE: To determine whether the faster recovery after early surgery for sciatica compared with prolonged conservative care is attained at reasonable costs. DESIGN: Cost utility analysis alongside a randomised controlled trial. SETTING: Nine Dutch hospitals. PARTICIPANTS: 283 patients with sciati

  15. Cost-Utility Analysis of Telemonitoring Interventions for Patients with Chronic Obstructive Pulmonary Disease (COPD) in Germany.

    Science.gov (United States)

    Hofer, Florian; Achelrod, Dmitrij; Stargardt, Tom

    2016-12-01

    Chronic obstructive pulmonary disease (COPD) poses major challenges for health care systems. Previous studies suggest that telemonitoring could be effective in preventing hospitalisations and hence reduce costs. The aim was to evaluate whether telemonitoring interventions for COPD are cost-effective from the perspective of German statutory sickness funds. A cost-utility analysis was conducted using a combination of a Markov model and a decision tree. Telemonitoring as add-on to standard treatment was compared with standard treatment alone. The model consisted of four transition stages to account for COPD severity, and a terminal stage for death. Within each cycle, the frequency of exacerbations as well as outcomes for 2015 costs and quality adjusted life years (QALYs) for each stage were calculated. Values for input parameters were taken from the literature. Deterministic and probabilistic sensitivity analyses were conducted. In the base case, telemonitoring led to an increase in incremental costs (€866 per patient) but also in incremental QALYs (0.05 per patient). The incremental cost-effectiveness ratio (ICER) was thus €17,410 per QALY gained. A deterministic sensitivity analysis showed that hospitalisation rate and costs for telemonitoring equipment greatly affected results. The probabilistic ICER averaged €34,432 per QALY (95 % confidence interval 12,161-56,703). We provide evidence that telemonitoring may be cost-effective in Germany from a payer's point of view. This holds even after deterministic and probabilistic sensitivity analyses.

  16. Cost-utility analysis of adjuvant goserelin (Zoladex and adjuvant chemotherapy in premenopausal women with breast cancer

    Directory of Open Access Journals (Sweden)

    Cheng Tsui

    2012-01-01

    Full Text Available Abstract Background Increased health care costs have made it incumbent on health-care facilities and physicians to demonstrate both clinical and cost efficacy when recommending treatments. Though studies have examined the cost-effectiveness of adjuvant goserelin with radiotherapy for locally advanced prostate cancer, few have compared the cost-effectiveness of adjuvant goserelin to adjuvant chemotherapy alone in premenopausal breast cancer. Methods In this retrospective study at one hospital, the records of 152 patients with stage Ia to IIIa ER + breast cancer who received goserelin or chemotherapy were reviewed. Survival analysis was assessed by the Kaplan-Meier method. Patients were interviewed to evaluate their quality of life using the European Organization for Research and Treatment Quality of Life questionnaire (EORTC-QLQ-C30, version 4.0, and to obtain the utility value by the standard gamble (SG and visual scale (VS methods. Total medical cost was assessed from the (National Health Insurance NHI payer's perspective. Results Survival at 11 years was significantly better in the groserelin group (P Conclusions Goserelin therapy results in better survival and higher utility-weighted life-years, and is more cost-effective than TC or TEC chemotherapy.

  17. One giant leap for mankind? A cost-utility analysis of abolishing the law of gravity.

    Science.gov (United States)

    Cyr, Claude; Lanthier, Luc

    2007-12-04

    Canada's Neo Rhino Party, a joke political party created in 2006 as a successor to the Parti Rhinocéros, is planning a new regulation to repeal the law of gravity, which could have an important impact on diseases attributable to gravity on earth. We sought to estimate the number of quality-adjusted life-years that would be saved if the proposed regulation is passed and determine the cost-effectiveness of adapting Boris Volfson's antigravity machine for use on earth. We performed an economic analysis using a hidden Markov model. Our results suggest that a microgravity environment would save over 2 million quality-adjusted life-years. The cost for every quality-adjusted life-year saved is estimated to be $328. Microgravity is the solution to the health care crisis in Canada. In addition, using technological, statistical and medical jargon gives us the opportunity to defy the laws of physics, mathematics and medicine.

  18. A cost-utility analysis of cervical cancer vaccination in preadolescent Canadian females

    Directory of Open Access Journals (Sweden)

    Merid Maraki

    2009-10-01

    Full Text Available Abstract Background Despite the fact that approximately 70% of Canadian women undergo cervical cancer screening at least once every 3 years, approximately 1,300 women were diagnosed with cervical cancer and approximately 380 died from it in 2008. This study estimates the effectiveness and cost-effectiveness of vaccinating 12-year old Canadian females with an AS04-adjuvanted cervical cancer vaccine. The indirect effect of vaccination, via herd immunity, is also estimated. Methods A 12-health-state 1-year-cycle Markov model was developed to estimate lifetime HPV related events for a cohort of 12-year old females. Annual transition probabilities between health-states were derived from published literature and Canadian population statistics. The model was calibrated using Canadian cancer statistics. From a healthcare perspective, the cost-effectiveness of introducing a vaccine with efficacy against HPV-16/18 and evidence of cross-protection against other oncogenic HPV types was evaluated in a population undergoing current screening practices. The base-case analysis included 70% screening coverage, 75% vaccination coverage, $135/dose for vaccine, and 3% discount rate on future costs and health effects. Conservative herd immunity effects were taken into account by estimated HPV incidence using a mathematical model parameterized by reported age-stratified sexual mixing data. Sensitivity analyses were performed to address parameter uncertainties. Results Vaccinating 12-year old females (n = 100,000 was estimated to prevent between 390-633 undiscounted cervical cancer cases (reduction of 47%-77% and 168-275 undiscounted deaths (48%-78% over their lifetime, depending on whether or not herd immunity and cross-protection against other oncogenic HPV types were included. Vaccination was estimated to cost $18,672-$31,687 per QALY-gained, the lower range representing inclusion of cross-protective efficacy and herd immunity. The cost per QALY-gained was most

  19. Telemonitoring for chronic obstructive pulmonary disease: a cost and cost-utility analysis of a randomised controlled trial.

    Science.gov (United States)

    Stoddart, Andrew; van der Pol, Marjon; Pinnock, Hilary; Hanley, Janet; McCloughan, Lucy; Todd, Allison; Krishan, Ashma; McKinstry, Brian

    2015-03-01

    We compared the costs and cost-effectiveness of telemonitoring vs usual care for patients with chronic obstructive pulmonary disease (COPD). A total of 256 patients were randomised to either telemonitoring or usual care. In the telemonitoring arm, the touch-screen telemonitoring equipment transmitted data to clinical teams monitoring the patients. Total healthcare costs were estimated over a 12-month period from a National Health Service perspective and quality adjusted life year (QALYs) were estimated by the EQ-5D tool. Telemonitoring was not significantly more costly than usual care (mean difference per patient £2065.90 (P telemonitoring service costs and non-significantly higher secondary care costs. Telemonitoring for COPD was not cost-effective at a base case of £137,277 per QALY with only 15% probability of being cost-effective at the usual threshold of £30,000 per QALY. Although there was some statistical and methodological uncertainty in the measures used, telemonitoring was not cost-effective in the sensitivity analyses performed. It seems unlikely that a telemonitoring service of the kind that was trialled would be cost-effective in providing care for people with COPD. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  20. Incorporating ulipristal acetate in the care of symptomatic uterine fibroids: a Canadian cost-utility analysis of pharmacotherapy management

    Directory of Open Access Journals (Sweden)

    Tsoi B

    2015-04-01

    cost-utility ratio for ulipristal would be $168/quality-adjusted life year. Conclusion: Ulipristal offers a unique opportunity to effectively and rapidly control menstrual bleeding in patients with uterine fibroids; thereby improving their quality of life while minimizing the probability of moderate-to-severe hot flashes that are common with leuprolide. The current economic analysis suggests that ulipristal remains the dominant strategy across extensive sensitivity analyses. Keywords: cost-utility analysis, uterine leiomyomas, preoperative care, decision tree, menorrhagia

  1. 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.

  2. Utility-Scale Solar 2014. An Empirical Analysis of Project Cost, Performance, and Pricing Trends in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Seel, Joachim [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2015-09-01

    Other than the nine Solar Energy Generation Systems (“SEGS”) parabolic trough projects built in the 1980s, virtually no large-scale or “utility-scale” solar projects – defined here to include any groundmounted photovoltaic (“PV”), concentrating photovoltaic (“CPV”), or concentrating solar thermal power (“CSP”) project larger than 5 MWAC – existed in the United States prior to 2007. By 2012 – just five years later – utility-scale had become the largest sector of the overall PV market in the United States, a distinction that was repeated in both 2013 and 2014 and that is expected to continue for at least the next few years. Over this same short period, CSP also experienced a bit of a renaissance in the United States, with a number of large new parabolic trough and power tower systems – some including thermal storage – achieving commercial operation. With this critical mass of new utility-scale projects now online and in some cases having operated for a number of years (generating not only electricity, but also empirical data that can be mined), the rapidly growing utility-scale sector is ripe for analysis. This report, the third edition in an ongoing annual series, meets this need through in-depth, annually updated, data-driven analysis of not just installed project costs or prices – i.e., the traditional realm of solar economics analyses – but also operating costs, capacity factors, and power purchase agreement (“PPA”) prices from a large sample of utility-scale solar projects in the United States. Given its current dominance in the market, utility-scale PV also dominates much of this report, though data from CPV and CSP projects are presented where appropriate.

  3. Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care

    DEFF Research Database (Denmark)

    Hansen, Tina Birgitte; Zwisler, Ann Dorthe; Berg, Selina Kikkenborg

    2017-01-01

    and monthly psycho-educational consultations or to usual care. Costs were measured from a societal perspective and quality-adjusted life years were based on the EuroQol five-dimensional questionnaire (EQ-5D). Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs...... and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality......Background While cardiac rehabilitation in patients with ischaemic heart disease and heart failure is considered cost-effective, this evidence may not be transferable to heart valve surgery patients. The aim of this study was to investigate the cost-effectiveness of cardiac rehabilitation following...

  4. Utility-Scale Solar 2015: An Empirical Analysis of Project Cost, Performance, and Pricing Trends in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Seel, Joachim [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division

    2016-08-17

    The utility-scale solar sector—defined here to include any ground-mounted photovoltaic (“PV”), concentrating photovoltaic (“CPV”), or concentrating solar power (“CSP”) project that is larger than 5 MWAC in capacity—has led the overall U.S. solar market in terms of installed capacity since 2012. It is expected to maintain its market-leading position for at least another five years, driven in part by December 2015’s three-year extension of the 30% federal investment tax credit (“ITC”) through 2019 (coupled with a favorable switch to a “start construction” rather than a “placed in service” eligibility requirement, and a gradual phase down of the credit to 10% by 2022). In fact, in 2016 alone, the utility-scale sector is projected to install more than twice as much new capacity as it ever has previously in a single year. This unprecedented boom makes it difficult, yet more important than ever, to stay abreast of the latest utility-scale market developments and trends. This report—the fourth edition in an ongoing annual series—is intended to help meet this need, by providing in-depth, annually updated, data-driven analysis of the utility-scale solar project fleet in the United States. Drawing on empirical project-level data from a wide range of sources, this report analyzes not just installed project costs or prices—i.e., the traditional realm of most solar economic analyses—but also operating costs, capacity factors, and power purchase agreement (“PPA”) prices from a large sample of utility-scale solar projects throughout the United States. Given its current dominance in the market, utility-scale PV also dominates much of this report, though data from CPV and CSP projects are also presented where appropriate.

  5. Cost-utility analysis of a randomized controlled weight loss trial among lactating overweight/obese women.

    Science.gov (United States)

    Hagberg, Lars A; Brekke, Hilde K; Bertz, Fredrik; Winkvist, Anna

    2014-01-15

    Overweight and obesity among young, adult women are increasing problems in Sweden as in many other countries. The postpartum period may be a good opportunity to improve eating habits and lose weight in a sustainable manner. The aim was to make a cost-utility analysis of a dietary behavior modification treatment alongside usual care, compared to usual care alone, among lactating overweight and obese women. This study was a cost-utility analysis based on a randomized controlled and longitudinal clinical diet intervention. Between 2007-2010, 68 women living in Sweden were, after baseline measurement at 8-12 weeks postpartum, randomly assigned to a 12-week dietary behavior modification treatment or control group. Inclusion criteria were: self-reported pre-pregnancy body mass index (BMI) 25-35 kg/m2, non-smoker, singleton term delivery, birth weight > 2500 g, intention to breastfeed for 6 mo and no diseases (mother and child). The women in the intervention group received 1.5 hour of individual counseling at study start and 1 hour at follow-up home visits after 6 weeks of intervention, with support through cell phone text messages every two wk. Dietary intervention aimed to reduce dietary intake by 500 kcal/day. The control group received usual care. Weight results have previously been reported. Here we report on analyses carried out during 2012-2013 of cost per quality adjusted life years (QALY), based on the changes in quality of life measured by EQ-5D-3 L and SF-6D. Likelihood of cost-effectiveness was calculated using Net Monetary Benefit method. Based on conservative assumptions of no remaining effect after 1 year follow-up, the diet intervention was cost-effective. Costs per gained QALY were 8 643 - 9 758 USD. The likelihood for cost-effectiveness, considering a willingness to pay 50 000 USD for a QALY, was 87-93%. The diet intervention is cost-effective. ClinicalTrials.gov Identifier: NCT01343238 Registered April 27, 2011.The regional ethics committee in

  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. Cost-utility analysis of indacaterol in Germany: a once-daily maintenance bronchodilator for patients with COPD.

    Science.gov (United States)

    Price, David; Gray, Alastair; Gale, Rupert; Asukai, Yumi; Mungapen, Laura; Lloyd, Adam; Peters, Lars; Neidhardt, Katja; Gantner, Tobias

    2011-11-01

    Indacaterol is a novel inhaled once-daily long-acting beta(2)-agonist (LABA) for the maintenance treatment of COPD that has been compared to existing inhaled monotherapies on a number of symptomatic endpoints in clinical studies. With constrained healthcare budgets, the objective of this analysis was to evaluate the cost-effectiveness of indacaterol 150 μg, the approved starting dose for maintenance therapy, from a German heath service perspective against the most widely used bronchodilator tiotropium, and the twice-daily LABA, salmeterol. A Markov model was developed with the following main health states: Mild, Moderate, Severe, and Very Severe COPD, based on pre-bronchodilator FEV(1) measures reported in the indacaterol clinical trials, and death. Each disease severity health state had two associated health states for severe or non-severe exacerbation. The model considered patients with moderate to severe COPD, with a mean age of 64 years. The base case time horizon was three years, with discounting set at 3% for costs and benefits. Selected clinical inputs and health state utilities were derived from indacaterol clinical trials, while costs were based on publicly available drug prices and tariffs or published sources. Inputs describing disease progression were based on published data on the rate of FEV(1) decline. Point-estimates show that indacaterol 150 μg is dominant (lower total costs and better outcomes) against tiotropium and salmeterol. An alternative analysis comparing indacaterol 300 μg (maximum dose) against tiotropium, showed an incremental cost-effectiveness ratio (ICER) of approximately €28,300 per QALY. Indacaterol is cost-effective compared to tiotropium and salmeterol. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. Determining the Cost of Capital for Turkish Electricity Distribution Utilities: Analysis and Recommendations

    OpenAIRE

    Mustafa GÖZEN

    2012-01-01

    Turkey has been transforming her electricity market to a competitive one since the electricity market law was approved by the parliament in 2001. As part of the new regime, electricity distribution activities are subject to incentive-based regulation by the energy regulator - EMRA. At the beginning of each implementation period, initial revenue is allowed by EMRA for a distribution utility in which a rate of return for investments in the utility is added. Setting a fair rate is relatively eas...

  9. Determining the Cost of Capital for Turkish Electricity Distribution Utilities: Analysis and Recommendations

    OpenAIRE

    GÖZEN, Mustafa

    2012-01-01

    Turkey has been transforming her electricity market to a competitive one since the electricity market law was approved by the parliament in 2001. As part of the new regime, electricity distribution activities are subject to incentive-based regulation by the energy regulator - EMRA. At the beginning of each implementation period, initial revenue is allowed by EMRA for a distribution utility in which a rate of return for investments in the utility is added. Setting a fair rate is relatively eas...

  10. Utilities Cost Comparison Analysis between a Public Work Center and the Non-DoD Sector

    Science.gov (United States)

    1992-12-01

    construction, consider innovative financing and 14 management arrangements (e.g. cost-sharing, public-private venture, leasing). Integrate...and services by financing all incurred costs. 27 Cash is put back into the working capital fund when customers pay cash from their O&M,N funds for the...firms, and other significantly sized business firms. The actual participants of the study may or may not be included in this listing. Disneyland was

  11. Revisitando a literatura sobre custo-efetividade e utilidade em saúde Reviewing the literature of cost-effectiveness and cost-utility analysis in health

    Directory of Open Access Journals (Sweden)

    Leyla Gomes Sancho

    2008-12-01

    Full Text Available Este trabalho tem por finalidade contribuir com a disseminação do conteúdo teórico desta área do conhecimento, assim como oferecer subsídios para reflexões no que tange à consecução de estudos, os quais resultem em reais benefícios para a população e a gestão do sistema de saúde. Para tanto se realizou, sob uma perspectiva histórica e com base no ponto de vista de reconhecidos autores, ampla revisão da literatura que abrangeu desde sua fundamentação teórica até a formalização de guias metodológicos. O estudo ressalta, inclusive, as controvérsias metodológicas conseqüentes da diversidade das abordagens teóricas. E, como decorrência, recomenda a realização de pesquisas sobre a fundamentação teórica, particularmente a abordada pelos extrawelfaristas.This study aims to contribute to the dissemination of the theoretical foundations for cost-effectiveness and cost-utility analysis. It also provides backing for reflections on the implementation of studies leading to real benefits for both the population and health system management. Taking a historical perspective, and drawing on the work of renowned authors, the study provides an extensive literature review on cost-effectiveness and cost-utility analysis, from the theoretical formulation to the definition of methodological guidelines. The study also highlights the methodological controversies resulting from the diversity of theoretical approaches. As a result, it recommends conducting research on the theoretical foundations, and particularly the position of the extra-welfarists.

  12. Clinical utility and cost analysis of routine postoperative head CT in elective aneurysm clippings.

    Science.gov (United States)

    Zygourakis, Corinna C; Winkler, Ethan; Pitts, Lawrence; Hannegan, Lisa; Franc, Benjamin; Lawton, Michael T

    2017-02-01

    OBJECTIVE Postoperative head CT scanning is performed routinely at the authors' institution on all neurosurgical patients after elective aneurysm clippings. The goal of this study was to determine how often these scans influence medical management and to quantify the associated imaging costs. METHODS The authors reviewed the medical records and accounting database of 304 patients who underwent elective (i.e., nonruptured) aneurysm clipping performed by 1 surgeon (M.T.L.) from 2010 to 2014 at the University of California, San Francisco. Specifically, the total number of postoperative head CT scans, radiographic findings, and the effect of these studies on patient management were determined. The authors obtained the total hospital costs for these patients, including the cost of imaging studies, from the hospital accounting database. RESULTS Overall, postoperative CT findings influenced clinical management in 3.6% of cases; specifically, they led to permissive hypertension in 4 patients for possible ischemia, administration of mannitol for edema and high-flow oxygen for pneumocephalus in 2 patients each, seizure prophylaxis in 1 patient, Plavix readjustment in 1 patient, and return to the operating room for an asymptomatic epidural hematoma evacuation in 1 patient. When patients were stratified on the basis of postoperative neurological examination, findings on CT scans altered management in 1.1%, 4.8%, and 9.0% of patients with no new neurological deficits, a nonfocal examination, and focal deficits, respectively. The mean total hospital cost for treating patients who undergo elective aneurysm clipping was $72,227 (± $53,966) (all values are US dollars), and the cost of obtaining a noncontrast head CT scan was $292. Neurologically intact patients required 99 head CT scans, at a cost of $28,908, to obtain 1 head CT scan that influenced medical management. In contrast, patients with a focal neurological deficit required only 11 head CT scans, at a cost of $3212, to

  13. Utilization of Recycled Asphalt Concrete with Warm Mix Asphalt and Cost-Benefit Analysis

    OpenAIRE

    Julide Oner; Burak Sengoz

    2015-01-01

    The asphalt paving industries are faced with two major problems. These two important challenges are generated with an increase in demand for environmentally friendly paving mixtures and the problem of rapidly rising raw materials. Recycling of reclaimed asphalt pavement (RAP) is a critical necessity to save precious aggregates and reduce the use of costly bitumen. Warm Mix Asphalt (WMA) technology provides not only the option of recycling asphalt pavement at a lower temperature than the tempe...

  14. Cost-utility of routine cataract surgery

    Directory of Open Access Journals (Sweden)

    Ryynänen Olli-Pekka

    2006-09-01

    Full Text Available Abstract Background If decisions on health care spending are to be as rational and objective as possible, knowledge on cost-effectiveness of routine care is essential. Our aim, therefore, was to evaluate the cost-utility of routine cataract surgery in a real-world setting. Methods Prospective assessment of health-related quality of life (HRQoL of patients undergoing cataract surgery. 219 patients (mean (SD age 71 (11 years entering cataract surgery (in 87 only first eye operated, in 73 both eyes operated, in 59 first eye had been operated earlier filled in the 15D HRQoL questionnaire before and six months after operation. Direct hospital costs were obtained from a clinical patient administration database and cost-utility analysis performed from the perspective of the secondary care provider extrapolating benefits of surgery to the remaining statistical life-expectancy of the patients. Results Mean (SD utility score (on a 0–1 scale increased statistically insignificantly from 0.82 (0.13 to 0.83 (0.14. Of the 15 dimensions of the HRQoL instrument, only seeing improved significantly after operation. Mean utility score improved statistically significantly only in patients reporting significant or major preoperative seeing problems. Of the subgroups, only those whose both eyes were operated during follow-up showed a statistically significant (p Conclusion Mean utility gain after routine cataract surgery in a real-world setting was relatively small and confined mostly to patients whose both eyes were operated. The cost of cataract surgery per quality-adjusted life year gained was much higher than previously reported and associated with considerable uncertainty.

  15. Cost-Utility Analysis of Human Papillomavirus Vaccination and Cervical Screening on Cervical Cancer Patient in Indonesia

    NARCIS (Netherlands)

    Setiawan, Didik; Dolk, Franklin Christiaan; Suwantika, Auliya A.; Westra, Tjalke Arend; WIlschut, Jan C.; Postma, Maarten Jacobus

    2016-01-01

    Background: Although cervical cancer is a preventable disease, the clinical and economic burdens of cervical cancer are still substantial issues in Indonesia. Objectives: The main purpose of this study was to model the costs, clinical benefits, and cost-utility of both visual inspection with acetic

  16. Cost-Utility Analysis of Human Papillomavirus Vaccination and Cervical Screening on Cervical Cancer Patient in Indonesia

    NARCIS (Netherlands)

    Setiawan, Didik; Dolk, Franklin Christiaan; Suwantika, Auliya A.; Westra, Tjalke Arend; WIlschut, Jan C.; Postma, Maarten Jacobus

    2016-01-01

    Background: Although cervical cancer is a preventable disease, the clinical and economic burdens of cervical cancer are still substantial issues in Indonesia. Objectives: The main purpose of this study was to model the costs, clinical benefits, and cost-utility of both visual inspection with acetic

  17. A Cost-Utility Analysis of 5 Strategies for the Management of Acute Otitis Media in Children.

    Science.gov (United States)

    Shaikh, Nader; Dando, Emily E; Dunleavy, Mark L; Curran, Dorothy L; Martin, Judith M; Hoberman, Alejandro; Smith, Kenneth J

    2017-10-01

    To assess whether antimicrobial therapy in young children with acute otitis media reduces time to resolution of symptoms, overall symptom burden, and persistence of otoscopic evidence of infection. We used a cost-utility model to evaluate whether immediate antimicrobial treatment seems to be worthwhile, and if so, which antimicrobial agent is most cost effective. We compared the cost per quality-adjusted life-day of 5 treatment regimens in children younger than 2 years of age with acute otitis media: immediate amoxicillin/clavulanate, immediate amoxicillin, immediate cefdinir, watchful waiting, and delayed prescription (DP) for antibiotic. The 5 treatment regimens, listed in order from least effective to most effective were DP, watchful waiting, immediate cefdinir, immediate amoxicillin, and immediate amoxicillin/clavulanate. Listed in order from least costly to most costly, the regimens were DP, immediate amoxicillin, watchful waiting, immediate amoxicillin/clavulanate, and immediate cefdinir. The incremental cost-utility ratio of immediate amoxicillin compared with DP was $101.07 per quality-adjusted life-day gained. The incremental cost-utility ratio of immediate amoxicillin/clavulanate compared with amoxicillin was $2331.28 per quality-adjusted life-day gained. In children younger than 2 years of age with acute otitis media and no recent antibiotic exposure, immediate amoxicillin seems to be the most cost-effective initial treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Adjuvant Trastuzumab in HER2-Positive Early Breast Cancer by Age and Hormone Receptor Status: A Cost-Utility Analysis

    Science.gov (United States)

    Leung, William; Kvizhinadze, Giorgi; Nair, Nisha; Blakely, Tony

    2016-01-01

    Background The anti–human epidermal growth factor receptor 2 (HER2) monoclonal antibody trastuzumab improves outcomes in patients with node-positive HER2+ early breast cancer. Given trastuzumab’s high cost, we aimed to estimate its cost-effectiveness by heterogeneity in age and estrogen receptor (ER) and progesterone receptor (PR) status, which has previously been unexplored, to assist prioritisation. Methods and Findings A cost-utility analysis was performed using a Markov macro-simulation model, with a lifetime horizon, comparing a 12-mo regimen of trastuzumab with chemotherapy alone using the latest (2014) effectiveness measures from landmark randomised trials. A New Zealand (NZ) health system perspective was adopted, employing high-quality national administrative data. Incremental quality-adjusted life-years for trastuzumab versus chemotherapy alone are two times higher (2.33 times for the age group 50–54 y; 95% CI 2.29–2.37) for the worst prognosis (ER−/PR−) subtype compared to the best prognosis (ER+/PR+) subtype, causing incremental cost-effectiveness ratios (ICERs) for the former to be less than half those of the latter for the age groups from 25–29 to 90–94 y (0.44 times for the age group 50–54 y; 95% CI 0.43–0.45). If we were to strictly apply an arbitrary cost-effectiveness threshold equal to the NZ gross domestic product per capita (2011 purchasing power parity [PPP]–adjusted: US$30,300; €23,700; £21,200), our study suggests that trastuzumab (2011 PPP-adjusted US$45,400/€35,900/£21,900 for 1 y at formulary prices) may not be cost-effective for ER+ (which are 61% of all) node-positive HER2+ early breast cancer patients but cost-effective for ER−/PR− subtypes (37% of all cases) to age 69 y. Market entry of trastuzumab biosimilars will likely reduce the ICER to below this threshold for premenopausal ER+/PR− cancer but not for ER+/PR+ cancer. Sensitivity analysis using the best-case effectiveness measure for ER+ cancer had

  19. Utility-Scale Solar 2016: An Empirical Analysis of Project Cost, Performance, and Pricing Trends in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark; Seel, Joachim; LaCommare, Kristina Hamachi

    2017-09-19

    The utility-scale solar sector has led the overall U.S. solar market in terms of installed capacity since 2012. In 2016, the utility-scale sector installed more than 2.5 times as much new capacity as did the residential and commercial sectors combined, and is expected to maintain its dominant position for at least another five years. This report—the fifth edition in an ongoing annual series—provides data-driven analysis of the utility-scale solar project fleet in the United States. We analyze not just installed project prices, but also operating costs, capacity factors, and power purchase agreement ("PPA") prices from a large sample of utility-scale PV and CSP projects throughout the United States. Highlights from this year's edition include the following: Installation Trends: The use of solar tracking devices dominated 2016 installations, at nearly 80% of all new capacity. In a reflection of the ongoing geographic expansion of the market beyond California and the Southwest, the median long-term average insolation level at newly built project sites declined again in 2016. While new fixed-tilt projects are now seen predominantly in less-sunny regions, tracking projects are increasingly pushing into these same regions. The median inverter loading ratio has stabilized in 2016 at 1.3 for both tracking and fixed-tilt projects. Installed Prices: Median installed PV project prices within a sizable sample have fallen by two-thirds since the 2007-2009 period, to $2.2/WAC (or $1.7/WDC) for projects completed in 2016. The lowest 20th percentile of projects within our 2016 sample were priced at or below $2.0/WAC, with the lowest-priced projects around $1.5/WAC. Overall price dispersion across the entire sample and across geographic regions decreased significantly in 2016. Operation and Maintenance (“O&M”) Costs: What limited empirical O&M cost data are publicly available suggest that PV O&M costs were in the neighborhood of $18/kWAC-year, or $8/MWh, in 2016. These

  20. Benefit-cost analysis of DOE's Current Federal Program to increase hydrothermal resource utilization. Final report

    Energy Technology Data Exchange (ETDEWEB)

    1981-12-10

    The impact of DOE's Current Federal Program on the commercialization of hydrothermal resources between 1980 and 2000 is analyzed. The hydrothermal resources of the United States and the types of DOE activities used to stimulate the development of these resources for both electric power and direct heat use are described briefly. The No Federal Program and the Current Federal Program are then described in terms of funding levels and the resultant market penetration estimates through 2000. These market penetration estimates are also compared to other geothermal utilization forecasts. The direct benefits of the Current Federal Program are next presented for electric power and direct heat use applications. An analysis of the external impacts associated with the additional hydrothermal resource development resulting from the Current Federal Program is also provided. Included are environmental effects, national security/balance-of-payments improvements, socioeconomic impacts and materials requirements. A summary of the analysis integrating the direct benefits, external impacts and DOE program costs concludes the report.

  1. A cost-utility analysis of lung cancer screening and the additional benefits of incorporating smoking cessation interventions.

    Directory of Open Access Journals (Sweden)

    Andrea C Villanti

    Full Text Available BACKGROUND: A 2011 report from the National Lung Screening Trial indicates that three annual low-dose computed tomography (LDCT screenings for lung cancer reduced lung cancer mortality by 20% compared to chest X-ray among older individuals at high risk for lung cancer. Discussion has shifted from clinical proof to financial feasibility. The goal of this study was to determine whether LDCT screening for lung cancer in a commercially-insured population (aged 50-64 at high risk for lung cancer is cost-effective and to quantify the additional benefits of incorporating smoking cessation interventions in a lung cancer screening program. METHODS AND FINDINGS: The current study builds upon a previous simulation model to estimate the cost-utility of annual, repeated LDCT screenings over 15 years in a high risk hypothetical cohort of 18 million adults between age 50 and 64 with 30+ pack-years of smoking history. In the base case, the lung cancer screening intervention cost $27.8 billion over 15 years and yielded 985,284 quality-adjusted life years (QALYs gained for a cost-utility ratio of $28,240 per QALY gained. Adding smoking cessation to these annual screenings resulted in increases in both the costs and QALYs saved, reflected in cost-utility ratios ranging from $16,198 per QALY gained to $23,185 per QALY gained. Annual LDCT lung cancer screening in this high risk population remained cost-effective across all sensitivity analyses. CONCLUSIONS: The findings of this study indicate that repeat annual lung cancer screening in a high risk cohort of adults aged 50-64 is highly cost-effective. Offering smoking cessation interventions with the annual screening program improved the cost-effectiveness of lung cancer screening between 20% and 45%. The cost-utility ratios estimated in this study were in line with other accepted cancer screening interventions and support inclusion of annual LDCT screening for lung cancer in a high risk population in clinical

  2. Cost-Utility Analysis of Three U.S. HIV Linkage and Re-engagement in Care Programs from Positive Charge.

    Science.gov (United States)

    Jain, Kriti M; Zulliger, Rose; Maulsby, Cathy; Kim, Jeeyon Janet; Charles, Vignetta; Riordan, Maura; Holtgrave, David

    2016-05-01

    Linking and retaining people living with HIV in ongoing, HIV medical care is vital for ending the U.S. HIV epidemic. Yet, 41-44 % of HIV+ individuals are out of care. In response, AIDS United initiated Positive Charge, a series of five HIV linkage and re-engagement projects around the U.S. This paper investigates whether three Positive Charge programs were cost effective and calculates a return on investment for each program. It uses standard methods of cost utility analysis and WHO-CHOICE thresholds. All three projects were found to be cost effective, and two were highly cost effective. Cost utility ratios ranged from $4439 to $137,271. These results suggest that HIV linkage to care programs are a productive and efficient use of public health funds.

  3. Medical resource utilization and associated costs in patients with ulcerative colitis in the UK: a chart review analysis.

    Science.gov (United States)

    Bodger, Keith; Yen, Linnette; Szende, Agota; Sharma, Gunjan; Chen, Yaozhu J; McDermott, John; Hodgkins, Paul

    2014-02-01

    Limited evidence is available on the economic burden of ulcerative colitis (UC) in the UK, particularly relating to the impact of relapse frequency on direct medical costs. This study identifies and assesses medical resource utilization (MRU) and associated direct costs in mild and moderate UC patients in the UK. A retrospective chart review of patients with mild-to-moderate UC diagnosed at least 1 year before the study was performed. From 33 general practitioner (GP) and 34 gastroenterologist sites, charts of the last three UC patients fulfilling the inclusion criteria were reviewed. Descriptive statistics were calculated for MRU and 2011 costs (GB£) by number of relapses. The study population included 201 patients with a mean age of 39.9 years; 44% were women and the mean disease duration was 7.4 years. UC-related costs of each MRU category increased with the number of relapses. Comparing patients without relapse with those with more than two relapses, the mean annual UC-related costs were £14 versus £2556 for hospitalizations; £218 versus £988 for visits (including nurse, GP, specialist, and other visits); £21 versus £1303 for procedures; £17 versus £188 for diagnostics; and £1168 versus £6660 for all-cause total costs. Age, sex, and site of data reporting (GP vs. gastroenterologist) were not associated with MRU or costs. Patients with mild-to-moderate UC incurred considerable costs that increased markedly with the number of relapses. These findings support the importance of maintenance therapies in UC that reduce or prevent relapses. Quantifying the relationship between relapse rate and costs will inform future health economic studies.

  4. Development of a web-based application and multicountry analysis framework for assessing interdicted infections and cost-utility of screening donated blood for HIV, HCV and HBV.

    Science.gov (United States)

    Custer, B; Janssen, M P; Hubben, G; Vermeulen, M; van Hulst, M

    2017-08-01

    Most countries test donations for HIV, HCV and HBV using serology with or without nucleic acid testing (NAT). Cost-utility analyses provide information on the relative value of different screening options. The aim of this project was to develop an open access risk assessment and cost-utility analysis web-tool for assessing HIV, HCV and HBV screening options (http://www.isbtweb.org/working-parties/transfusion-transmitted-infectious-diseases/). An analysis for six countries (Brazil, Ghana, the Netherlands, South Africa, Thailand and USA) was conducted. Four strategies; (1) antibody assays (Abs) for HIV and HCV + HBsAg, (2) antibody assays that include antigens for HIV and HCV (Combo) + HBsAg, (3) NAT in minipools of variable size (MP NAT) and (4) individual donation (ID) NAT can be evaluated using the tool. Country-specific data on donors, donation testing results, recipient outcomes and costs are entered using the online interface. Results obtained include the number infections interdicted using each screening options, and the (incremental and average) cost-utility of the options. In each of the six countries evaluated, the use of antibody assays is cost effective or even cost saving. NAT has varying cost-utility depending on the setting, and where adopted, the incremental cost-utility exceeds any previously defined or proposed threshold in each country. The web-tool allows an assessment of infectious units interdicted and value for money of different testing strategies. Regardless of gross national income (GNI) per capita, countries appear willing to dedicate healthcare resources to blood supply safety in excess of that for other sectors of health care. © 2017 International Society of Blood Transfusion.

  5. Healthcare Cost and Utilization Project (HCUP)

    Science.gov (United States)

    The Healthcare Cost and Utilization Project is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality.

  6. Cost Utility: An Aid to Decision Making.

    Science.gov (United States)

    Costa, Crist H.

    A set of procedures were developed which assist in structuring tasks and objectives in a manner to permit rational decision making. The model uses a jury of experts to rank various objectives and program processes in terms of their importance. Values are generated which relate to costs in the form of a utility-cost ratio. The model was tested in a…

  7. Impact of Renal Disease on Patients with Hepatitis C: A Retrospective Analysis of Disease Burden, Clinical Outcomes, and Health Care Utilization and Cost.

    Science.gov (United States)

    Solid, Craig A; Peter, Senaka A; Natwick, Tanya; Guo, Haifeng; Collins, Allan J; Arduino, Jean Marie

    2017-01-01

    Few studies explore the magnitude of the disease burden and health care utilization imposed by renal disease among patients with hepatitis C virus (HCV). We aimed to describe the characteristics, outcomes, and health care utilization and costs of patients with HCV with and without renal impairment. This retrospective analysis used 2 administrative claims databases: the US commercially insured population in Truven Health MarketScan® data (aged 20-64 years), and the US Medicare fee-for-service population in the Medicare 20% sample (aged ≥65 years). Baseline characteristics and comorbid conditions were identified from claims during 2011; patients were followed for up to 1 year (beginning January 1, 2012) to identify health outcomes of interest and health care utilization and costs. In the MarketScan and Medicare databases, 35,965 and 10,608 patients with HCV were identified, 8.5 and 26.5% with evidence of renal disease (chronic kidney disease [CKD] or end-stage renal disease [ESRD]). Most comorbid conditions and unadjusted outcome rates increased across groups from patients with no evidence of renal disease to non-ESRD CKD to ESRD. Health care utilization followed a similar pattern, as did the costs. Our findings suggest that HCV patients with concurrent renal disease have significantly more comorbidity, a higher likelihood of negative health outcomes, and higher health care utilization and costs. © 2017 S. Karger AG, Basel.

  8. Cost utility analysis of reduced intensity hematopoietic stem cell transplantation in adolescence and young adult with severe thalassemia compared to hypertransfusion and iron chelation program

    Science.gov (United States)

    2013-01-01

    Background Hematopoieticic stem cell transplantation is the only therapeutic option that can cure thalassemia disease. Reduced intensity hematopoietic stem cell transplantation (RI-HSCT) has demonstrated a high cure rate with minimal complications compared to other options. Because RI-HSCT is very costly, economic justification for its value is needed. This study aimed to estimate the cost-utility of RI-HSCT compared with blood transfusions combined with iron chelating therapy (BT-ICT) for adolescent and young adult with severe thalassemia in Thailand. Methods A Markov model was used to estimate the relevant costs and health outcomes over the patients’ lifetimes using a societal perspective. All future costs and outcomes were discounted at a rate of 3% per annum. The efficacy of RI-HSCT was based a clinical trial including a total of 18 thalassemia patients. Utility values were derived directly from all patients using EQ-5D and SF-6D. Primary outcomes of interest were lifetime costs, quality adjusted life-years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) in US ($) per QALY gained. One-way and probabilistic sensitivity analyses (PSA) were conducted to investigate the effect of parameter uncertainty. Results In base case analysis, the RI-HSCT group had a better clinical outcomes and higher lifetime costs. The incremental cost per QALY gained was US $ 3,236 per QALY. The acceptability curve showed that the probability of RI-HSCT being cost-effective was 71% at the willingness to pay of 1 time of Thai Gross domestic product per capita (GDP per capita), approximately US $ 4,210 per QALY gained. The most sensitive parameter was utility of severe thalassemia patients without cardiac complication patients. Conclusion At a societal willingness to pay of 1 GDP per capita, RI-HSCT was a cost-effective treatment for adolescent and young adult with severe thalassemia in Thailand compared to BT-ICT. PMID:23379888

  9. Calculating cost savings in utilization management.

    Science.gov (United States)

    MacMillan, Donna

    2014-01-01

    A major motivation for managing the utilization of laboratory testing is to reduce the cost of medical care. For this reason it is important to understand the basic principles of cost accounting in the clinical laboratory. The process of laboratory testing includes three distinct components termed the pre-analytic, analytic and post-analytic phases. Utilization management efforts may impact the cost structure of these three phases in different ways depending on the specific details of the initiative. Estimates of cost savings resulting from utilization management programs reported in the literature have often been fundamentally flawed due to a failure to understand basic concepts such as the difference between laboratory costs versus charges and the impact of reducing laboratory test volumes on the average versus marginal cost structure in the laboratory. This article will provide an overview of basic cost accounting principles in the clinical laboratory including both job order and process cost accounting. Specific examples will be presented to illustrate these concepts in various different scenarios.

  10. Cost - utility analysis of parenteral antibiotics prescribed in medical wards in a tertiary care health facility in southern province of Sri Lanka

    Directory of Open Access Journals (Sweden)

    Lukshmy Menik Hettihewa

    2012-10-01

    Full Text Available Introduction: Parenteral antibiotic (PA prescription pattern in a hospital will directly influence the annual budget allocation, development of bacterial resistance and occurrence of unnecessary adverse drug reactions if it is done with poor adherence to the standard guidelines of prescription. As specialist in the field we understand the need of conducting economic studies in relation to the cost and utility of PA prescription pattern. It will be helpful to predict the drug procurement plan for the next year and also to prevent unnecessary complications mentioned above. Objective: Our main objective was to analyze the cost/utility relationship of PA drugs which were used in medical wards in this hospital according to the top ten of the cost (TTTC and the top ten of the consumption (TTCS. Materials and method : Aggregate data from the pharmacy record books were collected for year 2010 from indoor pharmacy. Unit prize was obtained from medical supplies division. Total quantity consumed by each medical ward was considered for analysis of the cost /utility relationship. Two top ten lists were prepared according to the cost and the consumption respectively for medical wards and the correlation was analyzed using non parametric testing with spearman test. Results: Regarding PA drugs used in this hospital, 7/10 PA drugs in TTTC are not included in the TTCS. Out of the total cost for TTTC, 82.6% of the cost had been spent for the PA drugs which are not in the TTCS and 17.5% of the cost of TTTC was used to purchase only three drugs from the TTCS. But these three drugs had contributed only 28% of top ten consumption. 72% of the PA drugs in TTCS were not costly drugs and highly consumed in medical wards. Correlation was significantly positive between cost and utility of PA drugs. ( r=-0.91,p<0.001 Conclusion: Majority of the consumed PA drugs are non-costly and it indicates the prescriptions had been done according to the rational guidelines including

  11. Cost Analysis of Utilizing Electric Vehicles and Photovoltaic Solar Energy in the United States Marine Corps Commercial Vehicle Fleet

    Science.gov (United States)

    2009-12-01

    The purpose of this MBA project is to examine the upfront cost associated with purchasing electric vehicles and installing photovoltaic (PV) solar...analysis for implementing Low Speed Vehicle (LSV), Pure Electric Vehicles (PEV), and PV solar electric energy in the United States Marine Corps commercial vehicle fleet at Marine Corps Logistics Base Barstow.

  12. Cost-utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

    DEFF Research Database (Denmark)

    Wilson, E; Gurusamy, K; Gluud, C

    2010-01-01

    -of-information analysis estimated the likely return from further investment in research in this area. RESULTS:: ELC is less costly (approximately - pound820 per patient) and results in better quality of life (+0.05 QALYs per patient) than DLC. Given a willingness-to-pay threshold of pound20 000 per QALY gained......, there is a 70.9 per cent probability that ELC is cost effective compared with DLC. Full implementation of ELC could save the NHS pound8.5 million per annum. CONCLUSION:: The results of this decision analytic modelling study suggest that on average ELC is less expensive and results in better quality of life than...

  13. Cost and resource utilization associated with fluconazole as first-line therapy for invasive candidiasis: a retrospective database analysis.

    Science.gov (United States)

    Craver, Christopher W; Tarallo, Miriam; Roberts, Craig S; Blanchette, Christopher M; Ernst, Frank R

    2010-12-01

    Fluconazole is a standard first-line therapy for candidemia/invasive candidiasis (C/IC), based on its efficacy, safety profile, and comparatively low acquisition cost. However, little is known about the total costs associated with fluconazole treatment for this indication, particularly in cases of clinical failure. The aim of this study was to examine overall costs, resource use, and treatment outcomes associated with fluconazole as first-line therapy for invasive Candida infections in the United States. A retrospective analysis of data from a US hospital-based (>500 hospitals), service-level database was performed. All patients aged >16 years with primary or secondary International Classification of Diseases, Ninth Revision, Clinical Modification codes for IC or septicemia, receiving intravenous fluconazole treatment, and discharged between October 1, 2004 and September 30, 2005 were selected. Costs and resource use were calculated from the start of antifungal therapy until discharge. Two groups were analyzed: patients who received fluconazole only and those who required a second-line antifungal. Separate analyses for the survivor subpopulations were also conducted. A total of 7170 patients met the inclusion criteria; 21.2% required an additional antifungal agent. Overall mortality was 27.1%, and total mean treatment cost for all patients was $44,482 (in 2005 US dollars). Patients treated with fluconazole alone incurred mean costs of $36,319. Mean hospital and intensive care unit stays in the fluconazole monotherapy group were 17.9 days and 7.1 days, respectively. Patients requiring additional therapy had a mortality rate of 34.5% and a mean treatment cost of $76,329; in this group, the mean hospital and intensive care unit stays were 31.7 days and 14.8 days, respectively. The overall resource use associated with fluconazole as first-line treatment for C/IC was high, especially in patients who required additional antifungal therapy. Future studies should examine

  14. Should Israel screen all mothers-to-be to prevent early-onset of neonatal group B streptococcal disease? A cost-utility analysis

    OpenAIRE

    Ginsberg Gary M; Eidelman Arthur I; Shinwell Eric; Anis Emilia; Peyser Reuven; Lotan Yoram

    2013-01-01

    Abstract Background In Israel, an average of 37 children are born each year with sepsis and another four with meningitis as a result of Group B Streptococcal (GBS) disease. Israel currently only screens mothers with defined risk factors (around 15% of all pregnancies) in order to identify candidates for Intrapartum Antiobiotic Prophyhlaxis (IAP) of GBS. This paper presents a cost-utility analysis of implementing an alternative strategy, which would expand the current protocol to one aiming to...

  15. Cost utility analysis of immunosuppressive regimens in adult renal transplant recipients in England and Wales

    Directory of Open Access Journals (Sweden)

    Muduma G

    2014-11-01

    Full Text Available Gorden Muduma,1 Jane Shaw,2 Warren M Hart,3 Abayomi Odeyemi,3 Isaac Odeyemi21Astellas Pharma Europe Limited, Chertsey, UK; 2Astellas Pharma Limited, Chertsey, UK; 3EcoStat Consulting UK Limited, London, UKBackground: End-stage renal disease is the irreversible final stage of chronic kidney disease and is fatal when not managed by either transplantation or dialysis. Transplantation is generally preferred over dialysis. However, to prevent graft rejection or loss, lifelong immunosuppression is required. Tacrolimus is currently the cornerstone of post-transplantation immunosuppression. The study aim was to carry out an economic evaluation of immunosuppression, including more recent agents such as a once-daily prolonged-release formulation of tacrolimus (Advagraf™ and belatacept, relative to a twice-daily immediate-release formulation of tacrolimus (Prograf™.Methods: A model was constructed comprising six states: onset of biopsy-confirmed acute rejection, functioning graft with or without a biopsy-confirmed acute rejection, non-functioning graft (dialysis, re-transplantation, and death. Data on clinical effectiveness were derived from a systematic literature review and the model captured the effects of patient adherence to immunosuppressant therapy on graft survival using relative risk of graft survival and published data on adherence in patients using Advagraf and Prograf. In the base case, the time horizon was 25 years and one-way and probabilistic sensitivity analyses were conducted.Results: The analysis demonstrated that Prograf was cost-effective when compared with cyclosporin and belatacept and was more effective than sirolimus, but would not be considered cost-effective against sirolimus. The modeled improvement in the adherence profile of patients using Advagraf relative to Prograf resulted in both improved clinical outcomes and reduced costs. Conclusion: Prograf was more clinically effective than cyclosporin, belatacept, and sirolimus

  16. Epidemiology and cost of hospital care for Lyme borreliosis in Germany: lessons from a health care utilization database analysis.

    Science.gov (United States)

    Lohr, B; Müller, I; Mai, M; Norris, D E; Schöffski, O; Hunfeld, K-P

    2015-02-01

    To date, relatively little is known about the economic and medical impact of Lyme borreliosis (LB) on European health care systems, especially for the inpatient sector. This retrospective analysis is based on data provided for the years 2007-2011 by a German statutory health insurance company (DAK-Gesundheit) covering approximately 6 million insured. Total cost was calculated for a 1-year period both from the third-party payers and from the societal perspective, respectively. In our cohort the incident diagnosis of LB was coded for 2163 inpatient cases during the years 2008-2011. The median inpatient time was 9 days resulting in a median direct medical cost per hospital stay of 3917€ for adolescents and 2843€ for adults. Based on extrapolation of our findings to the German population, we would expect an average hospital admission of 5200 adults and 2300 adolescents (<18 years) for LB treatment incurring direct medical costs of more than 23 million Euro annually. The annual indirect costs due to loss of productivity would add up to more than 7 million Euro as assessed by the human capital method. Cases tended to accumulate between June and September with remarkable changes in disease manifestations in the course of the year documented in the coded secondary diagnoses. Also specific differences in the disease pattern of adolescents and adults became obvious. Age-specific incidence showed male predominance and a bimodal distribution. Incidence was highest in children aged between 3 and 17 (highest mean incidence of 29 cases/100,000 inhabitants in 6-9 year olds) with a second peak in 60-79 year old individuals. During the study period the nationwide inpatient incidence was 9/100,000 with marked regional variability. In summary, our study is one of the first European investigations on hospital care for LB inpatients and identifies LB as a possibly underestimated socioeconomic factor for health care in Germany.

  17. Cost-utility analysis of different treatments for post-traumatic stress disorder in sexually abused children

    Directory of Open Access Journals (Sweden)

    Gospodarevskaya Elena

    2012-04-01

    demonstrated that all psychotherapy treatments for PTSD in sexually abused children have a favourable ICER relative to no treatment. The results also highlighted the loss of quality of life in children who do not receive any psychotherapy. Results of the base-case analysis suggest that TF-CBT + SSRI is more cost-effective than TF-CBT alone, however, considering the uncertainty associated with prescribing SSRIs to children and adolescents, clinicians and parents may exercise some caution in choosing this treatment alternative.

  18. Cost-benefit analysis of the energy conservation scheme of a regional public utility; Kosten-Nutzen-Analyse des Energiespar-Programms eines regionalen Energieversorgers

    Energy Technology Data Exchange (ETDEWEB)

    Engel, H. [Energie-Versorgung Schwaben AG, Stuttgart (Germany). Abt. Sondervertragskunden; Karel, A. [Heag Versorgungs-AG, Darmstadt (Germany). Abt. Anwendungsberatung; Setzer, M. [Technische Hochschule Darmstadt (Germany). Inst. fuer Volkswirtschaftslehre

    1996-04-22

    Public utilities increasingly advocate energy conservation, not additional power consumption. With this regard, Heag AG, in its ``energy conservation scheme 2000``, offers a broad range of possibilities. It includes incentives for energy conservation and renewable energy use. As an instrument of analysis for this scheme, cost-benefit analysis was chosen. The authors describe the scheme and test the applicability of cost-benefit analysis. (orig.) [Deutsch] Die EVU setzen sich zunehmend fuer das Energieeinsparen ein, statt fuer zusaetzlichen Stromabsatz. Die Heag Versorgungs-AG bietet dazu ein breit angelegtes Foerderprogramm: `Energiespar-Aktion 2000`. Im Rahmen dieser Aktion werden Massnahmen zur Energieeinsparung und Nutzung regenerativer Energie finanziell gefoerdert. Als Analyseinstrument fuer die Energiespar-Aktion wurde die Kosten-Nutzen-Analyse gewaehlt. Die Verfasser erlaeutern die Energiespar-Aktion und pruefen auch die Anwendbarkeit der Kosten-Nutzen-Analyse. (orig.)

  19. A cost-utility analysis of sacral anterior root stimulation (SARS) compared with medical treatment in patients with complete spinal cord injury with a neurogenic bladder.

    Science.gov (United States)

    Morlière, Camille; Verpillot, Elise; Donon, Laurence; Salmi, Louis-Rachid; Joseph, Pierre-Alain; Vignes, Jean-Rodolphe; Bénard, Antoine

    2015-12-01

    Sacral anterior root stimulation (SARS) and posterior sacral rhizotomy restores the ability to urinate on demand with low residual volumes, which is a key for preventing urinary complications that account for 10% of the causes of death in patients with spinal cord injury with a neurogenic bladder. Nevertheless, comparative cost-effectiveness results on a long time horizon are lacking to adequately inform decisions of reimbursement. This study aimed to estimate the long-term cost-utility of SARS using the Finetech-Brindley device compared with medical treatment (anticholinergics+catheterization). The following study design is used for the paper: Markov model elaborated with a 10-year time horizon; with four irreversible states: (1) initial treatment, (2) year 1 of surgery for urinary complication, (3) year >1 of surgery for urinary complication, and (4) death; and reversible states: urinary calculi; Finetech-Brindley device failures. The sample consisted of theoretical cohorts of patients with a complete spinal cord lesion since ≥1 year, and a neurogenic bladder. Effectiveness was expressed as quality adjusted life years (QALYs). Costs were valued in EUR 2013 in the perspective of the French health system. A systematic review and meta-analyses were performed to estimate transition probabilities and QALYs. Costs were estimated from the literature, and through simulations using the 2013 French prospective payment system classification. Probabilistic analyses were conducted to handle parameter uncertainty. In the base case analysis (2.5% discount rate), the cost-utility ratio was 12,710 EUR per QALY gained. At a threshold of 30,000 EUR per QALY the probability of SARS being cost-effective compared with medical treatment was 60%. If the French Healthcare System reimbursed SARS for 80 patients per year during 10 years (anticipated target population), the expected incremental net health benefit would be 174 QALYs, and the expected value of perfect information (EVPI

  20. 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...

  1. Microscopic observation drug-susceptibility assay vs. Xpert(®) MTB/RIF for the diagnosis of tuberculosis in a rural African setting: a cost-utility analysis.

    Science.gov (United States)

    Wikman-Jorgensen, Philip E; Llenas-García, Jara; Pérez-Porcuna, Tomàs M; Hobbins, Michael; Ehmer, Jochen; Mussa, Manuel A; Ascaso, Carlos

    2017-06-01

    To compare the cost-utility of microscopic observation drug-susceptibility assay (MODS) and Xpert(®) MTB/RIF implementation for tuberculosis (TB) diagnosis in rural northern Mozambique. Stochastic transmission compartmental TB model from the healthcare provider perspective with parameter input from direct measurements, systematic literature reviews and expert opinion. MODS and Xpert(®) MTB/RIF were evaluated as replacement test of smear microscopy (SM) or as an add-on test after a negative SM. Costs were calculated in 2013 USD, effects in disability-adjusted life years (DALY). Willingness to pay threshold (WPT) was established at once the per capita Gross National Income of Mozambique. MODS as an add-on test to negative SM produced an incremental cost-effectiveness ratio (ICER) of 5647.89USD/DALY averted. MODS as a substitute for SM yielded an ICER of 5374.58USD/DALY averted. Xpert(®) MTB/RIF as an add-on test to negative SM yielded ICER of 345.71USD/DALY averted. Xpert(®) MTB/RIF as a substitute for SM obtained an ICER of 122.13USD/DALY averted. TB prevalence and risk of infection were the main factors impacting MODS and Xpert(®) MTB/RIF ICER in the one-way sensitivity analysis. In the probabilistic sensitivity analysis, Xpert(®) MTB/RIF was most likely to have an ICER below the WPT, whereas MODS was not. Our cost-utility analysis favours the implementation of Xpert(®) MTB/RIF as a replacement of SM for all TB suspects in this rural high TB/HIV prevalence African setting. © 2017 John Wiley & Sons Ltd.

  2. Cost-utility analysis of certolizumab pegol versus alternative tumour necrosis factor inhibitors available for the treatment of moderate-to-severe active rheumatoid arthritis in Spain

    OpenAIRE

    2015-01-01

    Background Certolizumab pegol, a PEGylated tumour necrosis factor (TNF)-inhibitor, improves the clinical signs and symptoms of rheumatoid arthritis (RA) when used in combination with methotrexate or as monotherapy. This study evaluatedthe cost-utility of certolizumab pegol versusTNF-inhibitors plus methotrexate in the treatment of moderate-to-severe RA in Spain. Methods A Markov cohort health state transition model was developed to evaluate the cost-utility (costs and quality-adjusted life ye...

  3. Retrospective analysis of drug utilization, health care resource use, and costs associated with IFN therapy for adjuvant treatment of malignant melanoma

    Directory of Open Access Journals (Sweden)

    Zhang Y

    2015-07-01

    Full Text Available ≥Ying Zhang,1 Trong Kim Le,1 James W Shaw,2 Srividya Kotapati31Center for Observational Research and Data Sciences, Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Research and Development, Hopewell, NJ, USA; 2Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Research and Development, Princeton, NJ, USA; 3Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Research and Development, Wallingford Center, CT, USABackground: This study examines real-world drug utilization patterns, health care resource use, and costs among patients receiving adjuvant treatment with IFN versus patients receiving no treatment ("observation" for malignant melanoma following surgery.Methods: A retrospective cohort study was conducted using administrative claims from Truven Health Analytics (MarketScan® to identify all adjuvant melanoma patients (aged ≥18 years diagnosed between June 2007 and June 2011 who had a lymph node dissection (ie, index surgery and were treated with IFN or subsequently observed. Health care resource use and costs of services were converted to 2012 US dollars and were evaluated and compared using multivariable regression.Results: Of 1,999 eligible subjects with melanoma surgery claims, 179 (9.0% were treated with IFN and 1,820 (91.0% were observed. The median duration (days and number of doses of IFN therapy were 73 and 36, respectively. Among IFN-treated patients, only 10.6% completed ≥80% of maintenance therapy. The total average cost for patients treated with IFN was US$60,755±$3,972 (n=179; significantly higher than for patients undergoing observation ($31,641±$2,471; P<0.0001. Similar trends were observed when evaluating total cost components, including melanoma-related and non-melanoma–related medical costs. Among the melanoma-related medical costs, outpatient services, including office visits and laboratory testing, represented between 33% and 53% of total costs and

  4. Operating cost analysis of anaesthesia: Activity based costing (ABC analysis

    Directory of Open Access Journals (Sweden)

    Majstorović Branislava M.

    2011-01-01

    Full Text Available Introduction. Cost of anaesthesiology represent defined measures to determine a precise profile of expenditure estimation of surgical treatment, which is important regarding planning of healthcare activities, prices and budget. Objective. In order to determine the actual value of anaestesiological services, we started with the analysis of activity based costing (ABC analysis. Methods. Retrospectively, in 2005 and 2006, we estimated the direct costs of anestesiological services (salaries, drugs, supplying materials and other: analyses and equipment. of the Institute of Anaesthesia and Resuscitation of the Clinical Centre of Serbia. The group included all anesthetized patients of both sexes and all ages. We compared direct costs with direct expenditure, “each cost object (service or unit” of the Republican Health-care Insurance. The Summary data of the Departments of Anaesthesia documented in the database of the Clinical Centre of Serbia. Numerical data were utilized and the numerical data were estimated and analyzed by computer programs Microsoft Office Excel 2003 and SPSS for Windows. We compared using the linear model of direct costs and unit costs of anaesthesiological services from the Costs List of the Republican Health-care Insurance. Results. Direct costs showed 40% of costs were spent on salaries, (32% on drugs and supplies, and 28% on other costs, such as analyses and equipment. The correlation of the direct costs of anaestesiological services showed a linear correlation with the unit costs of the Republican Healthcare Insurance. Conclusion. During surgery, costs of anaesthesia would increase by 10% the surgical treatment cost of patients. Regarding the actual costs of drugs and supplies, we do not see any possibility of costs reduction. Fixed elements of direct costs provide the possibility of rationalization of resources in anaesthesia.

  5. Costs and utilities of manual therapy and orthopedic standard care for low-prioritized orthopedic outpatients of working age: a cost consequence analysis.

    Science.gov (United States)

    Lilje, Stina C; Persson, Ulf B; Tangen, Stine T; Kåsamoen, Stine; Skillgate, Eva

    2014-08-01

    Treatment for musculoskeletal disorders in primary care in Sweden is generally initiated with advice and medication. Second-line therapy is physiotherapy and/or injection and radiography; third-line therapy is referral to an orthopedist. Manual therapy is not routine. It is a challenge to identify patients who benefit from treatment by different specialists. The current referral strategy probably contributes to long waiting lists in orthopedic departments, which is costly and implies prolonged suffering for the patients. The aim of this health economic evaluation was to compare costs and outcomes from naprapathic manual therapy (NMT) with orthopedic standard care for common, low-prioritized, nonsurgical musculoskeletal disorders, after second-line treatment. Diagnose Related Groups were used to define the costs, and the SF-36 was encoded to evaluate the outcomes in cost per quality adjusted life years gained. Results from a 12 months' follow-up showed significantly larger improvement for the NMT than for orthopedic standard care, significantly lower mean cost per patient; 5427 SEK (*Price level 2009; 1 Euro=106,213 SEK; 1 US Dollar=76,457 SEK) (95% confidence interval, 3693-7161) compared to14298 SEK (95% confidence interval, 8322-20,274), and more gains in outcomes in cost per quality adjusted life years per patient (0.066 compared with 0.026). Thus the result is "dominant." It is plausible that improved outcomes and reasonable cost savings for low-prioritized nonsurgical outpatients would be attainable if NMT were available as an additional standard care option in orthopedic outpatient clinics.

  6. Educational Cost Analysis.

    Science.gov (United States)

    Flynn, Donald L.

    Traditional approaches to the cost analysis of educational programs involve examining annual budgets. Such approaches do not properly consider the cost of either new capital expenditures or the current value of previously purchased items. This paper presents the methodology for a new approach to educational cost analysis that identifies the actual…

  7. Utility-Scale Solar 2013: An empirical analysis of project cost, performance, and pricing trends in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Weaver, Samantha [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2014-09-17

    Other than the SEGS I-IX parabolic trough projects built in the 1980s, virtually no large-scale or "utility-scale" solar projects-defined here to include any ground-mounted photovoltaic ("PV"), concentrating photovoltaic ("CPV"), or concentrating solar power ("CSP" or solar thermal) project larger than 5 MWAC-existed in the United States prior to 2007.

  8. Treatment patterns, healthcare resource utilization, and costs following first-line antidepressant treatment in major depressive disorder: a retrospective US claims database analysis.

    Science.gov (United States)

    Gauthier, Geneviève; Guérin, Annie; Zhdanava, Maryia; Jacobson, William; Nomikos, George; Merikle, Elizabeth; François, Clément; Perez, Vanessa

    2017-06-19

    Although the symptoms of major depressive disorder (MDD) are often manageable with pharmacotherapy, response to first-line antidepressant treatment is often less than optimal. This study describes long-term treatment patterns in MDD patients in the United States and quantifies the economic burden associated with different treatment patterns following first-line antidepressant therapy. MDD patients starting first-line antidepressant monotherapy and having continuous enrollment ≥12 months before and ≥24 months following the index date (i.e., the first documented prescription fill) were selected from the Truven Health Analytics MarketScan (2003-2014) database. Based on the type of first treatment change following initiation, six treatment cohorts were defined a priori ("persistence"; "discontinuation"; "switch"; "dose escalation"; "augmentation"; and "combination"). Treatment patterns through the fourth line of therapy within each cohort, healthcare resource utilization (HCRU), and cost analyses were restricted to patients with adequate treatment duration (defined as ≥42 days) in each line (analysis sub-sample, N = 21,088). HCRU and costs were described at the cohort and pattern levels. Treatment cohorts representing patterns. Median time to discontinuation was 23 weeks. The switch cohort exhibited the highest HCRU (18.9 days with medical visits per-patient-per-year) and greatest healthcare costs ($11,107 per-patient-per-year) following the index date. Treatment patterns representing a cycling on and off treatment in the switch cohort were associated with the greatest healthcare costs overall. A high proportion of patients discontinue first-line antidepressant shortly after initiation. Patterns representing a cycling on and off treatment in the switch cohort were associated with the highest healthcare costs. These findings underscore challenges in effectively treating patients with MDD and a need for personalized patient management.

  9. Do Pneumococcal Conjugate Vaccines Represent Good Value for Money in a Lower-Middle Income Country? A Cost-Utility Analysis in the Philippines.

    Directory of Open Access Journals (Sweden)

    Manuel Alexander Haasis

    Full Text Available The objective of this study is to assess the value for money of introducing pneumococcal conjugate vaccines as part of the immunization program in a lower-middle income country, the Philippines, which is not eligible for GAVI support and lower vaccine prices. It also includes the newest clinical evidence evaluating the efficacy of PCV10, which is lacking in other previous studies.A cost-utility analysis was conducted. A Markov simulation model was constructed to examine the costs and consequences of PCV10 and PCV13 against the current scenario of no PCV vaccination for a lifetime horizon. A health system perspective was employed to explore different funding schemes, which include universal or partial vaccination coverage subsidized by the government. Results were presented as incremental cost-effectiveness ratios (ICERs in Philippine peso (Php per QALY gained (1 USD = 44.20 Php. Probabilistic sensitivity analysis was performed to determine the impact of parameter uncertainty.With universal vaccination at a cost per dose of Php 624 for PCV10 and Php 700 for PCV13, both PCVs are cost-effective compared to no vaccination given the ceiling threshold of Php 120,000 per QALY gained, yielding ICERs of Php 68,182 and Php 54,510 for PCV10 and PCV13, respectively. Partial vaccination of 25% of the birth cohort resulted in significantly higher ICER values (Php 112,640 for PCV10 and Php 84,654 for PCV13 due to loss of herd protection. The budget impact analysis reveals that universal vaccination would cost Php 3.87 billion to 4.34 billion per annual, or 1.6 to 1.8 times the budget of the current national vaccination program.The inclusion of PCV in the national immunization program is recommended. PCV13 achieved better value for money compared to PCV10. However, the affordability and sustainability of PCV implementation over the long-term should be considered by decision makers.

  10. A UK-based cost-utility analysis of indacaterol, a once-daily maintenance bronchodilator for patients with COPD, using real world evidence on resource use.

    Science.gov (United States)

    Price, David; Asukai, Yumi; Ananthapavan, Jaithri; Malcolm, Bill; Radwan, Amr; Keyzor, Ian

    2013-06-01

    Chronic Obstructive Pulmonary Disease (COPD) is a chronic, progressive disease that is not curable. However, there are effective treatments available. In the UK, long-acting bronchodilators are first-line treatments for COPD patients requiring maintenance therapy, and there are several options available. The aim of this study is to establish, from the UK National Health Service (NHS) perspective, the cost-effectiveness profile of indacaterol, the first once-daily long-acting beta2-agonist (LABA), compared with tiotropium and salmeterol, in patients with moderate to severe COPD. In assessing the cost-effectiveness of COPD therapies, this study has the advantage of using real world evidence on the resource use associated with COPD management across the spectrum of the disease. A Markov model was developed with four health states following the GOLD classification for severity of airflow limitation. The model time horizon was 3 years, and the cycle length was 3 months. From each state, patients could experience a severe or non-severe exacerbation, move to a different COPD state, remain in the current state or die. Transition probabilities were based on data from the indacaterol clinical trials. The majority of the resource use data was taken from the Optimum Patient Care Research Database (OPCRD), which contains data from over 20,000 COPD patients in England and Scotland. Cost data were taken from UK-based sources and published literature and presented for the cost year 2011. Health-related quality of life was the main outcome of interest and utility data for the COPD states were based on data from the indacaterol clinical trials and disutility due to exacerbations were taken from the literature. Both one way and probabilistic sensitivity analyses were performed to test the robustness of the results. Indacaterol dominated in the comparison with salmeterol producing an incremental QALY gain of 0.008 and cost savings of £110 per patient over a 3-year time horizon. In

  11. Medical resource utilization and costs associated with autosomal dominant polycystic kidney disease in the USA: a retrospective matched cohort analysis of private insurer data

    Science.gov (United States)

    Knight, Tyler; Schaefer, Caroline; Krasa, Holly; Oberdhan, Dorothee; Chapman, Arlene; Perrone, Ronald D

    2015-01-01

    Background Autosomal dominant polycystic kidney disease (ADPKD) results in kidney cyst development and enlargement, resulting in chronic kidney disease (CKD) leading to renal failure. This study sought to determine if ADPKD patients in the early stages of CKD contribute to a sizable economic burden for the US health care system. Methods This was a retrospective, matched cohort study, reviewing medical resource utilization (MRU) and costs for adults in a US private-payer claims database with a diagnosis code of ADPKD (ICD-9-CM 753.13). ADPKD patients were matched by age grouping (0–17, 18–34, 35–44, 45–54, 55–64, and 65+ years) and sex to controls to understand the burden of ADPKD. Descriptive statistics on 6-month MRU and costs were assessed by CKD stages, dialysis use, or previous renal transplant. Results The analysis included ADPKD patients in CKD stages 1–5 (n=316 to n=860), dialysis (n=586), and post-transplant (n=615). Mean ages did not differ across CKD stages (range 43–56 years). Men were the majority in the later stages but the minority in the early stages. The proportion of patients with at least one hospitalization increased with CKD stage, (12% to >40% CKD stage 2 to stage 5, dialysis or post-transplant). The majority had at least one hospital outpatient visit and at least one pharmacy claim. Total 6-month per-patient costs were greater among ADPKD patients than in age-matched and sex-matched healthy non-ADPKD controls (P<0.001 for all comparisons). Conclusion ADPKD patients with normal kidney function are associated with a significant economic burden to the health care system relative to the general population. Any treatments that delay progression to later stages of CKD may provide potential health care cost offsets. PMID:25759590

  12. Medical resource utilization and costs associated with autosomal dominant polycystic kidney disease in the USA: a retrospective matched cohort analysis of private insurer data

    Directory of Open Access Journals (Sweden)

    Knight T

    2015-02-01

    Full Text Available Tyler Knight,1 Caroline Schaefer,1 Holly Krasa,2 Dorothee Oberdhan,2 Arlene Chapman,3 Ronald D Perrone4 1Covance Market Access Services Inc., Gaithersburg, MD, 2Otsuka Pharmaceutical Development and Commercialization, Inc., Rockville, MD, 3Emory University, Atlanta, GA, 4Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA Background: Autosomal dominant polycystic kidney disease (ADPKD results in kidney cyst development and enlargement, resulting in chronic kidney disease (CKD leading to renal failure. This study sought to determine if ADPKD patients in the early stages of CKD contribute to a sizable economic burden for the US health care system. Methods: This was a retrospective, matched cohort study, reviewing medical resource utilization (MRU and costs for adults in a US private-payer claims database with a diagnosis code of ADPKD (ICD-9-CM 753.13. ADPKD patients were matched by age grouping (0–17, 18–34, 35–44, 45–54, 55–64, and 65+ years and sex to controls to understand the burden of ADPKD. Descriptive statistics on 6-month MRU and costs were assessed by CKD stages, dialysis use, or previous renal transplant. Results: The analysis included ADPKD patients in CKD stages 1–5 (n=316 to n=860, dialysis (n=586, and post-transplant (n=615. Mean ages did not differ across CKD stages (range 43–56 years. Men were the majority in the later stages but the minority in the early stages. The proportion of patients with at least one hospitalization increased with CKD stage, (12% to >40% CKD stage 2 to stage 5, dialysis or post-transplant. The majority had at least one hospital outpatient visit and at least one pharmacy claim. Total 6-month per-patient costs were greater among ADPKD patients than in age-matched and sex-matched healthy non-ADPKD controls (P<0.001 for all comparisons. Conclusion: ADPKD patients with normal kidney function are associated with a significant economic burden to the health care system

  13. [Cost-utility analysis on universal childhood hepatitis A vaccination in regions with different anti-HAV prevalence rates of China].

    Science.gov (United States)

    Pan, Xin-juan; Feng, Yan-ming; Zhuang, Gui-hua

    2012-08-01

    To explore the inputs and outputs of areas with different anti-HAV prevalence rates on universal childhood vaccination, and to provide a scientific basis for the formulation of the immunization strategy. Since hepatitis A vaccination was scheduled at 12 and 18 months of age for all the healthy children, a single cohort including 1 000 000 individuals was formed in 2009, using the Chinese inactivated vaccine. Decision analysis was used to build Markov-decision tree model. The universal childhood hepatitis A vaccination was compared with non-vaccination group to evaluate the number of symptomatic infection, hospitalization, death, quality-adjusted life years (QALYs) lost, and the incremental cost-utility from the health system and the societal perspectives. Outcomes of the vaccination for the next 70 years were also predicted. The process of analysis was run separately in five regions defined by the anti-HAV prevalence rates (around 50%, 50% - 69%, 70% - 79%, 80% - 89% and > 90%). Sensitivity analysis was performed to test the stability or reliability of the results, and to identify sensitive variables. The study projected that, in the lowest, lower, and intermediate infection regions, the cost and output indicators of universal childhood hepatitis A vaccination were all lower than non-vaccinated group. Universal vaccination could gain QALYs and save both costs from the health system or the society. In the regions with higher infection rate, the output indicators of universal childhood hepatitis A vaccination were lower than in those non-vaccinated groups, except for the number of death due to hepatitis A, which had a 20 cases of increase. The model also predicted that in the highest infected region, universal vaccination would increase 4 560 814 and 5 840 430 RMB Yuan in the total costs from both the health system and the societies, respectively, when compared to the non-vaccination groups. Universal vaccination would also decrease the numbers of symptomatic

  14. Trial-Based Cost-Utility Analysis of Icotinib versus Gefitinib as Second-Line Therapy for Advanced Non-Small Cell Lung Cancer in China.

    Directory of Open Access Journals (Sweden)

    Chunxiang Zhang

    Full Text Available Our objective is to compare the cost-utility of icotinib and gefitinib for the second-line treatment of advanced non-small cell lung cancer (NSCLC from the perspective of the Chinese healthcare system.Model technology was applied to assess the data of randomized clinical trials and the direct medical costs from the perspective of the Chinese healthcare system. Five-year quality-adjusted life years (QALYs and incremental cost-utility ratios (ICURs were calculated. One-way and probabilistic sensitivity analyses (PSA were performed.Our model suggested that the median progression-free survival (PFS was 4.2 months in the icotinib group and 3.5 months in the gefitinib group while they were 4.6 months and 3.4 months, respectively, in the trials. The 5-year QALYs was 0.279 in the icotinib group and 0.269 in the gefitinib group, and the according medical costs were $10662.82 and $13127.57. The ICUR/QALY of icotinib versus gefitinib presented negative in this study. The most sensitive parameter to the ICUR was utility of PFS, ranging from $-1,259,991.25 to $-182,296.61; accordingly the icotinib treatment consistently represented a dominant cost-utility strategy.The icotinib strategy, as a second-line therapy for advanced NSCLC patients in China, is the preferred strategy relative to gefitinib because of the dominant cost-utility. In addition, icotinib shows a good curative effect and safety, resulting in a strong demand for the Chinese market.

  15. 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 

  16. Electricity prices in a competitive environment: Marginal cost pricing of generation services and financial status of electric utilities. A preliminary analysis through 2015

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-08-01

    The emergence of competitive markets for electricity generation services is changing the way that electricity is and will be priced in the United States. This report presents the results of an analysis that focuses on two questions: (1) How are prices for competitive generation services likely to differ from regulated prices if competitive prices are based on marginal costs rather than regulated {open_quotes}cost-of-service{close_quotes} pricing? (2) What impacts will the competitive pricing of generation services (based on marginal costs) have on electricity consumption patterns, production costs, and the financial integrity patterns, production costs, and the financial integrity of electricity suppliers? This study is not intended to be a cost-benefit analysis of wholesale or retail competition, nor does this report include an analysis of the macroeconomic impacts of competitive electricity prices.

  17. Cost-utility analysis of rufinamide versus topiramate and lamotrigine for the treatment of children with Lennox-Gastaut Syndrome in the United Kingdom.

    Science.gov (United States)

    Verdian, Lara; Yi, Yunni

    2010-01-01

    To estimate the cost-effectiveness of rufinamide relative to topiramate and lamotrigine as adjunctive treatment for children with Lennox-Gastaut Syndrome (LGS). A Markov decision analytic model was developed to estimate the incremental cost-effectiveness ratio over a three-year time horizon in patients with LGS uncontrolled by up to three antiepileptic drugs. Utilities were assigned to health states, defined according to a patient's response to treatment (> or =75%, > or =50% and <75%, and <50% reduction in tonic-atonic [drop attack] seizure frequency and death). Efficacy and safety estimates were made using indirect/mixed-treatment comparisons of data obtained from published literature. Outcomes included costs and quality-adjusted life-years (QALYs), allowing the incremental cost-effectiveness ratio to be estimated as cost per QALY gained. Over three years, the total cumulative costs for rufinamide, topiramate, and lamotrigine were pound24,992, pound23,360, and pound21,783, respectively. Rufinamide resulted in an incremental QALY gain of 0.079 relative to topiramate and 0.021 relative to lamotrigine. The incremental costs of rufinamide were pound1632 and pound3209, relative to topiramate and lamotrigine, resulting in an incremental cost per QALY gained of pound20,538 and pound154,831, respectively. Considering the underlying assumptions, this current economic evaluation demonstrates that rufinamide is likely to be a cost-effective alternative to topiramate as adjunctive treatment for children with LGS in the UK. In addition, when compared to lamotrigine, which is an inexpensive treatment, rufinamide should be considered as a cost-effective alternative due to the importance of patient choice and equity of access in such a rare and devastating condition. Copyright 2009 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  18. 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

  19. Healthcare Utilization and Costs of Systemic Lupus Erythematosus in Medicaid

    Directory of Open Access Journals (Sweden)

    Hong J. Kan

    2013-01-01

    Full Text Available Objective. Healthcare utilization and costs associated with systemic lupus erythematosus (SLE in a US Medicaid population were examined. Methods. Patients ≥ 18 years old with SLE diagnosis (ICD-9-CM 710.0x were extracted from a large Medicaid database 2002–2009. Index date was date of the first SLE diagnosis. Patients with and without SLE were matched. All patients had a variable length of followup with a minimum of 12 months. Annualized healthcare utilization and costs associated with SLE and costs of SLE flares were assessed during the followup period. Multivariate regressions were conducted to estimate incremental healthcare utilization and costs associated with SLE. Results. A total of 14,777 SLE patients met the study criteria, and 14,262 were matched to non-SLE patients. SLE patients had significantly higher healthcare utilization per year than their matched controls. The estimated incremental annual cost associated with SLE was $10,984, with the highest increase in inpatient costs (P<0.001. Cost per flare was $11,716 for severe flares, $562 for moderate flares, and $129 for mild flares. Annual total costs for patients with severe flares were $49,754. Conclusions. SLE patients had significantly higher healthcare resource utilization and costs than non-SLE patients. Patients with severe flares had the highest costs.

  20. An economic evaluation of a video- and text-based computer-tailored intervention for smoking cessation: a cost-effectiveness and cost-utility analysis of a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Nicola E Stanczyk

    Full Text Available BACKGROUND: Although evidence exists for the effectiveness of web-based smoking cessation interventions, information about the cost-effectiveness of these interventions is limited. OBJECTIVE: The study investigated the cost-effectiveness and cost-utility of two web-based computer-tailored (CT smoking cessation interventions (video- vs. text-based CT compared to a control condition that received general text-based advice. METHODS: In a randomized controlled trial, respondents were allocated to the video-based condition (N = 670, the text-based condition (N = 708 or the control condition (N = 721. Societal costs, smoking status, and quality-adjusted life years (QALYs; EQ-5D-3L were assessed at baseline, six-and twelve-month follow-up. The incremental costs per abstinent respondent and per QALYs gained were calculated. To account for uncertainty, bootstrapping techniques and sensitivity analyses were carried out. RESULTS: No significant differences were found in the three conditions regarding demographics, baseline values of outcomes and societal costs over the three months prior to baseline. Analyses using prolonged abstinence as outcome measure indicated that from a willingness to pay of €1,500, the video-based intervention was likely to be the most cost-effective treatment, whereas from a willingness to pay of €50,400, the text-based intervention was likely to be the most cost-effective. With regard to cost-utilities, when quality of life was used as outcome measure, the control condition had the highest probability of being the most preferable treatment. Sensitivity analyses yielded comparable results. CONCLUSION: The video-based CT smoking cessation intervention was the most cost-effective treatment for smoking abstinence after twelve months, varying the willingness to pay per abstinent respondent from €0 up to €80,000. With regard to cost-utility, the control condition seemed to be the most preferable treatment. Probably

  1. An economic evaluation of a video- and text-based computer-tailored intervention for smoking cessation: a cost-effectiveness and cost-utility analysis of a randomized controlled trial.

    Science.gov (United States)

    Stanczyk, Nicola E; Smit, Eline S; Schulz, Daniela N; de Vries, Hein; Bolman, Catherine; Muris, Jean W M; Evers, Silvia M A A

    2014-01-01

    Although evidence exists for the effectiveness of web-based smoking cessation interventions, information about the cost-effectiveness of these interventions is limited. The study investigated the cost-effectiveness and cost-utility of two web-based computer-tailored (CT) smoking cessation interventions (video- vs. text-based CT) compared to a control condition that received general text-based advice. In a randomized controlled trial, respondents were allocated to the video-based condition (N = 670), the text-based condition (N = 708) or the control condition (N = 721). Societal costs, smoking status, and quality-adjusted life years (QALYs; EQ-5D-3L) were assessed at baseline, six-and twelve-month follow-up. The incremental costs per abstinent respondent and per QALYs gained were calculated. To account for uncertainty, bootstrapping techniques and sensitivity analyses were carried out. No significant differences were found in the three conditions regarding demographics, baseline values of outcomes and societal costs over the three months prior to baseline. Analyses using prolonged abstinence as outcome measure indicated that from a willingness to pay of €1,500, the video-based intervention was likely to be the most cost-effective treatment, whereas from a willingness to pay of €50,400, the text-based intervention was likely to be the most cost-effective. With regard to cost-utilities, when quality of life was used as outcome measure, the control condition had the highest probability of being the most preferable treatment. Sensitivity analyses yielded comparable results. The video-based CT smoking cessation intervention was the most cost-effective treatment for smoking abstinence after twelve months, varying the willingness to pay per abstinent respondent from €0 up to €80,000. With regard to cost-utility, the control condition seemed to be the most preferable treatment. Probably, more time will be required to assess changes in quality of life

  2. Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial.

    Science.gov (United States)

    Waaler Bjørnelv, G M; Frihagen, F; Madsen, J E; Nordsletten, L; Aas, E

    2012-06-01

    We estimated the cost-effectiveness of hemiarthroplasty compared to internal fixation for elderly patients with displaced femoral neck fractures. Over 2 years, patients treated with hemiarthroplasty gained more quality-adjusted life years than patients treated with internal fixation. In addition, costs for hemiarthroplasty were lower. Hemiarthroplasty was thus cost effective. Estimating the cost utility of hemiarthroplasty compared to internal fixation in the treatment of displaced femoral neck fractures in the elderly. A cost-utility analysis (CUA) was conducted alongside a clinical randomized controlled trial at a university hospital in Norway; 166 patients, 124 (75%) women with a mean age of 82 years were randomized to either internal fixation (n = 86) or hemiarthroplasty (n = 80). Patients were followed up at 4, 12, and 24 months. Health-related quality of life was assessed with the EQ-5D, and in combination with time used to calculate patients' quality-adjusted life years (QALYs). Resource use was identified, quantified, and valued for direct and indirect hospital costs and for societal costs. Results were expressed in incremental cost-effectiveness ratios. Over the 2-year period, patients treated with hemiarthroplasty gained 0.15-0.20 more QALYs than patients treated with internal fixation. For the hemiarthroplasty group, the direct hospital costs, total hospital costs, and total costs were non-significantly less costly compared with the internal fixation group, with an incremental cost of €2,731 (p = 0.81), €2,474 (p = 0.80), and €14,160 (p = 0.07), respectively. Thus, hemiarthroplasty was the dominant treatment. Sensitivity analyses by bootstrapping supported these findings. Hemiarthroplasty was a cost-effective treatment. Trial registration, NCT00464230.

  3. Cost-utility analysis of genotype-guided antiplatelet therapy in patients with moderate-to-high risk acute coronary syndrome and planned percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Patel V

    2014-09-01

    Full Text Available Background: Prasugrel is recommended over clopidogrel in poor/intermediate CYP2C19 metabolizers with acute coronary syndrome (ACS and planned percutaneous coronary intervention (PCI, reducing the risk of ischemic events. CYP2C19 genetic testing can guide antiplatelet therapy in ACS patients. Objective: The purpose of this study was to evaluate the cost-utility of genotype-guided treatment, compared with prasugrel or generic clopidogrel treatment without genotyping, from the US healthcare provider’s perspective. Methods: A decision model was developed to project lifetime economic and humanistic burden associated with clinical outcomes (myocardial infarction [MI], stroke and major bleeding for the three strategies in patients with ACS. Probabilities, costs and age-adjusted quality of life were identified through systematic literature review. Incremental cost-utility ratios (ICURs were calculated for the treatment strategies, with quality-adjusted life years (QALYs as the primary effectiveness outcome. Relative risk of developing myocardial infarction and stroke between patients with and without variant CYP2C19 when receiving clopidogrel were estimated to be 1.34 and 3.66, respectively. One-way and probabilistic sensitivity analyses were performed. Results: Clopidogrel cost USD19,147 and provided 10.03 QALYs versus prasugrel (USD21,425, 10.04 QALYs and genotype-guided therapy (USD19,231, 10.05 QALYs. The ICUR of genotype-guided therapy compared with clopidogrel was USD4,200. Genotype-guided therapy provided more QALYs at lower costs compared with prasugrel. Results were sensitive to the cost of clopidogrel and relative risk of myocardial infarction and stroke between CYP2C19 variant vs. non-variant. Net monetary benefit curves showed that genotype-guided therapy had at least 70% likelihood of being the most cost-effective alternative at a willingness-to-pay of USD100,000/QALY. In comparison with clopidogrel, prasugrel therapy was more cost

  4. General medications utilization and cost patterns in hospitalized children

    Directory of Open Access Journals (Sweden)

    Kassis I

    2009-03-01

    Full Text Available Drug utilization in the in-patient setting can provide mechanisms to assess drug prescribing trends, efficiency and cost-effectiveness of hospital formularies and examine sub-populations such as children for which prescribing habits are different from adults. Objectives: The aim of this descriptive study was to analyze general medication utilization patterns and costs excluding antimicrobials prescriptions and to compare two pediatric admission units in a tertiary care university hospital. Methods: The total number of admitted children was 1,521 and 1,467 for the A and B admission units, respectively. The electronic data from 252 and 253 hospitalized children in the A and B admission unit were prospectively screened for general medication prescriptions, children on antimicrobials were excluded from the analysis. Their electronic charts were viewed once weekly from October 15, 2007 up to April 7, 2008 using the prescription-point prevalence method. One medication was considered to be one prescription. Results: The general medications prescription number was 790 for 94 children (8.4 prescription/patient in A and 959 for 88 children (10.9 prescription/patient in B (p=0.02. The general medications defined daily dose (DDD and drug utilization 90% (DU90% index were 2,509.63, 2,259 for A; and 6,110.35, 5,499 for B, respectively. The DU90% index placed salbutamol inhalation with 835 DDD and sodium heparin with 2,102 DDD in the first place for the A and B admission units, respectively. A net increment in medication cost was registered according to the calculated cost from the depicted DU90% when the A (20,263 NIS and B (6,269 NIS admission units were compared (p=0.04. Conclusions: A significant difference in the prescription utilization of general medications was shown between the A and B admission units. The A admission unit had lower prescriptions measured by the DU90% index with higher medication cost. Potential drug-drug interactions were depicted in

  5. Self-report versus care provider registration of healthcare utilization: impact on cost and cost-utility

    NARCIS (Netherlands)

    M. Hoogendoorn (Martine); C.R. van Wetering (Carel); A.M.W.J. Schols (Annemie)

    2009-01-01

    textabstractOBJECTIVES: This study aims to compare the impact of two different sources of resource use, self-report versus care provider registrations, on cost and cost utility. METHODS: Data were gathered for a cost-effectiveness study performed alongside a 2-year randomized controlled trial evalua

  6. Self-report versus care provider registration of healthcare utilization: impact on cost and cost-utility

    NARCIS (Netherlands)

    M. Hoogendoorn (Martine); C.R. van Wetering (Carel); A.M.W.J. Schols (Annemie)

    2009-01-01

    textabstractOBJECTIVES: This study aims to compare the impact of two different sources of resource use, self-report versus care provider registrations, on cost and cost utility. METHODS: Data were gathered for a cost-effectiveness study performed alongside a 2-year randomized controlled trial evalua

  7. An economic and legal perspective on electric utility transition costs

    Energy Technology Data Exchange (ETDEWEB)

    Rose, K.

    1996-07-01

    The issue of possibly unrecoverable cost incurred by a utility, or `stranded costs,` has emerged as a major obstacle to developing a competitive generation market. Stranded or transition costs are defined as costs incurred by a utility to serve its customers that were being recovered in rates but are no longer due to availability of lower-priced alternative suppliers. The idea of `stranded cost,` and more importantly arguments for its recovery, is a concept with little basis in economic theory, legal precedence, or precedence in other deregulated industries. The main argument recovery is that the ``regulatory compact`` requires it. This is based on the misconception that the regulator compact is simply: the utility incurs costs on behalf of its customers because of the ``obligation to serve`` so, therefore, customers are obligated to pay. This is a mischaracterization of what the compact was and how it developed. Another argument is that recovery is required for economic efficiency. This presumes, however, a very narrow definition of efficiency based on preventing ``uneconomic`` bypass of the utility and that utilities minimize costs. A broader definition of efficiency and the likelihood of cost inefficiencies in the industry suggest that the cost imposed on customers from inhibiting competition could exceed the gains from preventing uneconomic bypass. Both these issues are examined in this paper.

  8. Cost-utility and cost-benefit analyses: how did we get here and where are we going?

    Science.gov (United States)

    Moayyedi, Paul; Mason, James

    2004-06-01

    Cost-utility and cost-benefit analyses are currently the only tools available for evaluating whether the cost of an intervention is a good use of resources when compared with other ways that money could be spent on health care (allocative efficiency). Cost-utility analyses assess health in terms of length and quality of life using the quality adjusted life year whilst cost-benefit analyses measure health in monetary terms. The measurement of health gain with either approach has a number of problems and the accuracy of these measures is uncertain. Cost-benefit analysis has certain advantages when measuring improvements in mild diseases such as irritable bowel disease and dyspepsia, which are common problems in gastroenterology. The results of cost-benefit analysis may provide more transparent guidance for policy makers, doctors and patients.

  9. Least-cost utility planning consumer participation manual. [Final report

    Energy Technology Data Exchange (ETDEWEB)

    Mitchell, C.; Wellinghoff, J.; Goldberg, F.

    1989-12-31

    This manual is designed to provide guidance to state consumer advocates and other state consumer groups interested in either initiating and/or participating in an Least-Cost Utility Planning (LCUP) process in their state. Least cost utility planning examined primarily as a regulatory framework to be implemented by an appropriate state authority -- usually the public utility commission -- for the benefit of the state`s citizens and electric utility customers. LCUP is also a planning process to be used by investor owned and public utilities to select, support and justify future expenditures in resource additions. This manual is designed as a ``How-To`` manual for implementing and participating in a statewide LCUP process. Its goal is to guide the reader through the LCUP maze so that meaningful, forward-looking, and cost minimizing electric utility planning can be initiated and sustained in your state.

  10. Least-cost utility planning consumer participation manual

    Energy Technology Data Exchange (ETDEWEB)

    Mitchell, C.; Wellinghoff, J.; Goldberg, F.

    1989-01-01

    This manual is designed to provide guidance to state consumer advocates and other state consumer groups interested in either initiating and/or participating in an Least-Cost Utility Planning (LCUP) process in their state. Least cost utility planning examined primarily as a regulatory framework to be implemented by an appropriate state authority -- usually the public utility commission -- for the benefit of the state's citizens and electric utility customers. LCUP is also a planning process to be used by investor owned and public utilities to select, support and justify future expenditures in resource additions. This manual is designed as a How-To'' manual for implementing and participating in a statewide LCUP process. Its goal is to guide the reader through the LCUP maze so that meaningful, forward-looking, and cost minimizing electric utility planning can be initiated and sustained in your state.

  11. Análisis de coste-utilidad del manejo de la fibrilación auricular concomitante en España Cost-utility analysis of concomitant atrial fibrillation management in Spain

    Directory of Open Access Journals (Sweden)

    María Jesús López Gude

    2010-01-01

    for stroke and is associated with substantial morbidity and mortality. Our objective was to develop a cost-utility analysis of the different treatment alternatives in patients aged 40 years old or more with concomitant AF with valve disease in Spain, from the National Health System perspective. Methods: An economic evaluation through a Markov model with four health states (sinus rhythm, AF, dependent stroke, death was developed to simulate the evolution of a cohort of 1,000 patients receiving each treatment alternative in addition to mitral valve surgery (drug therapy, surgical ablation and catheter ablation. The time horizon was 5 years, with a cycle length of 3 months. Data on costs and effects were obtained from the published literature and expert opinion and were discounted at 3.5%. A sensitivity analysis was developed to determine the robustness of the results. Results: The quality-adjusted life years (QALY gained were 3.29, 3.89, and 3.83, respectively, for the alternatives of no ablation, surgical ablation and catheter ablation. The costs per patient were 5,770€, 10,034€ and 11,289€, respectively. The surgical ablation cost/QALY rate compared with no ablation was 7,145€. Surgical ablation was dominant versus catheter ablation. The probabilistic sensitivity analysis showed that the results were robust. Conclusions: Surgical ablation is a cost-effective treatment option in patients with concomitant AF, with a cost-effectiveness ratio under the efficiency threshold commonly accepted in Spain.

  12. Healthcare Cost and Utilization Project (HCUP) - National Inpatient Sample

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2001 to 2013. The National (Nationwide) Inpatient Sample (NIS) is part of a family of databases and software tools developed for the Healthcare Cost and Utilization...

  13. The Impact of Medicaid Peer Support Utilization on Cost

    Data.gov (United States)

    U.S. Department of Health & Human Services — According to findings reported in The Impact of Medicaid Peer Support Utilization on Cost, published in Volume 4, Issue 1 of the Medicare and Medicaid Research...

  14. 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,.

  15. The Impact of Medicaid Peer Support Utilization on Cost

    Data.gov (United States)

    U.S. Department of Health & Human Services — According to findings reported in The Impact of Medicaid Peer Support Utilization on Cost, published in Volume 4, Issue 1 of the Medicare and Medicaid Research...

  16. Reducing Operating Costs and Energy Consumption at Water Utilities

    Science.gov (United States)

    Due to their unique combination of high energy usage and potential for significant savings, utilities are turning to energy-efficient technologies to help save money. Learn about cost and energy saving technologies from this brochure.

  17. Healthcare Cost and Utilization Project (HCUP) - National Inpatient Sample

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2001 forward. The National (Nationwide) Inpatient Sample (NIS) is part of a family of databases and software tools developed for the Healthcare Cost and Utilization...

  18. Bendamustine versus chlorambucil for the first-line treatment of chronic lymphocytic leukemia in England and Wales: a cost-utility analysis.

    Science.gov (United States)

    Woods, Beth; Hawkins, Neil; Dunlop, William; O'Toole, Alison; Bramham-Jones, Steve

    2012-01-01

    To evaluate the cost-effectiveness of bendamustine compared with chlorambucil as first-line treatment for patients with chronic lymphocytic leukemia who would be considered unsuitable for treatment with fludarabine combination chemotherapy regimens. A semi-Markov approach was used to estimate time in each health state. The model was parameterized primarily by using data from a phase III randomized, open-label trial comparing bendamustine with chlorambucil. It captured the increased progression-free survival and improved response rates with bendamustine, and the cost and quality of life impacts of postprogression treatments. The analysis was conducted from the perspective of the National Health Service in England and Wales. A lifetime (35-year) time horizon was used. Deterministic sensitivity analyses, probabilistic sensitivity analyses, and subgroup analyses in older patients and patients with poor performance status were carried out. The estimated incremental cost-effectiveness ratio was £ 11,960 per quality-adjusted life-year. None of the deterministic sensitivity analyses increased the incremental cost-effectiveness ratio by more than £ 2000. Subgroup analyses showed that bendamustine remained cost-effective across different patient groups. Probabilistic sensitivity analysis showed that at the £ 20,000 threshold, bendamustine has a 90% probability of being cost-effective. Bendamustine represents good value for first-line treatment of patients with chronic lymphocytic leukemia who are unsuitable for treatment with fludarabine combination chemotherapy. The incremental cost-effectiveness ratio is below the thresholds commonly applied in England and Wales (£ 20,000-£ 30,000 per quality-adjusted life-year). Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  19. Tweedie distributions for fitting semicontinuous health care utilization cost data

    OpenAIRE

    2016-01-01

    We explore a statistical distribution that can simultaneously model the probability of zero outcome for non-users of health care utilization and continuous costs for users. We compare this distribution to other com- monly used models on example data and show that it fits cost data well and has some appealing properties that provide flexible use.

  20. Trade study for water and waste management concepts. Task 7: Support special analysis. [cost analysis of life support systems for waste utilization during space missions

    Science.gov (United States)

    1975-01-01

    Cost analyses and tradeoff studies are given for waste management in the Space Station, Lunar Surface Bases, and interplanetary space missions. Crew drinking water requirements are discussed and various systems to recycle water are examined. The systems were evaluated for efficiency and weight savings. The systems considered effective for urine water recovery were vapor compression, flash evaporation, and air evaporation with electrolytic pretreatment. For wash water recovery, the system of multifiltration was selected. A wet oxidation system, which can process many kinds of wastes, is also considered.

  1. Organizational Uses of Health Information Exchange to Change Cost and Utilization Outcomes: A Typology from a Multi-Site Qualitative Analysis.

    Science.gov (United States)

    Vest, Joshua R; Abramson, Erika

    2015-01-01

    Health information exchange (HIE) systems facilitate access to patient information for a variety of health care organizations, end users, and clinical and organizational goals. While a complex intervention, organizations' usage of HIE is often conceptualized and measured narrowly. We sought to provide greater specificity to the concept of HIE as an intervention by formulating a typology of organizational HIE usage. We interviewed representatives of a regional health information organization and health care organizations actively using HIE information to change patient utilization and costs. The resultant typology includes three dimensions: user role, usage initiation, and patient set. This approach to categorizing how health care organizations are actually applying HIE information to clinical and business tasks provides greater clarity about HIE as an intervention and helps elucidate the conceptual linkage between HIE an organizational and patient outcomes.

  2. Manufacturing cost analysis of integrated photonic packages

    Science.gov (United States)

    Stirk, Charles W.; Liu, Qin; Ball, Matthew V.

    1999-04-01

    This paper analyzes the manufacturing cost of photonic system using software that combines several methods for accurate cost accounting. Activity based costing assigns al capital equipment, material and labor costs directly to the product rather than to overheads. Cost of ownership models determine the cost of using machines under different financial and utilization scenarios. Libraries of standard machines, process steps, and process sequences facilitate rapid model building and modification. Using libraries for semiconductor and photonics fabrication, along with packaging and optomechanical assembly, we construct cost models for 2D VCSEL array communication modules. The result of the analysis is that the model cost is driven mainly by the epitaxial material cost, and laser yield limits VCSEL arrays to small scale integration.

  3. Cost-utility analysis of a one-time supervisor telephone contact at 6-weeks post-partum to prevent extended sick leave following maternity leave in The Netherlands: results of an economic evaluation alongside a randomized controlled trial.

    Science.gov (United States)

    Uegaki, Kimi; Stomp-van den Berg, Suzanne G M; de Bruijne, Martine C; van Poppel, Mireille N M; Heymans, Martijn W; van Mechelen, Willem; van Tulder, Maurits W

    2011-01-27

    Working women of childbearing age are a vital part of the population. Following childbirth, this group of women can experience a myriad of physical and mental health problems that can interfere with their ability to work. Currently, there is little known about cost-effective post-partum interventions to prevent work disability. The purpose of the study was to evaluate whether supervisor telephone contact (STC) during maternity leave is cost-effective from a societal perspective in reducing sick leave and improving quality-adjusted life years (QALYs) compared to common practice (CP). We conducted an economic evaluation alongside a randomized controlled trial. QALYs were measured by the EuroQol 5-D, and sick leave and presenteeism by the Health and work Performance Questionnaire. Resource use was collected by questionnaires. Data were analysed according to intention-to-treat. Missing data were imputed via multiple imputation. Uncertainty was estimated by 95% confidence intervals, cost-utility planes and curves, and sensitivity analyses. 541 working women from 15 companies participated. Response rates were above 85% at each measurement moment. At the end of the follow-up, no statistically significant between-group differences in QALYs, mean hours of sick leave or presenteeism or costs were observed. STC was found to be less effective and more costly. For willingness-to-pay levels from €0 through €50,000, the probability that STC was cost-effective compared to CP was 0.2. Overall resource use was low. Mean total costs were €3678 (95% CI: 3386; 3951). Productivity loss costs represented 37% of the total costs and of these costs, 48% was attributable to sick leave and 52% to work presenteeism. The cost analysis from a company's perspective indicated that there was a net cost associated with the STC intervention. STC was not cost-effective compared to common practice for a healthy population of working mothers; therefore, implementation is not indicated. The cost-utility

  4. Cost-utility analysis of a one-time supervisor telephone contact at 6-weeks post-partum to prevent extended sick leave following maternity leave in The Netherlands: results of an economic evaluation alongside a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    van Poppel Mireille NM

    2011-01-01

    Full Text Available Abstract Background Working women of childbearing age are a vital part of the population. Following childbirth, this group of women can experience a myriad of physical and mental health problems that can interfere with their ability to work. Currently, there is little known about cost-effective post-partum interventions to prevent work disability. The purpose of the study was to evaluate whether supervisor telephone contact (STC during maternity leave is cost-effective from a societal perspective in reducing sick leave and improving quality-adjusted life years (QALYs compared to common practice (CP. Methods We conducted an economic evaluation alongside a randomized controlled trial. QALYs were measured by the EuroQol 5-D, and sick leave and presenteeism by the Health and work Performance Questionnaire. Resource use was collected by questionnaires. Data were analysed according to intention-to-treat. Missing data were imputed via multiple imputation. Uncertainty was estimated by 95% confidence intervals, cost-utility planes and curves, and sensitivity analyses. Results 541 working women from 15 companies participated. Response rates were above 85% at each measurement moment. At the end of the follow-up, no statistically significant between-group differences in QALYs, mean hours of sick leave or presenteeism or costs were observed. STC was found to be less effective and more costly. For willingness-to-pay levels from €0 through €50,000, the probability that STC was cost-effective compared to CP was 0.2. Overall resource use was low. Mean total costs were €3678 (95% CI: 3386; 3951. Productivity loss costs represented 37% of the total costs and of these costs, 48% was attributable to sick leave and 52% to work presenteeism. The cost analysis from a company's perspective indicated that there was a net cost associated with the STC intervention. Conclusions STC was not cost-effective compared to common practice for a healthy population of working

  5. Survey of state regulatory activities on least cost planning for gas utilities

    Energy Technology Data Exchange (ETDEWEB)

    Goldman, C.A. (Lawrence Berkeley Lab., CA (United States) National Association of Regulatory Utility Commissioners, Washington, DC (United States)); Hopkins, M.E. (Fleming Group, Washington, DC (United States))

    1991-04-01

    Integrated resource planning involves the creation of a process in which supply-side and demand-side options are integrated to create a resource mix that reliably satisfies customers' short-term and long-term energy service needs at the lowest cost. Incorporating the concept of meeting customer energy service needs entails a recognition that customers' costs must be considered along with the utility's costs in the economic analysis of energy options. As applied to gas utilities, an integrated resource plan seeks to balance cost and reliability, and should not be interpreted simply as the search for lowest commodity costs. All state commissions were surveyed to assess the current status of gas planning and demand-side management and to identify significant regulatory issues faced by commissions during the next several years. The survey was to determine the extent to which they have undertaken least-cost planning for gas utilities. The survey included the following topics: (1) status of state PUC least-cost planning regulations and practices for gas utilities; (2) type and scope ofnatural gas DSM programs in effect, includeing fuel substitution; (3) economic tests and analysis methods used to evaluate DSM programs; (4) relationship between prudence reviews of gas utility purchasing practices and integrated resource planning; and (5) key regulatory issues facing gas utilities during the next five years. 34 refs., 6 figs., 10 tabs.

  6. Healthcare costs and utilization for Medicare beneficiaries with Alzheimer's

    Directory of Open Access Journals (Sweden)

    Kuo Tzu-Chun

    2008-05-01

    Full Text Available Abstract Background Alzheimer's disease (AD is a neurodegenerative disorder incurring significant social and economic costs. This study uses a US administrative claims database to evaluate the effect of AD on direct healthcare costs and utilization, and to identify the most common reasons for AD patients' emergency room (ER visits and inpatient admissions. Methods Demographically matched cohorts age 65 and over with comprehensive medical and pharmacy claims from the 2003–2004 MEDSTAT MarketScan® Medicare Supplemental and Coordination of Benefits (COB Database were examined: 1 25,109 individuals with an AD diagnosis or a filled prescription for an exclusively AD treatment; and 2 75,327 matched controls. Illness burden for each person was measured using Diagnostic Cost Groups (DCGs, a comprehensive morbidity assessment system. Cost distributions and reasons for ER visits and inpatient admissions in 2004 were compared for both cohorts. Regression was used to quantify the marginal contribution of AD to health care costs and utilization, and the most common reasons for ER and inpatient admissions, using DCGs to control for overall illness burden. Results Compared with controls, the AD cohort had more co-morbid medical conditions, higher overall illness burden, and higher but less variable costs ($13,936 s. $10,369; Coefficient of variation = 181 vs. 324. Significant excess utilization was attributed to AD for inpatient services, pharmacy, ER visits, and home health care (all p Conclusion Patients with AD have significantly more co-morbid medical conditions and higher healthcare costs and utilization than demographically-matched Medicare beneficiaries. Even after adjusting for differences in co-morbidity, AD patients incur excess ER visits and inpatient admissions.

  7. Cost-Utility of Group Acceptance and Commitment Therapy for Fibromyalgia Versus Recommended Drugs: An Economic Analysis Alongside a 6-Month Randomized Controlled Trial Conducted in Spain (EFFIGACT Study).

    Science.gov (United States)

    Luciano, Juan V; D'Amico, Francesco; Feliu-Soler, Albert; McCracken, Lance M; Aguado, Jaume; Peñarrubia-María, María T; Knapp, Martin; Serrano-Blanco, Antoni; García-Campayo, Javier

    2017-07-01

    The aim of this study was to analyze the cost utility of a group-based form of acceptance and commitment therapy (GACT) in patients with fibromyalgia (FM) compared with patients receiving recommended pharmacological treatment (RPT) or on a waiting list (WL). The data were derived from a previously published study, a randomized controlled trial that focused on clinical outcomes. Health economic outcomes included health-related quality of life and health care use at baseline and at 6-month follow-up using the EuroQoL and the Client Service Receipt Inventory, respectively. Analyses included quality-adjusted life years, direct and indirect cost differences, and incremental cost effectiveness ratios. A total of 156 FM patients were randomized (51 GACT, 52 RPT, 53 WL). GACT was related to significantly less direct costs over the 6-month study period compared with both control arms (GACT €824.2 ± 1,062.7 vs RPT €1,730.7 ± 1,656.8 vs WL €2,462.7 ± 2,822.0). Lower direct costs for GACT compared with RPT were due to lower costs from primary care visits and FM-related medications. The incremental cost effectiveness ratios were dominant in the completers' analysis and remained robust in the sensitivity analyses. In conclusion, acceptance and commitment therapy appears to be a cost-effective treatment compared with RPT in patients with FM. Decision-makers have to prioritize their budget on the treatment option that is the most cost effective for the management of a specific patient group. From government as well as health care perspectives, this study shows that a GACT is more cost effective than pharmacological treatment in management of FM. Copyright © 2017 American Pain Society. Published by Elsevier Inc. All rights reserved.

  8. Cost and quality of fuels for electric utility plants, 1994

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-07-14

    This document presents an annual summary of statistics at the national, Census division, State, electric utility, and plant levels regarding the quantity, quality, and cost of fossil fuels used to produce electricity. Purpose of this publication is to provide energy decision-makers with accurate, timely information that may be used in forming various perspectives on issues regarding electric power.

  9. Cost and quality of fuels for electric utility plants, 1992

    Energy Technology Data Exchange (ETDEWEB)

    1993-08-02

    This publication presents an annual summary of statistics at the national, Census division, State, electric utility, and plant levels regarding the quantity, quality, and cost of fossil fuels used to produce electricity. The purpose of this publication is to provide energy decision-makers with accurate and timely information that may be used in forming various perspectives on issues regarding electric power.

  10. Marginal ambulatory teaching cost under varying levels of service utilization.

    Science.gov (United States)

    Panton, D M; Mushlin, A I; Gavett, J W

    1980-06-01

    The ambulatory component of residency training jointly produces two products, namely, training and patient services. In costing educational programs of this type, two approaches are frequently taken. The first considers the total costs of the educational program, including training and patient services. These costs are usually constructed from historical accounting records. The second approach attempts to cost the joint products separately, based upon estimates of future changes in program costs, if the product in question is added to or removed from the program. The second approach relates to typical decisions facing the managers of medical centers and practices used for teaching purposes. This article reports such a study of costs in a primary-care residency training program in a hospital outpatient setting. The costs of the product, i.e., on-the-job training, are evaluated using a replacement-cost concept under different levels of patient services. The results show that the cost of the product, training, is small at full clinical utilization and is sensitive to changes in the volume of services provided.

  11. The utility of a model-based cost-effectiveness analysis of degarelix versus leuprolide in the therapy of hormone-dependent advanced prostate cancer

    Directory of Open Access Journals (Sweden)

    Massimo Perachino

    2013-09-01

    Full Text Available INTRODUCTION: Prostate cancer (PC is a very common tumor among men: in Italy its prevalence in 2006 was 0.9%. Androgen deprivation therapy is a way to treat hormone-responsive PC by decreasing testosterone levels. GnRH-analogues, including GnRH-agonists and GnRH-antagonists, are effective for this purpose. AIM: This article presents a cost-effectiveness analysis based on a semi-Markov model comparing the GnRH-antagonist degarelix and GnRH-agonist leuprolide in the treatment of hormone-dependent advanced prostate cancer from the perspective of the Regional Health Service in Veneto Region (Italy.MATERIALS AND METHODS: Effectiveness data were retrieved by a 12-month phase III non-inferiority clinical trial, comparing degarelix and 7,5 mg leuprolide in 610 patients treated for hormone-dependent prostate cancer. Epidemiological data came from a national database and were referred to Veneto Region. The values of the healthcare resources were calculated using regional and national prices (€ 2012. The model considers 3 exhaustive and mutually exclusive health status: first-line treatment, further-lines treatment and death. It lasts 10 years, with 28 days per cycle. The entry in the model is hypothesized at the age of 70 (the age with most PCs in Veneto Region. Effectiveness endpoints were life years saved and quality-adjusted life years, using 3% social discount rate. The incremental cost per QALY was related to the range of acceptability proposed by the Associazione Italiana di Economia Sanitaria (€ 25,000-40,000. The budget impact was calculated on a 5-year time horizon. Univariate and probabilistic sensitivity analyses were performed on every hypothesis of the model.RESULTS: Degarelix resulted in minor costs if compared to 7.5 mg leuprolide (€ 20,511.64 vs 22,256.49. The cost-driver was chemotherapic care (32.45% degarelix vs 44.30% 7.5 mg leuprolide. Life years saved were the same for both the alternatives (5.58, while QALYs obtained were

  12. Recovery of Utility Fixed Costs: Utility, Consumer, Environmental and Economist Perspectives

    Energy Technology Data Exchange (ETDEWEB)

    Wood, Lisa [Inst. for Electric Innovation and The Edison Foundation, Washington DC (United States); Hemphill, Ross [RCHemphill Solutions, Columbus, OH (United States); Howat, John [National Consumer Law Center, Boston, MA (United States); Cavanagh, Ralph [Natural Resources Defense Council, New York, NY (United States); Borenstein, Severin [Univ. of California, Berkeley, CA (United States); Deason, Jeff [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Schwartz, Lisa [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Schwartz, Lisa [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2016-06-14

    Utilities recover costs for providing electric service to retail customers through a combination of rate components that together comprise customers’ monthly electric bills. Rates and rate designs are set by state regulators and vary by jurisdiction, utility and customer class. In addition to the fundamental tenet of setting fair and reasonable rates, rate design balances economic efficiency, equity and fairness, customer satisfaction, utility revenue stability, and customer price and bill stability.1 At the most basic level, retail electricity bills in the United States typically include a fixed monthly customer charge — a set dollar amount regardless of energy usage — and a volumetric energy charge for each kilowatt-hour consumed.2 The energy charge may be flat across all hours, vary by usage level (for example, higher rates at higher levels of usage), or vary based on time of consumption.3 While some utility costs, such as fuel costs, clearly vary according to electricity usage, other costs are “fixed” over the short run — generally, those that do not vary over the course of a year. Depending on your point of view, and whether the state’s electricity industry has been restructured or remains vertically integrated, the set of costs that are “fixed” may be quite limited. Or the set may extend to all capacity costs for generation, transmission and distribution. In the long run, all costs are variable. In the context of flat or declining loads in some regions, utilities are proposing a variety of changes to retail rate designs, particularly for residential customers, to recover fixed costs. In this report, authors representing utility (Chapter 1), consumer (Chapter 2), environmentalist (Chapter 3) and economist (Chapter 4) perspectives discuss fixed costs for electric utilities and set out their principles for recovering those costs. The table on the next page summarizes each author’s relative preferences for various options for fixed cost

  13. Applying electrical utility least-cost approach to transportation planning

    Energy Technology Data Exchange (ETDEWEB)

    McCoy, G.A.; Growdon, K.; Lagerberg, B.

    1994-09-01

    Members of the energy and environmental communities believe that parallels exist between electrical utility least-cost planning and transportation planning. In particular, the Washington State Energy Strategy Committee believes that an integrated and comprehensive transportation planning process should be developed to fairly evaluate the costs of both demand-side and supply-side transportation options, establish competition between different travel modes, and select the mix of options designed to meet system goals at the lowest cost to society. Comparisons between travel modes are also required under the Intermodal Surface Transportation Efficiency Act (ISTEA). ISTEA calls for the development of procedures to compare demand management against infrastructure investment solutions and requires the consideration of efficiency, socioeconomic and environmental factors in the evaluation process. Several of the techniques and approaches used in energy least-cost planning and utility peak demand management can be incorporated into a least-cost transportation planning methodology. The concepts of avoided plants, expressing avoidable costs in levelized nominal dollars to compare projects with different on-line dates and service lives, the supply curve, and the resource stack can be directly adapted from the energy sector.

  14. The economic impact of acute coronary syndrome on length of stay: an analysis using the Healthcare Cost and Utilization Project (HCUP) databases.

    Science.gov (United States)

    LaMori, Joyce C; Shoheiber, Omar; Dudash, Kellie; Crivera, Concetta; Mody, Samir H

    2014-03-01

    To assess the economic impact of initial and repeat hospitalizations associated with acute coronary syndrome (ACS) over 1 year (2009). National- and state-level data on length of stay (LOS) and related charges for ACS-associated hospital admissions were assessed using two Healthcare Utilization Project databases. The first, the Nationwide Inpatient Sample (NIS), provided clinical and resource use information from ∼8 million hospital stays, representing a 20% stratified sample of ∼40 million annual hospital stays in the US in 2009. The second, the State Inpatient Databases, provided 100% of inpatient data from nine states that included both patient age and linked information on multiple patient admissions within the same calendar year. For patients with repeat admissions, the LOS, primary diagnosis, and total charges between the first and subsequent admissions were evaluated. All patients≥18 years of age with at least one diagnosis of ACS, defined using the International Classification of Diseases, 9th Revision, were included (code 410.xx [except 410.x2], 411.1x and 411.8x). Variables evaluated for each discharge included demographics, cardiovascular events and procedures, LOS, discharge status, and total charges. The NIS reported 1,437,735 discharges for ACS in 2009. In this dataset, mean LOS for an initial ACS event was 5.56 days. Patients>65 years of age had the highest numbers of admissions; this group also had the most comorbidities. Approximately 40% of ACS patients with data on repeat visits had more than one admission, >70% of these within 2 months of the primary discharge. Mean charges were $71,336 for the first admission and $53,290 for the second admission. Despite a variety of new therapies to prevent ACS, it remains a common condition. Better therapies are called for if the clinical and cost burden of ACS is to be alleviated.

  15. Cost effectiveness of angiotensin receptor blocker monotherapy in patients with hypertension in the Netherlands : a comparative analysis using clinical trial and drug utilization data

    NARCIS (Netherlands)

    Boersma, C.; Voors, A.A.; Visser, Sipke; de Jong-van den Berg, L.T.W.; Postma, M.J.

    2010-01-01

    Background and Objective: Health gains and related cost savings achieved by optimizing treatment in hypertensive patients is highly important. The aim of this study was to evaluate the costs and cost effectiveness of treatment with angiotensin II receptor antagonists (angiotensin II receptor

  16. Cost effectiveness of angiotensin receptor blocker monotherapy in patients with hypertension in the Netherlands : a comparative analysis using clinical trial and drug utilization data

    NARCIS (Netherlands)

    Boersma, C.; Voors, A.A.; Visser, Sipke; de Jong-van den Berg, L.T.W.; Postma, M.J.

    2010-01-01

    Background and Objective: Health gains and related cost savings achieved by optimizing treatment in hypertensive patients is highly important. The aim of this study was to evaluate the costs and cost effectiveness of treatment with angiotensin II receptor antagonists (angiotensin II receptor blocker

  17. Distributed utility technology cost, performance, and environmental characteristics

    Energy Technology Data Exchange (ETDEWEB)

    Wan, Y; Adelman, S

    1995-06-01

    Distributed Utility (DU) is an emerging concept in which modular generation and storage technologies sited near customer loads in distribution systems and specifically targeted demand-side management programs are used to supplement conventional central station generation plants to meet customer energy service needs. Research has shown that implementation of the DU concept could provide substantial benefits to utilities. This report summarizes the cost, performance, and environmental and siting characteristics of existing and emerging modular generation and storage technologies that are applicable under the DU concept. It is intended to be a practical reference guide for utility planners and engineers seeking information on DU technology options. This work was funded by the Office of Utility Technologies of the US Department of Energy.

  18. [Cost-utility of the vaccine against the Human Papiloma Virus in Peruvian women].

    Science.gov (United States)

    Gutiérrez-Aguado, Alfonso

    2011-01-01

    To estimate the cost-utility of the vaccine against the Human Papiloma Virus (HPV) in peruvian women after the application of the vaccine at 10 years of age. A cost-utility analysis was performed using the Markov´s hidden model in a hypothetical cohort of peruvian women, based on the information on epidemiological parameters, costs associated to uterine cervical cancer (UCC) and the efficacy and costs of the vaccine against the HPV. The vaccination costs were estimated from the Peruvian Ministry of Health perspective and were compared against the quality-adjusted life years (QALYs), using a discount rate of 5%. The annual cost of the vaccination was USD 16,861,490, for the Papanicoau screening it was USD 3,060,793 and the costs associated to the UCC were USD 15,580,000. The incremental cost utility ratio (ICUR) was 6,775 USD/QALY. Vaccination against HPV can be cost-utility compared to not vaccinating.

  19. Trend of cost and utilization of COPD medication in Korea

    Science.gov (United States)

    Lee, Jongmin; Lee, Jae Ha; Kim, Jee-Ae; Rhee, Chin Kook

    2017-01-01

    Background There are only a few longitudinal studies regarding medical utilization and costs for patients with COPD. The purpose of this study was to analyze the trend of medical utilization and costs on a long-term basis. Methods Using the Korean Health Insurance Review and Assessment Service (HIRA) data from 2008 to 2013, COPD patients were identified. The trend of medical utilization and costs was also analyzed. Results The number of COPD patients increased by 13.9% from 2008 to 2013. During the same period, the cost of COPD medication increased by 78.2%. Methylxanthine and systemic beta agonists were most widely prescribed between 2008 and 2013. However, inhaled medications such as long-acting beta-2 agonist (LABA), long-acting muscarinic agonist, and inhaled corticosteroid plus LABA were dispensed to a relatively low proportion of patients with COPD. The number of patients who were prescribed inhaled medications increased gradually from 2008 to 2013, while the number of patients prescribed systemic beta agonist and methylxanthine has decreased since 2010. Conclusion This study shows that there is a large gap between the COPD guidelines and clinical practice in Korea. Training programs for primary care physicians on diagnosis and guideline-based treatment are needed to improve the management of COPD. PMID:28031708

  20. Life-cycle preferences over consumption and health: when is cost-effectiveness analysis equivalent to cost-benefit analysis?

    Science.gov (United States)

    Bleichrodt, H; Quiggin, J

    1999-12-01

    This paper studies life-cycle preferences over consumption and health status. We show that cost-effectiveness analysis is consistent with cost-benefit analysis if the lifetime utility function is additive over time, multiplicative in the utility of consumption and the utility of health status, and if the utility of consumption is constant over time. We derive the conditions under which the lifetime utility function takes this form, both under expected utility theory and under rank-dependent utility theory, which is currently the most important nonexpected utility theory. If cost-effectiveness analysis is consistent with cost-benefit analysis, it is possible to derive tractable expressions for the willingness to pay for quality-adjusted life-years (QALYs). The willingness to pay for QALYs depends on wealth, remaining life expectancy, health status, and the possibilities for intertemporal substitution of consumption.

  1. An introduction to cost analysis.

    Science.gov (United States)

    Camponovo, Ernest

    2015-04-01

    This article describes the basics of cost accounting for healthcare providers and how these concepts relate to decision making in medical practice. By understanding cost accounting and cost analysis, providers can be better prepared to compete and survive in a changing healthcare environment.

  2. Cost Analysis: Methods and Realities.

    Science.gov (United States)

    Cummings, Martin M.

    1989-01-01

    Argues that librarians need to be concerned with cost analysis of library functions and services because, in the allocation of resources, decision makers will favor library managers who demonstrate understanding of the relationships between costs and productive outputs. Factors that should be included in a reliable scheme for cost accounting are…

  3. Administrative Utility Analysis: Study Summary.

    Science.gov (United States)

    Peat, Marwick, Mitchell and Co., San Juan, Puerto Rico.

    This document summarizes the recommendations made as a result of a study on administrative utility analysis and vocational education programs for Puerto Rico. The major recommendation was that the Area of Vocational and Technical Education (AVTE) in the Puerto Rico Department of Education be restructured at the central organizational level, for…

  4. The cost utility and budget impact of adjuvant racecadotril for acute diarrhea in children in Thailand.

    Science.gov (United States)

    Rautenberg, Tamlyn Anne; Zerwes, Ute

    2017-01-01

    To evaluate the cost utility and the budget impact of adjuvant racecadotril for the treatment of acute diarrhea in children in Thailand. A cost utility model has been adapted to the context of Thailand to evaluate racecadotril plus oral rehydration solution (R+ORS) versus oral rehydration solution (ORS) alone for acute diarrhea in children costs and effects (quality-adjusted life years) over a 6-day time horizon from a public health care payer's perspective in Thailand. Deterministic sensitivity analysis and budget impact analysis have been undertaken. According to the cost utility model, the intervention (R+ORS) is less costly and more effective than the comparator (ORS) for the base case with a dominant incremental cost-effectiveness ratio of -2,481,390฿ for the intervention. According to the budget impact analysis (assuming an increase of 5% market share for R+ORS over 5 years), the year-on-year reduction for diarrhea as a percentage of the total health care expenditure is -0.0027%, resulting in potential net cost savings of -35,632,482฿ over 5 years. Subject to the assumptions and limitations of the models, adjuvant racecadotril versus ORS alone is potentially cost-effective for children in Thailand and uptake could translate into savings for the Thailand public health care system.

  5. A municipal guide to least cost utility planning

    Energy Technology Data Exchange (ETDEWEB)

    1992-03-01

    The recent track record of traditional'' electricity planning, which entails selection of supply side resources to meet forecasted demand, has not been good. There are numerous examples of utilities incorrectly forecasting demand and over-building generating capacity while others underestimated growth and have had to cut demand and find alternate power sources to avoid outages. A potential solution to this problem is the continuing development of Least Cost Utility Plannning (LCUP). Regulatory commissions, consumer advocates and utilities are increasingly relying an LCUP as the most responsible way to avoid construction of new capacity and alleviate anticipated shortages caused by cancellation of construction projects, load growth, or natural replacement of aging capacity. The purpose of this report is to provide municipalities a starting point for evaluating their servicing utilities or states' least cost plan. This was accomplished by: Identifying key issues in LCUP; reviewing examples of the collaborative and classic approaches to LCUP in Illinois, California, New York State and Michigan; cataloging municipal authorities and strategies which can influence or support LCUP activities. Results of the project indicate that through a basic understanding of LCUP processes and issues, municipalities will be in a better position to influence plans or, if necessary, intervene in regulatory proceedings where plans are adopted. Constraints to municipal involvement in LCUP include statutory limitations, resource constraints, and a lack of knowledge of indirect authorities that support the LCUP process.

  6. A municipal guide to least cost utility planning

    Energy Technology Data Exchange (ETDEWEB)

    1992-03-01

    The recent track record of ``traditional`` electricity planning, which entails selection of supply side resources to meet forecasted demand, has not been good. There are numerous examples of utilities incorrectly forecasting demand and over-building generating capacity while others underestimated growth and have had to cut demand and find alternate power sources to avoid outages. A potential solution to this problem is the continuing development of Least Cost Utility Plannning (LCUP). Regulatory commissions, consumer advocates and utilities are increasingly relying an LCUP as the most responsible way to avoid construction of new capacity and alleviate anticipated shortages caused by cancellation of construction projects, load growth, or natural replacement of aging capacity. The purpose of this report is to provide municipalities a starting point for evaluating their servicing utilities or states` least cost plan. This was accomplished by: Identifying key issues in LCUP; reviewing examples of the collaborative and classic approaches to LCUP in Illinois, California, New York State and Michigan; cataloging municipal authorities and strategies which can influence or support LCUP activities. Results of the project indicate that through a basic understanding of LCUP processes and issues, municipalities will be in a better position to influence plans or, if necessary, intervene in regulatory proceedings where plans are adopted. Constraints to municipal involvement in LCUP include statutory limitations, resource constraints, and a lack of knowledge of indirect authorities that support the LCUP process.

  7. 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.

  8. SSL Pricing and Efficacy Trend Analysis for Utility Program Planning

    Energy Technology Data Exchange (ETDEWEB)

    Tuenge, J. R. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2013-10-01

    Report to help utilities and energy efficiency organizations forecast the order in which important SSL applications will become cost-effective and estimate when each "tipping point" will be reached. Includes performance trend analysis from DOE's LED Lighting Facts® and CALiPER programs plus cost analysis from various sources.

  9. Age-Dependent Cost-Utility of Pediatric Cochlear Implantation

    Science.gov (United States)

    Semenov, Yevgeniy R.; Yeh, Susan T.; Seshamani, Meena; Wang, Nae-Yuh; Tobey, Emily A.; Eisenberg, Laurie S.; Quittner, Alexandra L.; Frick, Kevin D.; Niparko, John K.

    2013-01-01

    Objective Cochlear implantation has become the mainstay of treatment for children with severe-to-profound sensorineural hearing loss (SNHL). Yet, despite mounting evidence on the clinical benefits of early implantation, little data are available on the long-term societal benefits and comparative effectiveness of this procedure across various ages of implantation--a choice parameter for parents and clinicians with high prognostic value for clinical outcome. As such, the aim of the current study is to evaluate a model of the consequences of the timing of this intervention from a societal economic perspective. Average cost-utility of pediatric cochlear implantation by age at intervention will be analyzed. Design Prospective, longitudinal assessment of health-utility and educational placement outcomes in 175 children recruited from 6 US centers between November 2002 and December 2004, who had severe-to-profound SNHL onset within 1 year of age, underwent cochlear implantation before 5 years of age, and had up to 6 years of post-implant follow-up that ended in November 2008 to December 2011. Costs of care were collected retrospectively and stratified by pre-operative, operative, and post-operative expenditures. Incremental costs and benefits of implantation were compared between the three age groups and relative to a non-implantation baseline. Results Children implanted at 36 months of age, respectively. Medical and surgical complication rates were not significantly different between the 3 age groups. Additionally, mean lifetime costs of implantation were similar between the 3 groups, at approximately $2,000/child/year (77.5 year life expectancy), yielding costs of $14,996, $17,849, and $19,173 per QALY for the youngest, middle, and oldest implant age groups, respectively. Full mainstream classroom integration rate was significantly higher in the youngest group at 81% as compared to 57% and 63% for the middle and oldest groups, respectively (peducational cost savings

  10. Identifying Cost-Effective Residential Energy Efficiency Opportunities for the Kauai Island Utility Cooperative

    Energy Technology Data Exchange (ETDEWEB)

    Busche, S.; Hockett, S.

    2010-06-01

    This analysis is an update to the 2005 Energy Efficiency Potential Study completed by KEMA for the Kauai Island Utility Cooperative (KIUC) and identifies potential energy efficiency opportunities in the residential sector on Kauai (KEMA 2005). The Total Resource Cost (TRC) test is used to determine which of the energy efficiency measures analyzed in the KEMA report are cost effective for KIUC to include in a residential energy efficiency program. This report finds that there remains potential energy efficiency savings that could be cost-effectively incentivized through a utility residential demand-side management program on Kauai if implemented in such a way that the program costs per measure are consistent with the current residential program costs.

  11. The performance and publication of cost-utility analyses in plastic surgery: Making our specialty relevant.

    Science.gov (United States)

    Thoma, Achilleas; Ignacy, Teegan A; Ziolkowski, Natalia; Voineskos, Sophocles

    2012-01-01

    Increased spending and reduced funding for health care is forcing decision makers to prioritize procedures and redistribute funds. Decision making is based on reliable data regarding the costs and benefits of medical and surgical procedures; such a study design is known as an economic evaluation. The onus is on the plastic surgery community to produce high-quality economic evaluations that support the cost effectiveness of the procedures that are performed. The present review focuses on the cost-utility analysis and its role in deciding whether a novel technique/procedure/technology should be accepted over one that is prevalent. Additionally, the five steps in undertaking a cost-utility (effectiveness) analysis are outlined.

  12. Assessing cost-utility of predictive biomarkers in oncology: a streamlined approach.

    Science.gov (United States)

    Safonov, Anton; Wang, Shiyi; Gross, Cary P; Agarwal, Divyansh; Bianchini, Giampaolo; Pusztai, Lajos; Hatzis, Christos

    2016-01-01

    Evaluation of cost-utility is critical in assessing the medical utility of predictive or prognostic biomarkers. Current methods involve complex state-transition models, requiring comprehensive data inputs. We propose a simplified decision-analytic tool to explore the relative effect of factors contributing to the cost-utility of a biomarker. We derived a cost-utility metric, the "test incremental cost-effectiveness ratio" (TICER) for biomarker-guided treatment compared to no biomarker use. This method uses data inputs readily accessible through clinical literature. We compared our results with traditional cost-effectiveness analysis of predictive biomarkers for established (HER2-guided trastuzumab, ALK-guided crizotinib, OncotypeDX-guided adjuvant chemotherapy) and emerging (ROS1-guided crizotinib) targeted treatments. We conducted sensitivity analysis to determine which factors had the greatest impact on TICER estimates. Base case TICER for HER2 was $149,600/quality-adjusted life year (QALY), for ALK was $22,200/QALY, and for OncotypeDX was $11,600/QALY, consistent with literature-reported estimates ($180,000/QALY, $202,800/QALY, $8900/QALY, respectively). Base case TICER for ROS1-guided crizotinib was $205,900/QALY. Generally, when treatment cost is considerably greater than biomarker testing costs, TICER is driven by clinical outcomes and health-related quality of life, while biomarker prevalence and treatment cost have a lesser effect. Our simplified decision-analytic approach produces values consistent with existing cost-effectiveness analyses. Our results suggest that biomarker value is mostly driven by the clinical efficacy of the targeted agent. A user-friendly web tool for complete TICER analysis has been made available for open use at http://medicine.yale.edu/lab/pusztai/ticer/ .

  13. 办公楼中水回用成本效益分析%Cost-benefit Analysis of Gray Water Recycling Utilized in Office Building

    Institute of Scientific and Technical Information of China (English)

    左婷婷; 袁岩; 王利生

    2013-01-01

      中水回用系统节省淡水资源,缓解城市给排水压力,社会效益显著。但是在经济效益层面,中水回用系统存在争议。针对北京地区办公楼中水回用问题,采用动态投资回收期分析法,结合对未来水价、电价的走势和维保费的模拟,针对Matlab软件计算结果,分析并讨论了中水系统在办公楼中的成本效益。结果表明,目前办公楼中水系统不具备经济投资效益;水价以及运行、维保费的增长率是影响中水回用系统经济效益的主要因素。但随着中水回用系统投入使用的推移,动态投资回收期在减少。到2021年以后中水回用系统投入使用,开始具备经济投资效益。%Gray water recycling system reserves water resource and relieves pressure of municipal water and wastewater which has great potential social benefit. However,gray water recycling system rises controversy in terms of economic benefit. Focusing on gray water recycling system in a research office building located in Beijing,cost-benefit analysis of gray water recycling in the research office building is analyzed and discussed in terms of using dynamic investment pay-back period method solved by Matlab software which combines the simulation of future running water prices,electricity prices and operating& maintenance fees. At present, economic investment of gray water recycling system is turned out to be in vain. Running water prices and increasing rate of operating& maintenance fees are the key factors which have a serious influence on economic benefit of gray water recycling system. With delay of implementation of gray water recycling system,dynamic investment pay-back period is decreasing. Economic investment efficiency of gray water recycling system emerges when the system implements after 2021.

  14. Reducing an already low dental diagnostic X-ray dose: does it make sense? Comparison of three cost-utility analysis methods used to assess two dental dose-reduction measures.

    Science.gov (United States)

    Hoogeveen, R C; Sanderink, G C H; van der Stelt, P F; Berkhout, W E R

    2015-01-01

    To find a method that is suitable for providing an objective assessment of the cost effectiveness of a dose-reducing measure used for diagnostic dental X-ray exposures. Three cost-utility analysis (CUA) methods were evaluated by comparing their assessments of two dose-reduction measures, a rectangular collimator and the combination of two devices that reduce the radiation dose received during orthodontic lateral cephalography. The following CUA methods were used: (1) the alpha value (AV), a monetary valuation of dose reduction used in the nuclear industry; (2) the value of a statistical life for valuation of the reduction in stochastic adverse effects; and (3) the time-for-time method, based on the postulate that risk reduction is effective when the number of years of life gained is more than the years that an average worker must work to earn the costs of the risk-reducing measure. The CUA methods were used to determine the minimum number of uses that was required for the dose-reducing device to be cost effective. The methods were assessed for coherence (are comparable results achieved for comparable countries?) and adaptability (can the method be adjusted for age and gender of specific patient groups?). The performance of the time-for-time method was superior to the other methods. Both types of dose-reduction devices tested were assessed as cost effective after a realistic number of uses with all three methods except low AVs. CUA for the methods of X-ray dose reduction can be performed to determine if investment in low dose reduction is cost effective. The time-for-time method proved to be a coherent and versatile method for performing CUA.

  15. Cost-Utility Analysis of Intensive Blood Glucose Control with Metformin versus Usual Care in Overweight Type 2 Diabetes Mellitus Patients in Beijing, P.R. China

    NARCIS (Netherlands)

    Xie, Xuanqian; Vondeling, Hindrik

    2008-01-01

    Objective: The UKPDS 34 and 51 showed that intensive blood glucose control with metformin is cost-saving and increases life expectancy in overweight type 2 diabetic patients in the United Kingdom. Diabetes is becoming an important health problem in urban China. This study addresses the effects and c

  16. 5 CFR 591.220 - How does OPM calculate energy utility cost indexes?

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false How does OPM calculate energy utility... Areas Cost-Of-Living Allowances § 591.220 How does OPM calculate energy utility cost indexes? (a) OPM calculates energy utility cost indexes based on the relative cost of maintaining a standard size dwelling...

  17. Retail clinic utilization associated with lower total cost of care.

    Science.gov (United States)

    Sussman, Andrew; Dunham, Lisette; Snower, Kristen; Hu, Min; Matlin, Olga S; Shrank, William H; Choudhry, Niteesh K; Brennan, Troyen

    2013-04-01

    To better understand the impact of retail clinic use on a patient's annual total cost of care. A propensity score matched-pair, cohort design was used to analyze healthcare spending patterns among CVS Caremark employees in the year following a visit to a MinuteClinic, the retail clinics inside CVS pharmacies. De-identified medical and pharmacy claims for CVS Caremark employees and their dependents who received care at a retail clinic between June 1, 2009, and May 31, 2010, were matched to those of subjects who received care elsewhere. High-dimensional propensity score and greedy matching techniques were used to create a 1-to-1 matched cohort that was analyzed using generalized linear regression models. Individuals using a retail clinic had a lower total cost of care (-$262; 95% confidence interval, -$510 to -$31; P = .025) in the year following their clinic visit than individuals who received care in other settings. This savings was primarily due to lower medical expenses at physicians' offices ($77 savings, P = .008) and hospital inpatient care ($121 savings, P = .049). The 6022 retail clinic users also had 142 (12%) fewer emergency department visits (P = .01), though this was not related to significant cost savings. This study found that retail clinic use was associated with lower overall total cost of care compared with that at alternative sites. Savings may extend beyond the retail clinic visit itself to other types of medical utilization.

  18. The impact of HIV-associated lipodystrophy on healthcare utilization and costs

    Directory of Open Access Journals (Sweden)

    Lee Daniel

    2008-07-01

    Full Text Available Abstract Background HIV disease itself is associated with increased healthcare utilization and healthcare expenditures. HIV-infected persons with lipodystrophy have been shown to have poor self-perceptions of health. We evaluated whether lipodystrophy in the HIV-infected population was associated with increased utilization of healthcare services and increased healthcare costs. Objective To examine utilization of healthcare services and associated costs with respect to presence of lipodystrophy among HIV-infected patients. Methods Healthcare utilization and cost of healthcare services were collected from computerized accounting records for participants in a body image study among HIV-infected patients treated at a tertiary care medical center. Lipodystrophy was assessed by physical examination, and effects of lipodystrophy were assessed via body image surveys. Demographic and clinical characteristics were also ascertained. Analysis of healthcare utilization and cost outcomes was performed via between-group analyses. Multivariate modeling was used to determine predictors of healthcare utilization and associated costs. Results Of the 181 HIV-infected participants evaluated in the study, 92 (51% had clinical evidence of HIV-associated lipodystrophy according to physician examination. Total healthcare utilization, as measured by the number of medical center visits over the study period, was notably increased among HIV-infected subjects with lipodystrophy as compared to HIV-infected subjects without lipodystrophy. Similarly, total healthcare expenditures over the study period were $1,718 more for HIV-infected subjects with lipodystrophy than for HIV-infected subjects without lipodystrophy. Multivariate modeling demonstrated strong associations between healthcare utilization and associated costs, and lipodystrophy score as assessed by a clinician. Healthcare utilization and associated costs were not related to body image survey scores among HIV

  19. Relative value units and cost analysis, Part 3 of 4.

    Science.gov (United States)

    Glass, Kathryn P; Anderson, Jeffery R

    2002-01-01

    In recent years, the interest in relative value unit (RVU) cost analysis has been on the rise. Why all the excitement? RVU cost analysis places the knowledge, and therefore the power, in the hands of the administrator to negotiate revenues, analyze expenditures, and control costs. Cost analysis at the per (relative)-unit level allows for procedure profitability (or loss) analysis, setting internal fee schedules based on costs, contract negotiation based on RVU cost and utilization, equitable provider compensation packages based on productivity and overhead coverage, and tracking ancillary and referral utilization risks. In short, RVU cost accounting uses the Resource-Based Relative Value Scale (RBRVS) instead of stopwatches and clipboards when measuring clinical costs and activity.

  20. Utilities and industry should buy on total cost of ownership

    Energy Technology Data Exchange (ETDEWEB)

    Weigand, D

    1991-05-01

    The development of high efficiency transformers is outlined and linked to the energy shortage of the late 1970s and the consequent upward revision of loss evaluation factors by electric utilities. The factors affecting power losses in transformers are briefly discussed. Core loss (no-load loss) depends on such factors as flux density, core weight, and materials, and is closely interrelated with load loss, which depends on the number of turns in the transformer coil, coil length, and current density. Some loss evaluation formulas in use are illustrated. Manufacturers have responded to these formulas by producing transformers with larger cores and lower flux densities, causing the no-load loss to be lower. The transformers are larger and more expensive to purchase. However, by considering the effects of evaluated losses plus the cost of the transformer, the total owning cost of these new designs is lower than that of previous low-cost, high-loss designs. The user who buys on price alone will get a transformer with the highest losses possible. 2 figs., 1 tab.

  1. Resource utilization and costs associated with the diagnostic evaluation of nonrefluxing primary hydronephrosis in infants.

    Science.gov (United States)

    Akhavan, Ardavan; Shnorhavorian, Margarett; Garrison, Louis P; Merguerian, Paul A

    2014-09-01

    Long-term evaluation of postnatal nonrefluxing primary hydronephrosis presents a dilemma for urologists since most cases resolve without surgery. We report longitudinal resource utilization and costs associated with diagnostic evaluation of infants with isolated primary nonrefluxing hydronephrosis to determine the costs associated with diagnosing a surgical case, and we assess the implications using a cost-consequences analysis. A retrospective chart review was used to capture resource utilization for all patients younger than 6 months with hydronephrosis evaluated at our institution during a 5-year period. Infants with confounding urological diagnoses were excluded. Payer and societal perspectives were used. Costs were estimated from resource utilization, including radiographic imaging and clinical encounter types. Data were collected from first clinic visit until surgery or resolution or 3 years, whichever was shortest. Of 165 included patients surgical rates for hydronephrosis were 0% for grade I, 5% for grade II, 21% for grade III and 74% for grade IV. Median respective costs of identifying a single surgical case per increasing hydronephrosis grade 0 to IV were infinite, $37,600, $11,741 and $2,124 (p costs. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  2. Cost-utility of a visiting service for older widowed individuals: Randomised trial

    Directory of Open Access Journals (Sweden)

    Willemse Godelief

    2008-06-01

    Full Text Available Abstract Background Despite a growing understanding of the effectiveness of bereavement interventions and the groups that benefit most from them, we know little about the cost-effectiveness of bereavement interventions. Methods We conducted a cost-utility analysis alongside a randomized clinical trial on a visiting service for older widowed individuals (n = 110 versus care as usual (CAU; n = 106. The visiting service is a selective bereavement intervention that offers social support to lonely widows and widowers by a trained volunteer. Participants were contacted 6–9 months post-loss. Eleven percent of all contacted persons responded and eight percent participated in the trial. The primary outcome measure was quality adjusted life years (QALYs gained (assessed with the EQ-5D, which is a generic measure of health status. Costs were calculated from a societal perspective excluding costs arising from productivity losses. Using the bootstrap method, we obtained the incremental cost utility ratio (ICUR, projected these on a cost-utility plane and presented as an acceptability curve. Results Overall, the experimental group demonstrated slightly better results against slightly higher costs. Whether the visiting service is acceptable depends on the willingness to pay: at a willingness to pay equal to zero per QALY gained, the visiting service has a probability of 31% of being acceptable; beyond €20,000, the visiting service has a probability of 70% of being more acceptable than CAU. Conclusion Selective bereavement interventions like the visiting service will not produce large benefits from the health economic point of view, when targeted towards the entire population of all widowed individuals. We recommend that in depth analyses are conducted to identify who benefits most from this kind of interventions, and in what subgroups the incremental cost-utility is best. In the future bereavement interventions are then best directed to these groups. Trial

  3. Value analysis of wind energy systems to electric utilities

    Energy Technology Data Exchange (ETDEWEB)

    Percival, D.; Harper, J.

    1981-01-01

    A method has been developed for determining the value of utility-operated wind energy systems to electric utilities. The analysis is performed by a package of computer models that interface with most conventional utility planning models. Weather data are converted to wind turbine output powers, which are used to modify the utility load representation. Execution of the utility planning models with both the original and modified load representation yields the gross and marginal value ($/rated kW/) of the added wind energy systems. This value is then compared with cost estimates to determine if for economic reasons the wind energy system should be included in future generation plans.

  4. Extensive analysis of hydrogen costs

    Energy Technology Data Exchange (ETDEWEB)

    Guinea, D.M.; Martin, D.; Garcia-Alegre, M.C.; Guinea, D. [Consejo Superior de Investigaciones Cientificas, Arganda, Madrid (Spain). Inst. de Automatica Industrial; Agila, W.E. [Acciona Infraestructuras, Alcobendas, Madrid (Spain). Dept. I+D+i

    2010-07-01

    Cost is a key issue in the spreading of any technology. In this work, the cost of hydrogen is analyzed and determined, for hydrogen obtained by electrolysis. Different contributing partial costs are taken into account to calculate the hydrogen final cost, such as energy and electrolyzers taxes. Energy cost data is taken from official URLs, while electrolyzer costs are obtained from commercial companies. The analysis is accomplished under different hypothesis, and for different countries: Germany, France, Austria, Switzerland, Spain and the Canadian region of Ontario. Finally, the obtained costs are compared to those of the most used fossil fuels, both in the automotive industry (gasoline and diesel) and in the residential sector (butane, coal, town gas and wood), and the possibilities of hydrogen competing against fuels are discussed. According to this work, in the automotive industry, even neglecting subsidies, hydrogen can compete with fossil fuels. Hydrogen can also compete with gaseous domestic fuels. Electrolyzer prices were found to have the highest influence on hydrogen prices. (orig.)

  5. Nisin Production Utilizing Skimmed Milk Aiming to Reduce Process Cost

    Science.gov (United States)

    Jozala, Angela Faustino; de Andrade, Maura Sayuri; de Arauz, Luciana Juncioni; Pessoa, Adalberto; Penna, Thereza Christina Vessoni

    Nisin is a natural additive for conservation of food, pharmaceutical, and dental products and can be used as a therapeutic agent. Nisin inhibits the outgrowth of spores, the growth of a variety of Gram-positive and Gram-negative bacteria. This study was performed to optimize large-scale nisin production in skimmed milk and subproducts aiming at low-costs process and stimulating its utilization. Lactococcus lactis American Type Culture Collection (ATCC) 11454 was developed in a rotary shaker (30°C/36 h/100 rpm) in diluted skimmed milk and nisin activity, growth parameters, and media components were also studied. Nisin activity in growth media was expressed in arbitrary units (AU/mL) and converted to standard nisin concentration (Nisaplin®, 25 mg of pure nisin is 1.0×106 AU/mL). Nisin activity in skimmed milk 2.27 gtotal solids was up to threefold higher than transfers in skimmed milk 4.54 gtotal solids and was up to 85-fold higher than transfers in skimmed milk 1.14 gtotal solids. L. lactis was assayed in a New Brunswick fermentor with 1.5 L of diluted skimmed milk (2.27 gtotal solids) and airflow of 1.5 mL/min (30°C/36/200 rpm), without pH control. In this condition nisin activity was observed after 4 h (45.07 AU/mL) and in the end of 36 h process (3312.07 AU/mL). This work shows the utilization of a low-cost growth medium (diluted skimmed milk) to nisin production with wide applications. Furthermore, milk subproducts (milk whey) can be exploited in nisin production, because in Brazil 50% of milk whey is disposed with no treatment in rivers and because of high organic matter concentrations it is considered an important pollutant. In this particular case an optimized production of an antimicrobial would be lined up with industrial disposal recycling.

  6. Combined multi-criteria and cost-benefit analysis

    DEFF Research Database (Denmark)

    Moshøj, Claus Rehfeld

    1996-01-01

    of the application of utility-based Multi-Criteria Analyses methods as an extension and refinement of the traditional Cost-Benefit Analysis are provided. The theory presented in this paper is closely related the methods used in the WARP software (Leleur & Jensen, 1989). The presentation is however wider in scope......The paper is an introduction to both theory and application of combined Cost-Benefit and Multi-Criteria Analysis. The first section is devoted to basic utility theory and its practical application in Cost-Benefit Analysis. Based on some of the problems encountered, arguments in favour...

  7. Balancing Cost and Risk: The Treatment of Renewable Energy in Western Utility Resource Plans

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark; Wiser, Ryan

    2005-08-10

    Markets for renewable energy have historically been motivated primarily by policy efforts, but a less widely recognized driver is poised to also play a major role in the coming years: utility integrated resource planning (IRP). Resource planning has re-emerged in recent years as an important tool for utilities and regulators, particularly in regions where retail competition has failed to take root. In the western United States, the most recent resource plans contemplate a significant amount of renewable energy additions. These planned additions--primarily coming from wind power--are motivated by the improved economics of wind power, a growing acceptance of wind by electric utilities, and an increasing recognition of the inherent risks (e.g., natural gas price risk, environmental compliance risk) in fossil-based generation portfolios. This report examines how twelve western utilities treat renewable energy in their recent resource plans. In aggregate, these utilities supply approximately half of all electricity demand in the western United States. Our purpose is twofold: (1) to highlight the growing importance of utility IRP as a current and future driver of renewable energy, and (2) to identify methodological/modeling issues, and suggest possible improvements to methods used to evaluate renewable energy as a resource option. Here we summarize the key findings of the report, beginning with a discussion of the planned renewable energy additions called for by the twelve utilities, an overview of how these plans incorporated renewables into candidate portfolios, and a review of the specific technology cost and performance assumptions they made, primarily for wind power. We then turn to the utilities' analysis of natural gas price and environmental compliance risks, and examine how the utilities traded off portfolio cost and risk in selecting a preferred portfolio.

  8. 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

  9. Cost analysis of advanced turbine blade manufacturing processes

    Science.gov (United States)

    Barth, C. F.; Blake, D. E.; Stelson, T. S.

    1977-01-01

    A rigorous analysis was conducted to estimate relative manufacturing costs for high technology gas turbine blades prepared by three candidate materials process systems. The manufacturing costs for the same turbine blade configuration of directionally solidified eutectic alloy, an oxide dispersion strengthened superalloy, and a fiber reinforced superalloy were compared on a relative basis to the costs of the same blade currently in production utilizing the directional solidification process. An analytical process cost model was developed to quantitatively perform the cost comparisons. The impact of individual process yield factors on costs was also assessed as well as effects of process parameters, raw materials, labor rates and consumable items.

  10. Impact of power purchases from nonutilities on the utility cost of capital

    Energy Technology Data Exchange (ETDEWEB)

    Kahn, E.; Stoft, S.; Belden, T. [Lawrence Berkeley Lab., CA (United States). Energy and Environment Div.

    1994-03-01

    This report studies the debt-equivalence debate empirically. The topics of the study include a review of the literature on the cost of equity capital for regulated utilities, a formulation of the debate on NUGs and the utility`s cost of capital, a review of variable definitions and data sources, and a discussion of statistical issues and results.

  11. The association of comorbidities, utilization and costs for patients identified with low back pain

    Directory of Open Access Journals (Sweden)

    Ritzwoller Debra P

    2006-09-01

    Full Text Available Abstract Background Existing studies have examined the high prevalence of LBP along with the high treatment costs of patients with low back pain (LBP. Various factors have been shown to be correlated or predictive of chronic or episodic LBP including the characteristics of the initial episode, pain, comorbid conditions, psychosocial issues, and opiate use. This study replicates and extends earlier studies by examining the association of patient characteristics including baseline comorbidities with patterns of healthcare service use and cost. Methods This is a retrospective analysis of measures of comorbidities, healthcare use, and cost for patients identified with LBP, stratified by the number of LBP episodes. Administrative data associated with outpatient and hospital based care for the years 1996 through 2001, were used to identify adult patients with LBP. LBP patients continuously enrolled for 12 months prior and 24 months after their initial LBP event were included in the study. A LBP episode was identified as the number of 30-day periods where a patient had one or more healthcare events with a diagnosis consistent with LBP. Chi-square and multivariate regression analyses were employed to estimate the variation in utilization and costs. Results Of 16,567 patients enrolled, 67% were identified with only one LBP episode and 4.5% had ≥6. The prevalence of comorbidities, analgesic use, and healthcare service use, varied by the number of back pain episodes. Diabetes, rheumatoid arthritis, anxiety, psychotic illness, depression, use of opiates and NSAIDs were associated with significant incremental increases in costs (P Conclusion Physical and mental health co-morbidities and measures of analgesic use were associated with chronicity, healthcare utilization and costs. Given the association of comorbidities and cost for patients with LBP, management approaches that are effective across chronic illnesses may prove to be beneficial for high cost

  12. Early Treatment in HCV: Is it a Cost-Utility Option from the Italian Perspective?

    Science.gov (United States)

    Marcellusi, Andrea; Viti, Raffaella; Damele, Francesco; Cammà, Calogero; Taliani, Gloria; Mennini, Francesco Saverio

    2016-08-01

    In Italy, the Italian Pharmaceutical Agency (AIFA) criteria used F3-F4 fibrosis stages as the threshold to prioritise the treatment with interferon (IFN)-free regimens, while in genotype 1 chronic hepatitis C (G1 CHC) patients with fibrosis of liver stage 2, an approach with pegylated interferon (PEG-IFN)-based triple therapy with simeprevir was suggested. The key clinical question is whether, in an era of financial constraints, the application of a universal IFN-free strategy in naïve G1 CHC patients is feasible within a short time horizon. The aim of this study is to perform an economic analysis to estimate the cost-utility of the early innovative therapy in Italy for managing hepatitis C virus (HCV)-infected patients. The incremental cost-utility analysis was carried out to quantify the benefits of the early treatment approach in HCV subjects. A Markov simulation model including direct and indirect costs and health outcomes was developed from an Italian National Healthcare Service and societal perspective. A total of 5000 Monte Carlo simulations were performed on two distinct scenarios: standard of care (SoC) which includes 14,000 genotype 1 patients in Italy treated with innovative interferon-free regimens in the fibrosis of liver stages 3 and 4 (F3-F4) versus early-treatment scenario (ETS) where 2000 patients were additionally treated with simeprevir plus PEG-IFN and ribavirin in the fibrosis stage 2 (F2) (based on Italian Medicines Agency AIFA reimbursement criteria). A systematic literature review was carried out to identify epidemiological and economic data, which were subsequently used to inform the model. Furthermore, a one-way probabilistic sensitivity was performed to measure the relationship between the main parameters of the model and the cost-utility results. The model shows that, in terms of incremental cost-effectiveness ratio (ICER) per quality adjusted life year (QALY) gained, ETS appeared to be the most cost-utility option compared with both

  13. Drug utilization and cost in a Medicaid population: A simulation study of community vs. mail order pharmacy

    Directory of Open Access Journals (Sweden)

    Seoane-Vazquez Enrique

    2007-07-01

    Full Text Available Abstract Background Outpatient drugs are dispensed through both community and mail order pharmacies. There is no empirical evidence that substitution of community pharmacy with mail order reduces overall drug expenditures. The need for evaluating the potential effects on utilization and costs of the possible extension of mail order services in Medicaid provides the rationale for conducting this study. This study compares drug utilization and drug product cost in community vs. mail order pharmacy dispensing services in a Medicaid population. Methods This study is a retrospective cohort study comparing utilization and cost patterns in community vs. mail order pharmacy. A simulation model was employed to assess drug utilization and cost in mail order pharmacy using community pharmacy claim data. The model assumed that courses of drug therapy (CDT in mail order pharmacy would have utilization patterns similar to those found in community pharmacy. A 95% confidence interval surrounding changes in average utilization and average cost were estimated using bootstrap analysis. A sensitivity analysis was performed by varying drug selection criteria and supply, fill point, and medication possession ratio (MPR. Sub-analyses were performed to address differences between mail order and community pharmacy related to therapeutic class and dual-eligible patients. Data for the study derived from pharmacy claims database of Ohio Medicaid State program for the period January 2000-September 2004. Drug claims were aggregated to obtain a set of CDTs representing unique patient IDs and unique drug products. Drug product cost estimates excluded dispensing fees and were used to estimate the cost reduction required in mail order to become cost neutral in comparison with community pharmacy. Results The baseline model revealed that the use of mail order vs. community pharmacy would result in a 5.5% increase in drug utilization and a 5.4% cost reduction required in mail order

  14. Why don't All Exporters Benefit from Free Trade Agreements?: Estimating Utilization Costs

    OpenAIRE

    Ulloa, Alfie; Wagner, Rodrigo

    2012-01-01

    Free Trade Agreements (FTA) attract significant interest, but after these treaties are signed not all exporters use them. We provide a model of heterogeneous utilization, also developing a novel method to estimate treaty-utilization costs. We later apply the model to estimate the evolution utilization costs for the FTA between the US and a small open economy, Chile. Consistent with other studies, we find that utilization is indeed partial (on average 67% on the first year of the treaty, with ...

  15. The cost effectiveness and cost utility of valsartan in chronic heart failure therapy in Italy: a probabilistic markov model.

    Science.gov (United States)

    Pradelli, Lorenzo; Iannazzo, Sergio; Zaniolo, Orietta

    2009-01-01

    To evaluate the cost effectiveness and cost utility of the use of valsartan in addition to standard therapy for the treatment of patients with chronic heart failure with low left ventricular ejection fraction (LVEF). The study was conducted by means of a cohort simulation based on a probabilistic Markov model and projecting the 23-month follow-up results of the Val-HeFT (Valsartan Heart Failure Trial) study over a 10-year time horizon. The model included four states (New York Heart Association [NYHA] classes II, III, IV, and death), and had a cycle duration of 1 month. Probabilistic simulations were performed using the WinBUGS software for Bayesian analysis. The distribution of patient parameters (sex, age, use of beta-adrenoceptor antagonists, and ACE inhibitors) in the simulated population were derived from the Italian heart failure patient population. Individual mortality data were derived from general mortality data by multiplying by a NYHA state-specific relative risk, while the probability of changing NYHA class was taken from the Val-HeFT data. Costs (2007 values) were calculated from the perspective of the Italian Health Service (IHS) and included costs for drugs and heart failure hospitalizations. Quality-of-life (QOL) weights were obtained by using published health-related QOL data for heart failure patients. A 3.5% annual discount rate was applied. Probabilistic sensitivity analysis was performed on each parameter using original-source 95% confidence interval (CI) values, or a +/-10% range when 95% CI values were unavailable. For the 10-year time horizon, patients were estimated to live for an average of 2.3 years or 1.7 quality-adjusted life-years (QALYs), with slight increases in the valsartan group. In this group, hospitalizations for worsening heart failure were predicted to be significantly reduced and overall treatment costs per patient to decrease by about and U20AC;550. In subgroup analyses, valsartan lost dominance in patients in NYHA II, and in

  16. [From the therapeutic utility to the added therapeutic value and the incremental cost-effectiveness ratio].

    Science.gov (United States)

    Puig-Junoy, Jaume; Peiró, Salvador

    2009-01-01

    From the social perspective, the concepts of therapeutic utility and degree of innovation of new drugs should be referred to their social added value in relation to the available treatment alternatives and the added costs that they imply; that is, to their incremental cost-effectiveness ratio. The analytic elements highlighting this approach are: 1) the dimensions of the social value of the medication that should go beyond the conventional outcomes measures to also incorporate measures of health related quality of life, patient and family comfort and convenience, healthcare consumption avoided and productive losses avoided; 2) the relative or incremental character of this value that should be quantified in front of previous alternatives -not versus placebo- and under conditions of real use; and 3) the incremental costs that bears the administration of the new medication. The incremental cost-effectiveness ratio is the appropriate approach for decisions about coverage of a treatment by the public insurer, the price that he is willing to pay for the drug, and the clinical situations and patient groups in which it is recommended. The incremental cost-effectiveness analysis and the use of an indicative threshold of the maximum cost that the society is willing to pay for one additional "quality adjusted life year" are the essential elements of this approach, which doesn't require to fix the price of the new medications at the threshold of the willingness to pay.

  17. Cost analysis helps evaluate contract profitability.

    Science.gov (United States)

    Sides, R W

    2000-02-01

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

  18. Variable cost of ICU care, a micro-costing analysis.

    Science.gov (United States)

    Karabatsou, Dimitra; Tsironi, Maria; Tsigou, Evdoxia; Boutzouka, Eleni; Katsoulas, Theodoros; Baltopoulos, George

    2016-08-01

    Intensive care unit (ICU) costs account for a great part of a hospital's expenses. The objective of the present study was to measure the patient-specific cost of ICU treatment, to identify the most important cost drivers in ICU and to examine the role of various contributing factors in cost configuration. A retrospective cost analysis of all ICU patients who were admitted during 2011 in a Greek General, seven-bed ICU and stayed for at least 24hours was performed, by applying bottom-up analysis. Data collected included demographics and the exact cost of every single material used for patients' care. Prices were yielded from the hospital's purchasing costs and from the national price list of the imaging and laboratory tests, which was provided by the Ministry of Health. A total of 138 patients were included. Variable cost per ICU day was €573.18. A substantial cost variation was found in the total costs obtained for individual patients (median: €3443, range: €243.70-€116,355). Medicines were responsible for more than half of the cost and antibiotics accounted for the largest part of it, followed by blood products and cardiovascular drugs. Medical cause of admission, severe illness and increased length of stay, mechanical ventilation and dialysis were the factors associated with cost escalation. ICU variable cost is patient-specific, varies according to each patient's needs and is influenced by several factors. The exact estimation of variable cost is a pre-requisite in order to control ICU expenses.

  19. The Cost and Utility of Renal Transplantation in Malaysia.

    Science.gov (United States)

    Bavanandan, Sunita; Yap, Yok-Chin; Ahmad, Ghazali; Wong, Hin-Seng; Azmi, Soraya; Goh, Adrian

    2015-11-01

    Kidney transplantation is the optimal therapy for the majority of patients with end-stage renal disease. However, the cost and health outcomes of transplantation have not been assessed in a middle-income nation with a low volume of transplantation, such as Malaysia. This study used microcosting methods to determine the cost and health outcomes of living and deceased donor kidney transplantation in adult and pediatric recipients. The perspective used was from the Ministry of Health Malaysia. Cost-effectiveness measures were cost per life year (LY) and cost per quality-adjusted LYs. The time horizon was the lifetime of the transplant recipient from transplant to death. Records of 206 KT recipients (118 adults and 88 children) were obtained for microcosting. In adults, discounted cost per LY was US $8609(Malaysian Ringgit [RM]29 482) and US $13 209(RM45 234) for living-donor kidney transplant (LKT) and deceased donor kidney transplant (DKT), respectively, whereas in children, it was US $10 485(RM35 905) and US $14 985(RM51 317), respectively. Cost per quality-adjusted LY in adults was US $8826 (RM30 224) for LKT and US $13 592(RM46 546) for DKT. Total lifetime discounted costs of adult transplants were US $119 702 (RM409 921) for LKT, US $147 152 (RM503 922) for DKT. Total costs for pediatric transplants were US $154 841(RM530 252) and US $159 313(RM545 566) for the 2 categories respectively. Both LKT and DKT are economically favorable for Malaysian adult and pediatric patients with ESRD and result in improvement in quality of life.

  20. The Cost and Utility of Renal Transplantation in Malaysia

    OpenAIRE

    Bavanandan, Sunita; Yap, Yok-Chin; Ahmad, Ghazali; Wong, Hin-Seng; Azmi, Soraya; Goh, Adrian

    2015-01-01

    Background Kidney transplantation is the optimal therapy for the majority of patients with end-stage renal disease. However, the cost and health outcomes of transplantation have not been assessed in a middle-income nation with a low volume of transplantation, such as Malaysia. Aim and Methods This study used microcosting methods to determine the cost and health outcomes of living and deceased donor kidney transplantation in adult and pediatric recipients. The perspective used was from the Min...

  1. The Cost and Utility of Renal Transplantation in Malaysia

    OpenAIRE

    Bavanandan, Sunita; Yap, Yok-Chin; Ahmad, Ghazali; Wong, Hin-Seng; Azmi, Soraya; Goh, Adrian

    2015-01-01

    Background Kidney transplantation is the optimal therapy for the majority of patients with end-stage renal disease. However, the cost and health outcomes of transplantation have not been assessed in a middle-income nation with a low volume of transplantation, such as Malaysia. Aim and Methods This study used microcosting methods to determine the cost and health outcomes of living and deceased donor kidney transplantation in adult and pediatric recipients. The perspective used was from the Min...

  2. SOLIDWORKS COSTING ANALYSYS ON A DESIGNED PART

    Directory of Open Access Journals (Sweden)

    Catalin IANCU

    2016-05-01

    Full Text Available In this paperwork are presented the SolidWorks analysis steps taken for costing study of a designed part, using Costing module. There are presented the settings that have to be done for such analysis and the results shown by this software module. The costing elements that are taken into account are specific to default costing templates in SolidWorks, but can be adjusted (edited to costs specific to a given enterprise.

  3. REDUCING POWER PRODUCTION COSTS BY UTILIZING PETROLEUM COKE

    Energy Technology Data Exchange (ETDEWEB)

    Kevin C. Galbreath; Donald L. Toman; Christopher J. Zygarlicke

    1999-09-01

    Petroleum coke, a byproduct of the petroleum-refining process, is an attractive primary or supplemental fuel for power production primarily because of a progressive and predictable increase in the production volumes of petroleum coke (1, 2). Petroleum coke is most commonly blended with coal in proportions suitable to meet sulfur emission compliance. Petroleum coke is generally less reactive than coal; therefore, the cofiring of petroleum coke with coal typically improves ignition, flame stability, and carbon loss relative to the combustion of petroleum coke alone. Although petroleum coke is a desirable fuel for producing relatively inexpensive electrical power, concerns about the effects of petroleum coke blending on combustion and pollution control processes exist in the coal-fired utility industry (3). The Energy & Environmental Research Center (EERC) completed a 2-year technical assessment of petroleum coke as a supplemental fuel. A survey questionnaire was sent to seven electric utility companies that are currently cofiring coal and petroleum coke in an effort to solicit specific suggestions on research needs and fuel selections. An example of the letter and survey questionnaire is presented in Appendix A. Interest was expressed by most utilities in evaluating the effects of petroleum coke blending on grindability, combustion reactivity, fouling, slagging, and fly ash emissions control. Unexpectedly, concern over corrosion was not expressed by the utilities contacted. Although all seven utilities responded to the question, only two utilities, Northern States Power Company (NSP) and Ameren, sent fuels to the EERC for evaluation. Both utilities sent subbituminous coals from the Power River Basin and petroleum shot coke samples. Petroleum shot coke is produced unintentionally during operational upsets in the petroleum refining process. This report evaluates the effects of petroleum shot coke blending on grindability, fuel reactivity, fouling/slagging, and

  4. 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.

  5. [Clinical study using activity-based costing to assess cost-effectiveness of a wound management system utilizing modern dressings in comparison with traditional wound care].

    Science.gov (United States)

    Ohura, Takehiko; Sanada, Hiromi; Mino, Yoshio

    2004-01-01

    In recent years, the concept of cost-effectiveness, including medical delivery and health service fee systems, has become widespread in Japanese health care. In the field of pressure ulcer management, the recent introduction of penalty subtraction in the care fee system emphasizes the need for prevention and cost-effective care of pressure ulcer. Previous cost-effectiveness research on pressure ulcer management tended to focus only on "hardware" costs such as those for pharmaceuticals and medical supplies, while neglecting other cost aspects, particularly those involving the cost of labor. Thus, cost-effectiveness in pressure ulcer care has not yet been fully established. To provide true cost effectiveness data, a comparative prospective study was initiated in patients with stage II and III pressure ulcers. Considering the potential impact of the pressure reduction mattress on clinical outcome, in particular, the same type of pressure reduction mattresses are utilized in all the cases in the study. The cost analysis method used was Activity-Based Costing, which measures material and labor cost aspects on a daily basis. A reduction in the Pressure Sore Status Tool (PSST) score was used to measure clinical effectiveness. Patients were divided into three groups based on the treatment method and on the use of a consistent algorithm of wound care: 1. MC/A group, modern dressings with a treatment algorithm (control cohort). 2. TC/A group, traditional care (ointment and gauze) with a treatment algorithm. 3. TC/NA group, traditional care (ointment and gauze) without a treatment algorithm. The results revealed that MC/A is more cost-effective than both TC/A and TC/NA. This suggests that appropriate utilization of modern dressing materials and a pressure ulcer care algorithm would contribute to reducing health care costs, improved clinical results, and, ultimately, greater cost-effectiveness.

  6. CROSS DRIFT ALCOVE/NICHE UTILITIES ANALYSIS

    Energy Technology Data Exchange (ETDEWEB)

    S. Goodin

    1999-07-08

    The purpose of this analysis is to provide the design basis and general arrangement requirements of the non-potable water, waste water, compressed air and ventilation (post excavation) utilities required in support of the Cross Drift alcoves and niches.

  7. Medicares Hospice Benefit - Analysis of Utilization and..

    Data.gov (United States)

    U.S. Department of Health & Human Services — Descriptive analyses reported in Medicares Hospice Benefit - Analysis of Utilization and Resource Use, published in Volume 4, Issue 3 of the Medicare and Medicaid...

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

    Science.gov (United States)

    2014-01-01

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

  9. Project cost analysis under risk

    Directory of Open Access Journals (Sweden)

    Florica LUBAN

    2010-12-01

    Full Text Available In this paper, an integrated approach based on Monte Carlo simulation and Six Sigma methodology is used to analyze the risk associated with a project's total cost. Monte Carlo simulation is applied to understand the variability in total cost caused by the probabilistic cost items. By Six Sigma methodology the range of variation of the project cost can be reduced by operating on the input factors with the greatest impact on total cost to cover the variation of 6 between the limits that were established in the design phase of Six Sigma.

  10. The cost-utility of screening for depression in primary care.

    Science.gov (United States)

    Valenstein, M; Vijan, S; Zeber, J E; Boehm, K; Buttar, A

    2001-03-06

    Depressive disorders are common in primary care and cause substantial disability, but they often remain undiagnosed. Screening is a frequently proposed strategy for increasing detection of depression. To examine the cost-utility of screening for depression compared with no screening. Nonstationary Markov model. The published literature. Hypothetical cohort of 40-year-old primary care patients. Lifetime. Health care payer and societal. Self-administered questionnaire followed by provider assessment. Costs and quality-adjusted life-years (QALYs). Compared with no screening, the cost to society of annual screening for depression in primary care patients is $192 444/QALY. Screening every 5 years and one-time screening cost $50 988/QALY and $32 053/QALY, respectively, compared with no screening. From the payer perspective, the cost of annual screening is $225 467. Cost-utility ratios are most sensitive to the prevalence of major depression, the costs of screening, rates of treatment initiation, and remission rates with treatment. In Monte Carlo sensitivity analyses, the cost-utility of annual screening is less than $50 000/QALY only 2.2% of the time. In multiway analyses, four model variables must be changed to extreme values for the cost-utility of annual screening to fall below $50 000/QALY, but a change in only one variable increases the cost-utility of one-time screening to more than $50 000/QALY. One-time screening is more robustly cost-effective if screening costs are low and effective treatments are being given. Annual and periodic screening for depression cost more than $50 000/QALY, but one-time screening is cost-effective. The cost-effectiveness of screening is likely to improve if treatment becomes more effective.

  11. Resource utilization and direct costs of pediatric HIV in Italy.

    Science.gov (United States)

    Giacomet, V; Fabiano, V; Lo Muto, R; Caiazzo, M A; Curto, A; Rampon, O; Zuccotti, G V; Garattini, L

    2013-01-01

    This multicenter, prospective, observational study assessed the global economic impact of HIV care in a large cohort of HIV-infected children and adolescents in Italy. Three pediatric departments of reference participated on a voluntary basis. Centers were asked to enroll all their children during the period April 2010-March 2011. At enrollment, a pediatrician completed a questionnaire for each patient, including the type of service at access (outpatient consultation or day hospital), laboratory tests, instrumental examinations, specialists' consultations, antiretroviral therapy and opportunistic illness prophylaxis. Eligible patients had a confirmed diagnosis of HIV infection caused by direct vertical maternal-fetal transmission, their age ranging from 0 to 24 years. Since patients routinely have quarterly check-ups in all three centers, we adopted a three-month time horizon. Health-care services were priced using outpatient and inpatient tariffs. Drug costs were calculated by multiplying the daily dose by the public price for each active ingredient. A total of 142 patients were enrolled. More than half the patients were female and the mean age was 14 years, with no significant differences by center. There were substantial differences in health-care management among the three centers, particularly as regards the type of access. One center enrolled the majority of its patients in day-hospital and prescribed a large number of clinical tests, while children accessed another center almost exclusively through outpatient consultation. Drug therapy was the main cost component and was very similar in all three centers. The day-hospital was the second highest cost component, much higher than outpatient consultation (including examinations), leading to significant differences between total costs per center. These findings suggest that a recommendation to the Italian National Health Service would be to use more outpatient consultation for patients' access in order to

  12. Incorporating psychological influences in probabilistic cost analysis

    Energy Technology Data Exchange (ETDEWEB)

    Kujawski, Edouard; Alvaro, Mariana; Edwards, William

    2004-01-08

    Today's typical probabilistic cost analysis assumes an ''ideal'' project that is devoid of the human and organizational considerations that heavily influence the success and cost of real-world projects. In the real world ''Money Allocated Is Money Spent'' (MAIMS principle); cost underruns are rarely available to protect against cost overruns while task overruns are passed on to the total project cost. Realistic cost estimates therefore require a modified probabilistic cost analysis that simultaneously models the cost management strategy including budget allocation. Psychological influences such as overconfidence in assessing uncertainties and dependencies among cost elements and risks are other important considerations that are generally not addressed. It should then be no surprise that actual project costs often exceed the initial estimates and are delivered late and/or with a reduced scope. This paper presents a practical probabilistic cost analysis model that incorporates recent findings in human behavior and judgment under uncertainty, dependencies among cost elements, the MAIMS principle, and project management practices. Uncertain cost elements are elicited from experts using the direct fractile assessment method and fitted with three-parameter Weibull distributions. The full correlation matrix is specified in terms of two parameters that characterize correlations among cost elements in the same and in different subsystems. The analysis is readily implemented using standard Monte Carlo simulation tools such as {at}Risk and Crystal Ball{reg_sign}. The analysis of a representative design and engineering project substantiates that today's typical probabilistic cost analysis is likely to severely underestimate project cost for probability of success values of importance to contractors and procuring activities. The proposed approach provides a framework for developing a viable cost management strategy for

  13. Life-Cycle Cost-Benefit Analysis

    DEFF Research Database (Denmark)

    Thoft-Christensen, Palle

    2010-01-01

    The future use of Life-Cycle Cost-Benefit (LCCB) analysis is discussed in this paper. A more complete analysis including not only the traditional factors and user costs, but also factors which are difficult to include in the analysis is needed in the future.......The future use of Life-Cycle Cost-Benefit (LCCB) analysis is discussed in this paper. A more complete analysis including not only the traditional factors and user costs, but also factors which are difficult to include in the analysis is needed in the future....

  14. Clinical characteristics, healthcare costs, and resource utilization in hepatitis C vary by genotype.

    Science.gov (United States)

    Goolsby Hunter, Alyssa; Rosenblatt, Lisa; Patel, Chad; Blauer-Peterson, Cori; Anduze-Faris, Beatrice

    2017-05-01

    In the United States, approximately 3 million people are infected with hepatitis C virus (HCV). Genotypes of HCV variably affect disease progression and treatment response. However, the relationships between HCV genotypes and liver disease progression, healthcare resource utilization, and healthcare costs have not been fully explored. In this retrospective study of patients with chronic hepatitis C (CHC), healthcare claims from a large US health plan were used to collect data on patient demographic and clinical characteristics. Main outcome measures include healthcare resource utilization (HCRU) and healthcare costs. Linked laboratory data provided genotype and select measures to determine liver disease severity. The sample (mean age 50.6 years, 63.5% male) included 10,331 patients, of whom 79.1% had genotype (GT)1, 12.8% had GT2, and 8.1% had GT3. Descriptive analyses demonstrated variation by HCV genotype in liver and non-liver related comorbidities, liver disease severity, and healthcare costs. The highest percentage of patients with liver-related comorbidities and advanced liver disease was found among those with GT3. Meanwhile, patients with GT2 had lower HCRU and the lowest costs, and patients with GT1 had the highest total all-cause costs. These differences may reflect differing rates of non-liver-related comorbidities and all-cause care. Multivariable analyses showed that genotype was a significant predictor of costs and liver disease severity: compared with patients having GT1, those with GT3 were significantly more likely to have advanced liver disease. Patients with GT2 were significantly less likely to have advanced disease and more likely to have lower all-cause costs. Results may not be generalizable to patients outside the represented commercial insurance plans, and analysis of a prevalent population may underestimate HCRU and costs relative to a sample of treated patients. These results suggest that liver disease progression varies by genotype and

  15. A methodology to identify stranded generation facilities and estimate stranded costs for Louisiana's electric utility industry

    Science.gov (United States)

    Cope, Robert Frank, III

    1998-12-01

    The electric utility industry in the United States is currently experiencing a new and different type of growing pain. It is the pain of having to restructure itself into a competitive business. Many industry experts are trying to explain how the nation as a whole, as well as individual states, will implement restructuring and handle its numerous "transition problems." One significant transition problem for federal and state regulators rests with determining a utility's stranded costs. Stranded generation facilities are assets which would be uneconomic in a competitive environment or costs for assets whose regulated book value is greater than market value. At issue is the methodology which will be used to estimate stranded costs. The two primary methods are known as "Top-Down" and "Bottom-Up." The "Top-Down" approach simply determines the present value of the losses in revenue as the market price for electricity changes over a period of time into the future. The problem with this approach is that it does not take into account technical issues associated with the generation and wheeling of electricity. The "Bottom-Up" approach computes the present value of specific strandable generation facilities and compares the resulting valuations with their historical costs. It is regarded as a detailed and difficult, but more precise, approach to identifying stranded assets and their associated costs. This dissertation develops a "Bottom-Up" quantitative, optimization-based approach to electric power wheeling within the state of Louisiana. It optimally evaluates all production capabilities and coordinates the movement of bulk power through transmission interconnections of competing companies in and around the state. Sensitivity analysis to this approach is performed by varying seasonal consumer demand, electric power imports, and transmission inter-connection cost parameters. Generation facility economic dispatch and transmission interconnection bulk power transfers, specific

  16. Cost-utility analyses of drug therapies in breast cancer: a systematic review.

    Science.gov (United States)

    Nerich, Virginie; Saing, Sopany; Gamper, Eva Maria; Kemmler, Georg; Daval, Franck; Pivot, Xavier; Holzner, Bernhard

    2016-10-01

    The economic evaluation (EE) of health care products has become a necessity. Their quality must be high in order to trust the results and make informed decisions. While cost-utility analyses (CUAs) should be preferred to cost-effectiveness analyses in the oncology area, the quality of breast cancer (BC)-related CUA has been given little attention so far. Thus, firstly, a systematic review of published CUA related to drug therapies for BC, gene expression profiling, and HER2 status testing was performed. Secondly, the quality of selected CUA was assessed and the factors associated with a high-quality CUA identified. The systematic literature search was conducted in PubMed, MEDLINE/EMBASE, and Cochrane to identify published CUA between 2000 and 2014. After screening and data extraction, the quality of each selected CUA was assessed by two independent reviewers, using the checklist proposed by Drummond et al. The analysis of factors associated with a high-quality CUA (defined as a Drummond score ≥7) was performed using a two-step approach. Our systematic review was based on 140 CUAs and showed a wide variety of methodological approaches, including differences in the perspective adopted, the time horizon, measurement of cost and effectiveness, and more specially health-state utility values (HSUVs). The median Drummond score was 7 [range 3-10]. Only one in two of the CUA (n = 74) had a Drummond score ≥7, synonymous of "high quality." The statistically significant predictors of a high-quality CUA were article with "gene expression profiling" topic (p = 0.001), consulting or pharmaceutical company as main location of first author (p = 0.004), and articles with both incremental cost-utility ratio and incremental cost-effectiveness ratio as outcomes of EE (p = 0.02). Our systematic review identified only 140 CUAs published over the past 15 years with one in two of high quality. It showed a wide variety of methodological approaches, especially focused on HSUVs. A

  17. Cost-utility analysis of lopinavir/ritonavir versus atazanavir + ritonavir administered as first-line therapy for the treatment of HIV infection in Italy: from randomised trial to real world.

    Directory of Open Access Journals (Sweden)

    Emanuela Foglia

    Full Text Available OBJECTIVE: To estimate the lifetime cost utility of two antiretroviral regimens (once-daily atazanavir plus ritonavir [ATV+r] versus twice-daily lopinavir/ritonavir [LPV/r] in Italian human immunodeficiency virus (HIV-infected patients naïve to treatment. DESIGN: With this observational retrospective study we collected the clinical data of a cohort of HIV-infected patients receiving first-line treatment with LPV/r or ATV+r. METHODOLOGY: A Markov microsimulation model including direct costs and health outcomes of first- and second-line highly active retroviral therapy was developed from a third-party (Italian National Healthcare Service payer's perspective. Health and monetary outcomes associated with the long-term use of ATV+r and LPV/r regimens were evaluated on the basis of eight health states, incidence of diarrhoea and hyperbilirubinemia, AIDS events, opportunistic infections, coronary heart disease events and, for the first time in an economic evaluation, chronic kidney disease (CKD events. In order to account for possible deviations between real-life data and randomised controlled trial results, a second control arm (ATV+r 2 was created with differential transition probabilities taken from the literature. RESULTS: The average survival was 24.061 years for patients receiving LPV/r, 24.081 and 24.084 for those receiving ATV+r 1 and 2 respectively. The mean quality-adjusted life-years (QALYs were higher for the patients receiving LPV/r than those receiving ATV+r (13.322 vs. 13.060 and 13.261 for ATV+r 1 and 2. The cost-utility values were 15,310.56 for LPV/r, 15,902.99 and 15,524.85 for ATV+r 1 and 2. CONCLUSIONS: Using real-life data, the model produced significantly different results compared with other studies. With the innovative addition of an evaluation of CKD events, the model showed a cost-utility value advantage for twice-daily LPV/r over once-daily ATV+r, thus providing evidence for its continued use in the treatment of HIV.

  18. RECTIFIED ETHANOL PRODUCTION COST ANALYSIS

    Directory of Open Access Journals (Sweden)

    Nikola J Budimir

    2011-01-01

    Full Text Available This paper deals with the impact of the most important factors of the total production costs in bioethanol production. The most influential factors are: total investment costs, price of raw materials (price of biomass, enzymes, yeast, and energy costs. Taking into account these factors, a procedure for estimation total production costs was establish. In order to gain insight into the relationship of production and selling price of bioethanol, price of bioethanol for some countries of the European Union and the United States are given.

  19. Different approaches to estimating transition costs in the electric- utility industry

    Energy Technology Data Exchange (ETDEWEB)

    Baxter, L.W.

    1995-10-01

    The term ``transition costs`` describes the potential revenue shortfall (or welfare loss) a utility (or other actor) may experience through government-initiated deregulation of electricity generation. The potential for transition costs arises whenever a regulated industry is subject to competitive market forces as a result of explicit government action. Federal and state proposals to deregulate electricity generation sparked a national debate on transition costs in the electric-utility industry. Industry-wide transition cost estimates range from about $20 billion to $500 billion. Such disparate estimates raise important questions on estimation methods for decision makers. This report examines different approaches to estimating transition costs. The study has three objectives. First, we discuss the concept of transition cost. Second, we identify the major cost categories included in transition cost estimates and summarize the current debate on which specific costs are appropriately included in these estimates. Finally, we identify general and specific estimation approaches and assess their strengths and weaknesses. We relied primarily on the evidentiary records established at the Federal Energy Regulatory Commission and the California Public Utilities Commission to identify major cost categories and specific estimation approaches. We also contacted regulatory commission staffs in ten states to ascertain estimation activities in each of these states. We refined a classification framework to describe and assess general estimation options. We subsequently developed and applied criteria to describe and assess specific estimation approaches proposed by federal regulators, state regulators, utilities, independent power companies, and consultants.

  20. Comparative cost estimates of five coal utilization processes

    Energy Technology Data Exchange (ETDEWEB)

    1979-01-01

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

  1. Factors associated with the utilization and costs of health and social services in frail elderly patients

    Directory of Open Access Journals (Sweden)

    Kehusmaa Sari

    2012-07-01

    Full Text Available Abstract Background Universal access is one of the major aims in public health and social care. Services should be provided on the basis of individual needs. However, municipal autonomy and the fragmentation of services may jeopardize universal access and lead to variation between municipalities in the delivery of services. This paper aims to identify patient-level characteristics and municipality-level service patterns that may have an influence on the use and costs of health and social services of frail elderly patients. Methods Hierarchical analysis was applied to estimate the effects of patient and municipality-level variables on services utilization. Results The variation in the use of health care services was entirely due to patient-related variables, whereas in the social services, 9% of the variation was explained by the municipality-level and 91% by the patient-level characteristics. Health-related quality of life explained a major part of variation in the costs of health care services. Those who had reported improvement in their health status during the preceding year were more frequent users of social care services. Low informal support, poor functional status and poor instrumental activities of daily living, living at a residential home, and living alone were associated with higher social services expenditure. Conclusions The results of this study showed municipality-level variation in the utilization of social services, whereas health care services provided for frail elderly people seem to be highly equitable across municipalities. Another important finding was that the utilization of social and health services were connected. Those who reported improvement in their health status during the preceding year were more frequently also using social services. This result suggests that if municipalities continue to limit the provision of support services only for those who are in the highest need, this saving in the social sector may, in

  2. The effects of utility DSM programs on electricity costs and prices

    Energy Technology Data Exchange (ETDEWEB)

    Hirst, E.

    1991-11-01

    More and more US utilities are running more and larger demand-side management (DSM) programs. Assessing the cost-effectiveness of these programs raises difficult questions for utilities and their regulators. Should these programs aim to minimize the total cost of providing electric-energy services or should they minimize the price of electricity This study offers quantitative estimates on the tradeoffs between total costs and electricity prices. This study uses a dynamic model to assess the effects of energy-efficiency programs on utility revenues, total resource costs, electricity prices, and electricity consumption for the period 1990 to 2010. These DSM programs are assessed under alternative scenarios. In these cases, fossil-fuel prices, load growth, the amount of excess capacity the utility has in 1990, planned retirements of power plants, the financial treatment of DSM programs, and the costs of energy- efficient programs vary. These analyses are conducted for three utilities: a base'' that is typical of US utilities; a surplus'' utility that has excess capacity, few planned retirements, and slow growth in fossil-fuel prices and incomes; and a deficit'' utility that has little excess capacity, many planned retirements, and rapid growth in fossil-fuel prices and incomes. 28 refs.

  3. Ethics and Cost-Benefit Analysis

    DEFF Research Database (Denmark)

    Arler, Finn

    The purpose of this research report is threefold. Firstly, the author traces the origins and justification of cost-benefit analysis in moral and political philosophy. Secondly, he explain some of the basic features of cost-benefit analysis as a planning tool in a step-bystep presentation. Thirdly......, he presents and discusses some of the main ethical difficulties related to the use of cost-benefit analysis as a planning tool....

  4. Impact of depression on health care utilization and costs among multimorbid patients--from the MultiCare Cohort Study.

    Directory of Open Access Journals (Sweden)

    Jens-Oliver Bock

    Full Text Available OBJECTIVE: The objective of this study was to describe and analyze the effects of depression on health care utilization and costs in a sample of multimorbid elderly patients. METHOD: This cross-sectional analysis used data of a prospective cohort study, consisting of 1,050 randomly selected multimorbid primary care patients aged 65 to 85 years. Depression was defined as a score of six points or more on the Geriatric Depression Scale (GDS-15. Subjects passed a geriatric assessment, including a questionnaire for health care utilization. The impact of depression on health care costs was analyzed using multiple linear regression models. A societal perspective was adopted. RESULTS: Prevalence of depression was 10.7%. Mean total costs per six-month period were €8,144 (95% CI: €6,199-€10,090 in patients with depression as compared to €3,137 (95% CI: €2,735-€3,538; p<0.001 in patients without depression. The positive association between depression and total costs persisted after controlling for socio-economic variables, functional status and level of multimorbidity. In particular, multiple regression analyses showed a significant positive association between depression and pharmaceutical costs. CONCLUSION: Among multimorbid elderly patients, depression was associated with significantly higher health care utilization and costs. The effect of depression on costs was even greater than reported by previous studies conducted in less morbid patients.

  5. Antimicrobial agents' utilization and cost pattern in an Intensive Care Unit of a Teaching Hospital in South India

    Directory of Open Access Journals (Sweden)

    Nikhilesh Anand

    2016-01-01

    Full Text Available Background and Aims: High utilization and inappropriate usage of antimicrobial agents (AMAs in an Intensive Care Unit (ICU increases resistant organisms, morbidity, mortality, and treatment cost. Prescription audit and active feedback are a proven method to check the irrational prescription. Measuring drug utilization in DDD/100 bed-days is proposed by the WHO to analyze and compare the utilization of drugs. Data of AMAs utilization are required for planning an antibiotic policy and for follow-up of intervention strategies. Hence, in this study, we proposed to evaluate the utilization pattern and cost analysis of AMA used in the ICU. Methodology: A prospective observational study was conducted for 1 year from January 1, 2014, to December 31, 2014, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, relevant investigation, the utilization of different classes of AMAs (WHO-ATC classification as well as individual drugs and their costs were recorded. Results: One thousand eight hundred and sixty-two prescriptions of AMAs were recorded during the study period with an average of 1.73 ± 0.04 prescriptions/patient. About 80.4% patients were prescribed AMAs during admission. Ceftriaxone (22.77% was the most commonly prescribed AMA followed by piperacillin/tazobactam (15.79%, metronidazole (12%, amoxicillin/clavulanic acid (6.44%, and azithromycin (4.34%. Ceftriaxone, piperacillin/tazobactam, metronidazole, and linezolid were the five maximally utilized AMAs with 38.52, 19.22, 14.34, 8.76, and 8.16 DDD/100 bed-days respectively. An average cost of AMAs used per patient was 2213 Indian rupees (INR. Conclusion: A high utilization of AMAs and a high cost of treatment were noticed which was comparable to other published data, though an increased use of newer AMAs such as linezolid, clindamycin, meropenem, colistin was noticed.

  6. Costs and health care resource utilization among chronic obstructive pulmonary disease patients with newly acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Lin J

    2014-07-01

    Full Text Available Junji Lin,1 Yunfeng Li,2 Haijun Tian,2 Michael J Goodman,1 Susan Gabriel,2 Tara Nazareth,2 Stuart J Turner,2,3 Stephen Arcona,2 Kristijan H Kahler21Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA; 2Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 3Ernest Mario School of Pharmacy, Rutgers University, New Brunswick, NJ, USA Background: Patients with chronic obstructive pulmonary disease (COPD are at increased risk for lung infections and other pathologies (eg, pneumonia; however, few studies have evaluated the impact of pneumonia on health care resource utilization and costs in this population. The purpose of this study was to estimate health care resource utilization and costs among COPD patients with newly acquired pneumonia compared to those without pneumonia. Methods: A retrospective claims analysis using Truven MarketScan® Commercial and Medicare databases was conducted. COPD patients with and without newly acquired pneumonia diagnosed between January 1, 2004 and September 30, 2011 were identified. Propensity score matching was used to create a 1:1 matched cohort. Patient demographics, comorbidities (measured by Charlson Comorbidity Index, and medication use were evaluated before and after matching. Health care resource utilization (ie, hospitalizations, emergency room [ER] and outpatient visits, and associated health care costs were assessed during the 12-month follow-up. Logistic regression was conducted to evaluate the risk of hospitalization and ER visits, and gamma regression models and two-part models compared health care costs between groups after matching. Results: In the baseline cohort (N=467,578, patients with newly acquired pneumonia were older (mean age: 70 versus [vs] 63 years and had higher Charlson Comorbidity Index scores (3.3 vs 2.6 than patients without pneumonia. After propensity score matching, the pneumonia cohort was nine times more likely

  7. Quantification and Classification of E. coli Proteome Utilization and Unused Protein Costs across Environments

    DEFF Research Database (Denmark)

    O'Brien, Edward J.; Utrilla, Jose; Palsson, Bernhard

    2016-01-01

    The costs and benefits of protein expression are balanced through evolution. Expression of un-utilized protein (that have no benefits in the current environment) incurs a quantifiable fitness costs on cellular growth rates; however, the magnitude and variability of un-utilized protein expression...... and utility of the proteome on a per gene basis. We show that nearly half of the proteome mass is unused in certain environments and accounting for the cost of this unused protein expression explains >95% of the variance in growth rates of Escherichia coli across 16 distinct environments. Furthermore...... in natural settings is unknown, largely due to the challenge in determining environment-specific proteome utilization. We address this challenge using absolute and global proteomics data combined with a recently developed genome-scale model of Escherichia coli that computes the environment-specific cost...

  8. Utility-Scale Lithium-Ion Storage Cost Projections for Use in Capacity Expansion Models

    Energy Technology Data Exchange (ETDEWEB)

    Cole, Wesley J.; Marcy, Cara; Krishnan, Venkat K.; Margolis, Robert

    2016-11-21

    This work presents U.S. utility-scale battery storage cost projections for use in capacity expansion models. We create battery cost projections based on a survey of literature cost projections of battery packs and balance of system costs, with a focus on lithium-ion batteries. Low, mid, and high cost trajectories are created for the overnight capital costs and the operating and maintenance costs. We then demonstrate the impact of these cost projections in the Regional Energy Deployment System (ReEDS) capacity expansion model. We find that under reference scenario conditions, lower battery costs can lead to increased penetration of variable renewable energy, with solar photovoltaics (PV) seeing the largest increase. We also find that additional storage can reduce renewable energy curtailment, although that comes at the expense of additional storage losses.

  9. Ancillary-service costs for 12 US electric utilities

    Energy Technology Data Exchange (ETDEWEB)

    Kirby, B.; Hirst, E.

    1996-03-01

    Ancillary services are those functions performed by electrical generating, transmission, system-control, and distribution-system equipment and people to support the basic services of generating capacity, energy supply, and power delivery. The Federal Energy Regulatory Commission defined ancillary services as ``those services necessary to support the transmission of electric power from seller to purchaser given the obligations of control areas and transmitting utilities within those control areas to maintain reliable operations of the interconnected transmission system.`` FERC divided these services into three categories: ``actions taken to effect the transaction (such as scheduling and dispatching services) , services that are necessary to maintain the integrity of the transmission system [and] services needed to correct for the effects associated with undertaking a transaction.`` In March 1995, FERC published a proposed rule to ensure open and comparable access to transmission networks throughout the country. The rule defined six ancillary services and developed pro forma tariffs for these services: scheduling and dispatch, load following, system protection, energy imbalance, loss compensation, and reactive power/voltage control.

  10. Low Cost Scan Test by Test Correlation Utilization

    Institute of Scientific and Technical Information of China (English)

    Ozgur Sinanoglu

    2007-01-01

    Scan-based testing methodologies remedy the testability problem of sequential circuits; yet they suffer from prolonged test time and excessive test power due to numerous shift operations. The correlation among test data along with the high density of the unspecified bits in test data enables the utilization of the existing test data in the scan chain for the generation of the subsequent test stimulus, thus reducing both test time and test data volume. We propose a pair of scan approaches in this paper; in the first approach, a test stimulus partially consists of the preceding stimulus, while in the second approach, a test stimulus partially consists of the preceding test response bits. Both proposed scan-based test schemes access only a subset of scan cells for loading the subsequent test stimulus while freezing the remaining scan cells with the preceding test data, thus decreasing scan chain transitions during shift operations. The proposed scan architecture is coupled with test data manipulation techniques which include test stimuli ordering and partitioning algorithms, boosting test time reductions. The experimental results confirm that test time reductions exceeding 97%,and test power reductions exceeding 99% can be achieved by the proposed scan-based testing methodologies on larger ISCAS89 benchmark circuits.

  11. Combined multi-criteria and cost-benefit analysis

    DEFF Research Database (Denmark)

    Moshøj, Claus Rehfeld

    1996-01-01

    The paper is an introduction to both theory and application of combined Cost-Benefit and Multi-Criteria Analysis. The first section is devoted to basic utility theory and its practical application in Cost-Benefit Analysis. Based on some of the problems encountered, arguments in favour...... of the application of utility-based Multi-Criteria Analyses methods as an extension and refinement of the traditional Cost-Benefit Analysis are provided. The theory presented in this paper is closely related the methods used in the WARP software (Leleur & Jensen, 1989). The presentation is however wider in scope...... sensitivity. Since pair-wise comparisons contains information on the trade-off’s acceptable to the decision maker, it is possible to calculate the shadow price of the effect compared to a given price base. The final section discusses two different approaches for the building of weight profiles...

  12. Chapter 17. Engineering cost analysis

    Energy Technology Data Exchange (ETDEWEB)

    Higbee, Charles V.

    1998-01-01

    In the early 1970s, life cycle costing (LCC) was adopted by the federal government. LCC is a method of evaluating all the costs associated with acquisition, construction and operation of a project. LCC was designed to minimize costs of major projects, not only in consideration of acquisition and construction, but especially to emphasize the reduction of operation and maintenance costs during the project life. Authors of engineering economics texts have been very reluctant and painfully slow to explain and deal with LCC. Many authors devote less than one page to the subject. The reason for this is that LCC has several major drawbacks. The first of these is that costs over the life of the project must be estimated based on some forecast, and forecasts have proven to be highly variable and frequently inaccurate. The second problem with LCC is that some life span must be selected over which to evaluate the project, and many projects, especially renewable energy projects, are expected to have an unlimited life (they are expected to live for ever). The longer the life cycle, the more inaccurate annual costs become because of the inability to forecast accurately.

  13. Cost of bariatric surgery and factors associated with increased cost: an analysis of national inpatient sample.

    Science.gov (United States)

    Khorgami, Zhamak; Aminian, Ali; Shoar, Saeed; Andalib, Amin; Saber, Alan A; Schauer, Philip R; Brethauer, Stacy A; Sclabas, Guido M

    2017-08-01

    In the current healthcare environment, bariatric surgery centers need to be cost-effective while maintaining quality. The aim of this study was to evaluate national cost of bariatric surgery to identify the factors associated with a higher cost. A retrospective analysis of 2012-2013 Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS). We included all patients with a diagnosis of morbid obesity (ICD9 278.01) and a Diagnosis Related Group code related to procedures for obesity, who underwent Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), or adjustable gastric banding (AGB) as their primary procedure. We converted "hospital charges" to "cost," using hospital specific cost-to-charge ratio. Inflation was adjusted using the annual consumer price index. Increased cost was defined as the top 20th percentile of the expenditure and its associated factors were analyzed using the logistic regression multivariate analysis. A total of 45,219 patients (20,966 RYGBs, 22,380 SGs, and 1,873 AGBs) were included. The median (interquartile range) calculated costs for RYGB, SG, and AGB were $12,543 ($9,970-$15,857), $10,531 ($8,248-$13,527), and $9,219 ($7,545-$12,106), respectively (P<.001). Robotic-assisted procedures had the highest impact on the cost (odds ratio 3.6, 95% confidence interval 3.2-4). Hospital cost of RYGB and SG increased linearly with the length of hospital stay and almost doubled after 7 days. Furthermore, multivariate analysis showed that certain co-morbidities and concurrent procedures were associated with an increased cost. Factors contributing to the cost variation of bariatric procedures include co-morbidities, robotic platform, complexity of surgery, and hospital length of stay. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Patton, Michael Quinn

    1988-01-01

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

  15. 18 CFR 260.200 - Original cost statement of utility property.

    Science.gov (United States)

    2010-04-01

    ...), (2) the cost of the acquiring company, (3) the amount entered in the books as of the date of...) § 260.200 Original cost statement of utility property. Any natural gas company becoming subject to the... development of the company, including, particularly, a description (giving names of parties and dates) of...

  16. ECONOMIC AND ENERGETICAL ANALYSIS OF IMPROVED WASTE UTILIZATION PLASMA TECHNOLOGY

    Directory of Open Access Journals (Sweden)

    Serghei VAMBOL

    2015-07-01

    Full Text Available Purpose. Energy and economic evaluation of the improved plasma waste utilization technological process, as well as an expediency substantiation of the use of improved plasma technology by comparing its energy consumption with other thermal methods of utilization. Methodology. Analysis of existing modern and advanced methods of waste management and its impact on environmental safety. Considering of energy and monetary costs to implement two different waste management technologies. Results. Studies have shown regular gasification ensure greater heating value due to differences, a significant amount of nitrogen than for plasma gasification. From the point of view of minimizing energy and monetary costs and environmental safety more promising is to offer advanced technology for plasma waste. To carry out the energy assessment of the appropriateness of the considered technologies-comparative calculation was carried out at the standard conditions. This is because in the processing of waste produced useful products, such as liquefied methane, synthetic gas (94% methane and a fuel gas for heating, suitable for sale that provides cost-effectiveness of this technology. Originality. Shown and evaluated ecological and economic efficiency of proposed improved plasma waste utilization technology compared with other thermal techniques. Practical value. Considered and grounded of energy and monetary costs to implement two different waste management technologies, namely ordinary gasification and using plasma generators. Proposed plasma waste utilization technology allows to obtain useful products, such as liquefied methane, synthetic gas and a fuel gas for heating, which are suitable for sale. Plant for improved plasma waste utilization technological process allows to compensate the daily and seasonal electricity and heat consumption fluctuations by allowing the storage of obtained fuel products.

  17. Hospital Utilization and Cost Trends in Canada and the United States

    Science.gov (United States)

    Andersen, Ronald; Hull, John T.

    1969-01-01

    Differences in hospital costs and utilization between the United States and Canada are analyzed and an attempt made to measure the significance of various demographic, economic, and other factors thought to be related to the differences. Increases in utilization are traced to population increases and to actual increased use per person; and cost increases tied to general inflationary trends are separated from those attributable to specific hospital price increases. Differences in the financing and reimbursement mechanisms in the two countries are shown to have had little effect on relative cost increases, which in the period under consideration were parallelled by similar or greater increases in other industrialized nations. PMID:4981616

  18. Optimizing choice of oral interferon-free treatment for genotype 1 hepatitis C virus using testing for NS5A resistance: a cost-utility analysis from the perspective of the Italian National Health Service

    Science.gov (United States)

    Westerhout, Kirsten Y; Bouwmeester, Walter; Duchesne, Inge; Pisini, Marta; Piena, Marjanne A; Damele, Francesco; Gueron, Beatrice; Treur, Maarten; Belsey, Jonathan

    2017-01-01

    Background Patients with genotype-1 hepatitis C virus infection who have failed to respond to standard therapy or who relapse following treatment may be considered for an interferon-free regimen incorporating a nonstructural protein 5A (NS5A) inhibitor. Sustained virologic response (SVR) with these regimens is typically >90%, but this is reduced in patients with NS5A resistance. European Association for Study of the Liver guidelines recommend simeprevir + sofosbuvir ± ribavirin (SMV+SOF±R) for re-treating patients failing an NS5A inhibitor-containing regimen. An alternative strategy would be to test for NS5A resistance prior to treatment, with therapy optimized based on the results. This study investigates the cost-effectiveness of this strategy. Materials and methods A Markov model was used to estimate disease progression for treatment-experienced genotype 1 patients with severe fibrosis or compensated cirrhosis. Targeted treatment with either SMV+SOF±R or sofosbuvir + ledipasvir ± ribavirin (SOF+LDV±R) based on pretreatment NS5A resistance testing was compared to routine SOF+LDV±R without testing. Treatment duration was 12 or 24 weeks for patients with severe fibrosis or compensated cirrhosis (Metavir F3/F4). SVR data for the treatment options were based on the results of published clinical trials. The analysis was carried out from the perspective of the Italian National Health Service. Results Optimized treatment using NS5A resistance testing yielded 0.163 additional QALYs and increased costs of €2,789 per patient versus no testing. The incremental cost-effectiveness ratio (ICER) was €17,078/QALY. Sensitivity analysis identified the SVR attributable to each of the treatment regimens as the most sensitive determinant of ICER (range: €10,055/QALY–€43,501/QALY across plausible range). Probabilistic sensitivity analysis demonstrated that, at a willingness-to-pay threshold of €30,000/QALY, the probability that NS5A-directed treatment will be cost

  19. Summit Station Skiway Cost Analysis

    Science.gov (United States)

    2016-07-01

    pass, depend- ing on skiway condition. Total construction time will take approximately 27–30 hours, or 4 working days. Surface maintenance ...ERDC develops innovative solutions in civil and military engineering, geospatial sciences, water resources, and environmental sciences for the...cargo loads. To explore further skiway improvement and cost saving techniques, this report reviews alternative maintenance and construction options

  20. Cost-Utility of Interventions in Patients with Carpal Tunnel Syndrome in a Universitary Hospital in Cali, Colombia

    Directory of Open Access Journals (Sweden)

    César Augusto Guevara

    2015-05-01

    Full Text Available Introduction: Although there are several treatments for carpal tunnel syndrome (CTS, the efficiency of these has not evaluated in Colombia. Objective: Determine the incremental cost-utility ratio (ICUR of medical and surgical treatment in patients with CTS. Material and methods: A cost utility analysis was conducted from the societal perspective with patients older than 18 years diagnosed with CTS who received medical or surgical treatment. Quality-adjusted life-years (QALYs were calculated using the EQ-5D. Costs were obtained from the ISS national tariff 2001+30 %. The results were extrapolated to long term through a Markov model with a discount rate of 3,5 %. A probabilistic sensitivity analysis using Monte Carlo simulation was performed. Results: Fifty- three patients participated, women (71,7 %; mean age: 55,5 years. 79 % of patients received medical treatment. The most frequent treatment was medical observation (66,7 % and NSAIDs (16,6 %. Medical treatment provided 0,33 QALYs (± 0,11 and surgery 0,37 (± 0,10. The average total cost of medical treatment at 6 months and 20 years was COP 132 006 (95 % CI: COP 70 255 - 425 341 and COP 483 440 (95 % CI: COP 104 310 - 862 570 respectively. The cost of surgery was COP 1 972 644 (95 % CI: COP 981 204 - 8 517 065 and COP 979 585 (95 %: COP 684 912 - 1 274 258. The surgery was dominated by 6 months. The ICUR at 20 years was COP 1 033 635/QALY additional (95 % CI: COP 840 179 - 1 235 323/additional QALY with a 80 % of probability that surgery be cost-utility when there is a willingness to pay COP 5 000 000. Conclusion: The medical treatment is cost-effective with regard to the surgery in short term. However, in the long term the surgery is cost effective with respect to the medical treatment.

  1. 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.

  2. Cost analysis of whole genome sequencing in German clinical practice.

    Science.gov (United States)

    Plöthner, Marika; Frank, Martin; von der Schulenburg, J-Matthias Graf

    2017-06-01

    Whole genome sequencing (WGS) is an emerging tool in clinical diagnostics. However, little has been said about its procedure costs, owing to a dearth of related cost studies. This study helps fill this research gap by analyzing the execution costs of WGS within the setting of German clinical practice. First, to estimate costs, a sequencing process related to clinical practice was undertaken. Once relevant resources were identified, a quantification and monetary evaluation was conducted using data and information from expert interviews with clinical geneticists, and personnel at private enterprises and hospitals. This study focuses on identifying the costs associated with the standard sequencing process, and the procedure costs for a single WGS were analyzed on the basis of two sequencing platforms-namely, HiSeq 2500 and HiSeq Xten, both by Illumina, Inc. In addition, sensitivity analyses were performed to assess the influence of various uses of sequencing platforms and various coverage values on a fixed-cost degression. In the base case scenario-which features 80 % utilization and 30-times coverage-the cost of a single WGS analysis with the HiSeq 2500 was estimated at €3858.06. The cost of sequencing materials was estimated at €2848.08; related personnel costs of €396.94 and acquisition/maintenance costs (€607.39) were also found. In comparison, the cost of sequencing that uses the latest technology (i.e., HiSeq Xten) was approximately 63 % cheaper, at €1411.20. The estimated costs of WGS currently exceed the prediction of a 'US$1000 per genome', by more than a factor of 3.8. In particular, the material costs in themselves exceed this predicted cost.

  3. Rapid increase of health care utilization and cost due to benign prostatic hyperplasia in Korean men: retrospective population-based analysis using the Health Insurance Review and Assessment service data.

    Science.gov (United States)

    Son, Hwancheol; Park, Juhyun; Song, Sang Hoon; Kang, Jung Yoon; Hong, Sung Kyu; Lee, Hyun Moo; Kim, Sun-Hee; Park, Byung-Joo; Lee, Hyung-Lae; Lee, Kyung Seop

    2015-02-01

    Using the Korean public health insurance database, we analyzed patients diagnosed as benign prostatic hyperplasia (BPH) from 2004 to 2008. Age and year-specific amount and seasonal variation of hospital visits (HV), duration of treatment (DT), the total and per capita amount of insurance payment (TAIP, PCIP) were evaluated. A total of 12,088,995 HV were studied. Total HV increased 1.7 times and DT almost doubled in 2008 compared to those in 2004. HV, DT, and TAIP showed linearly increasing patterns year by year. In a time series analysis, HV increased in winter and demonstrated seasonality in a 12-month cycle. In a Poisson regression analysis, the annual variations of HV, DT, TAIP, and PCIP were different by age groups. In patients older than 40 yr, HV significantly increased 1.10-1.16 times compared to that of the previous year. DT markedly increased in their 60s and 80s patients. The rate of increase in PCIP was steeper in patients 50 yr and older than in the others.Health care utilization due to BPH was rapidly increasing in Korea and it was remarkable in the elderly population. Seasonal variation of HV demonstrated that health care utilization increased in winter.

  4. Methods for Analyzing the Benefits and Costs of Distributed Photovoltaic Generation to the U.S. Electric Utility System

    Energy Technology Data Exchange (ETDEWEB)

    Denholm, P.; Margolis, R.; Palmintier, B.; Barrows, C.; Ibanez, E.; Bird, L.; Zuboy, J.

    2014-09-01

    This report outlines the methods, data, and tools that could be used at different levels of sophistication and effort to estimate the benefits and costs of DGPV. In so doing, we identify the gaps in current benefit-cost-analysis methods, which we hope will inform the ongoing research agenda in this area. The focus of this report is primarily on benefits and costs from the utility or electricity generation system perspective. It is intended to provide useful background information to utility and regulatory decision makers and their staff, who are often being asked to use or evaluate estimates of the benefits and cost of DGPV in regulatory proceedings. Understanding the technical rigor of the range of methods and how they might need to evolve as DGPV becomes a more significant contributor of energy to the electricity system will help them be better consumers of this type of information. This report is also intended to provide information to utilities, policy makers, PV technology developers, and other stakeholders, which might help them maximize the benefits and minimize the costs of integrating DGPV into a changing electricity system.

  5. Activity Analysis and Cost Analysis in Medical Schools.

    Science.gov (United States)

    Koehler, John E.; Slighton, Robert L.

    There is no unique answer to the question of what an ongoing program costs in medical schools. The estimates of program costs generated by classical methods of cost accounting are unsatisfactory because such accounting cannot deal with the joint production or joint cost problem. Activity analysis models aim at calculating the impact of alternative…

  6. A comparison of costs associated with utility management options for dry active waste

    Energy Technology Data Exchange (ETDEWEB)

    Hornibrook, C. [EPRI, Palo Alto, CA (United States)

    1995-12-31

    The economics of low level waste management is receiving more attention today than ever before. This is due to four factors: (1) the increases in the cost of processing of these wastes; (2) increases in the cost of disposal; (3) the addition of storage costs for those without access to disposal; and (4) the increasing competitive nature of the electric generation industry. These pressures are forcing the industry to update it`s evaluation of the mix of processing that will afford it the best long term economics and minimize it`s risks for unforeseen costs. Whether disposal is available or not, all utilities face the same challenge of minimizing the costs associated with the management of these wastes. There are a number of variables that will impact how a utility manages their wastes but the problem is the uncertainty of what will actually happen, i.e., will disposal be available, when and at what cost. Using the EPRI-developed WASTECOST: DAW code, this paper explores a variety of LLW management options available to utilities. Along with providing the costs and benefits, other technical considerations which play an important part in the management of these wastes are also addressed.

  7. Cross-Continuum Tool Is Associated with Reduced Utilization and Cost for Frequent High-Need Users

    Science.gov (United States)

    Hardin, Lauran; Kilian, Adam; Muller, Leslie; Callison, Kevin; Olgren, Michael

    2017-01-01

    Introduction High-need, high-cost (HNHC) patients can over-use acute care services, a pattern of behavior associated with many poor outcomes that disproportionately contributes to increased U.S. healthcare cost. Our objective was to reduce healthcare cost and improve outcomes by optimizing the system of care. We targeted HNHC patients and identified root causes of frequent healthcare utilization. We developed a cross-continuum intervention process and a succinct tool called a Complex Care Map (CCM)© that addresses fragmentation in the system and links providers to a comprehensive individualized analysis of the patient story and causes for frequent access to health services. Methods Using a pre-/post-test design in which each subject served as his/her own historical control, this quality improvement project focused on determining if the interdisciplinary intervention called CCM© had an impact on healthcare utilization and costs for HNHC patients. We conducted the analysis between November 2012 and December 2015 at Mercy Health Saint Mary’s, a Midwestern urban hospital with greater than 80,000 annual emergency department (ED) visits. All referred patients with three or more hospital visits (ED or inpatient [IP]) in the 12 months prior to initiation of a CCM© (n=339) were included in the study. Individualized CCMs© were created and made available in the electronic medical record (EMR) to all healthcare providers. We compared utilization, cost, social, and healthcare access variables from the EMR and cost-accounting system for 12 months before and after CCMs© implementation. We used both descriptive and limited inferential statistics. Results ED mean visits decreased 43% (phealthcare system overutilization and cost of care. PMID:28210351

  8. Cost benefit analysis for climate change adaption

    NARCIS (Netherlands)

    Ierland, van E.C.; Weikard, H.P.; Wesseler, J.H.H.; Groeneveld, R.A.; Ansink, E.J.H.; Bruin, de K.; Rietveld, P.; Bockarjova, M.; Hofkes, M.; Brouwer, R.; Dekker, T.

    2012-01-01

    The focus of this programme was on the development of decision making tools based on cost benefit analysis under uncertainty, for analysing adaptation and mitigation options related to spatial planning in the Netherlands. The full programme focused on the methodological issues for cost benefit analy

  9. Optimizing choice of oral interferon-free treatment for genotype 1 hepatitis C virus using testing for NS5A resistance: a cost-utility analysis from the perspective of the Italian National Health Service

    Directory of Open Access Journals (Sweden)

    Westerhout KY

    2017-02-01

    Full Text Available Kirsten Y Westerhout,1 Walter Bouwmeester,1 Inge Duchesne,2 Marta Pisini,2 Marjanne A Piena,1 Francesco Damele,3 Beatrice Gueron,2 Maarten Treur,1 Jonathan Belsey4 1Pharmerit BV, Marten Meesweg, Rotterdam, the Netherlands; 2Janssen EMEA, Turnhoutseweg, Beerse, Belgium; 3Janssen-Cilag SpA, Via Michelangelo Buonarroti, Cologno Monzese, Italy; 4JB Medical Ltd, Old Brickworks, Little Cornard, United Kingdom Background: Patients with genotype-1 hepatitis C virus infection who have failed to respond to standard therapy or who relapse following treatment may be considered for an interferon-free regimen incorporating a nonstructural protein 5A (NS5A inhibitor. Sustained virologic response (SVR with these regimens is typically >90%, but this is reduced in patients with NS5A resistance. European Association for Study of the Liver guidelines recommend simeprevir + sofosbuvir ± ribavirin (SMV+SOF±R for re-treating patients failing an NS5A inhibitor-containing regimen. An alternative strategy would be to test for NS5A resistance prior to treatment, with therapy optimized based on the results. This study investigates the cost-effectiveness of this strategy.Materials and methods: A Markov model was used to estimate disease progression for treatment-experienced genotype 1 patients with severe fibrosis or compensated cirrhosis. Targeted treatment with either SMV+SOF±R or sofosbuvir + ledipasvir ± ribavirin (SOF+LDV±R based on pretreatment NS5A resistance testing was compared to routine SOF+LDV±R without testing. Treatment duration was 12 or 24 weeks for patients with severe fibrosis or compensated cirrhosis (Metavir F3/F4. SVR data for the treatment options were based on the results of published clinical trials. The analysis was carried out from the perspective of the Italian National Health Service.Results: Optimized treatment using NS5A resistance testing yielded 0.163 additional QALYs and increased costs of €2,789 per patient versus no testing. The

  10. Utilization of UV Curing Technology to Significantly Reduce the Manufacturing Cost of LIB Electrodes

    Energy Technology Data Exchange (ETDEWEB)

    Voelker, Gary [Miltec UV International, LLC, Stevensville, MD (United States); Arnold, John [Miltec UV International, LLC, Stevensville, MD (United States)

    2015-11-30

    Previously identified novel binders and associated UV curing technology have been shown to reduce the time required to apply and finish electrode coatings from tens of minutes to less than one second. This revolutionary approach can result in dramatic increases in process speeds, significantly reduced capital (a factor of 10 to 20) and operating costs, reduced energy requirements, and reduced environmental concerns and costs due to the virtual elimination of harmful volatile organic solvents and associated solvent dryers and recovery systems. The accumulated advantages of higher speed, lower capital and operating costs, reduced footprint, lack of VOC recovery, and reduced energy cost is a reduction of 90% in the manufacturing cost of cathodes. When commercialized, the resulting cost reduction in Lithium batteries will allow storage device manufacturers to expand their sales in the market and thereby accrue the energy savings of broader utilization of HEVs, PHEVs and EVs in the U.S., and a broad technology export market is also envisioned.

  11. Health care costs, utilization and patterns of care following Lyme disease.

    Science.gov (United States)

    Adrion, Emily R; Aucott, John; Lemke, Klaus W; Weiner, Jonathan P

    2015-01-01

    Lyme disease is the most frequently reported vector borne infection in the United States. The Centers for Disease Control have estimated that approximately 10% to 20% of individuals may experience Post-Treatment Lyme Disease Syndrome - a set of symptoms including fatigue, musculoskeletal pain, and neurocognitive complaints that persist after initial antibiotic treatment of Lyme disease. Little is known about the impact of Lyme disease or post-treatment Lyme disease symptoms (PTLDS) on health care costs and utilization in the United States. 1) to examine the impact of Lyme disease on health care costs and utilization, 2) to understand the relationship between Lyme disease and the probability of developing PTLDS, 3) to understand how PTLDS may impact health care costs and utilization. This study utilizes retrospective data on medical claims and member enrollment for persons aged 0-64 years who were enrolled in commercial health insurance plans in the United States between 2006-2010. 52,795 individuals treated for Lyme disease were compared to 263,975 matched controls with no evidence of Lyme disease exposure. Lyme disease is associated with $2,968 higher total health care costs (95% CI: 2,807-3,128, pLyme disease, having one or more PTLDS-related diagnosis is associated with $3,798 higher total health care costs (95% CI: 3,542-4,055, pLyme disease is associated with increased costs above what would be expected for an easy to treat infection. The presence of PTLDS-related diagnoses after treatment is associated with significant health care costs and utilization.

  12. 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.

  13. Cost and quality of fuels for electric utility plants: Energy data report. 1980 annual

    Energy Technology Data Exchange (ETDEWEB)

    1981-06-25

    In 1980 US electric utilities reported purchasng 594 million tons of coal, 408.5 million barrels of oil and 3568.7 billion ft/sup 3/ of gas. As compared with 1979 purchases, coal rose 6.7%, oil decreased 20.9%, and gas increased for the fourth year in a row. This volume presents tabulated and graphic data on the cost and quality of fossil fuel receipts to US electric utilities plants with a combined capacity of 25 MW or greater. Information is included on fuel origin and destination, fuel types, and sulfur content, plant types, capacity, and flue gas desulfurization method used, and fuel costs. (LCL)

  14. Quantification and Classification of E. coli Proteome Utilization and Unused Protein Costs across Environments.

    Directory of Open Access Journals (Sweden)

    Edward J O'Brien

    2016-06-01

    Full Text Available The costs and benefits of protein expression are balanced through evolution. Expression of un-utilized protein (that have no benefits in the current environment incurs a quantifiable fitness costs on cellular growth rates; however, the magnitude and variability of un-utilized protein expression in natural settings is unknown, largely due to the challenge in determining environment-specific proteome utilization. We address this challenge using absolute and global proteomics data combined with a recently developed genome-scale model of Escherichia coli that computes the environment-specific cost and utility of the proteome on a per gene basis. We show that nearly half of the proteome mass is unused in certain environments and accounting for the cost of this unused protein expression explains >95% of the variance in growth rates of Escherichia coli across 16 distinct environments. Furthermore, reduction in unused protein expression is shown to be a common mechanism to increase cellular growth rates in adaptive evolution experiments. Classification of the unused protein reveals that the unused protein encodes several nutrient- and stress- preparedness functions, which may convey fitness benefits in varying environments. Thus, unused protein expression is the source of large and pervasive fitness costs that may provide the benefit of hedging against environmental change.

  15. Cost analysis of youth violence prevention.

    Science.gov (United States)

    Sharp, Adam L; Prosser, Lisa A; Walton, Maureen; Blow, Frederic C; Chermack, Stephen T; Zimmerman, Marc A; Cunningham, Rebecca

    2014-03-01

    Effective violence interventions are not widely implemented, and there is little information about the cost of violence interventions. Our goal is to report the cost of a brief intervention delivered in the emergency department that reduces violence among 14- to 18-year-olds. Primary outcomes were total costs of implementation and the cost per violent event or violence consequence averted. We used primary and secondary data sources to derive the costs to implement a brief motivational interviewing intervention and to identify the number of self-reported violent events (eg, severe peer aggression, peer victimization) or violence consequences averted. One-way and multi-way sensitivity analyses were performed. Total fixed and variable annual costs were estimated at $71,784. If implemented, 4208 violent events or consequences could be prevented, costing $17.06 per event or consequence averted. Multi-way sensitivity analysis accounting for variable intervention efficacy and different cost estimates resulted in a range of $3.63 to $54.96 per event or consequence averted. Our estimates show that the cost to prevent an episode of youth violence or its consequences is less than the cost of placing an intravenous line and should not present a significant barrier to implementation.

  16. Association Between Intensive Care Unit Utilization During Hospitalization and Costs, Use of Invasive Procedures, and Mortality.

    Science.gov (United States)

    Chang, Dong W; Shapiro, Martin F

    2016-10-01

    Maximizing the value of critical care services requires understanding the relationship between intensive care unit (ICU) utilization, clinical outcomes, and costs. To examine whether hospitals had consistent patterns of ICU utilization across 4 common medical conditions and the association between higher use of the ICU and hospital costs, use of invasive procedures, and mortality. Retrospective cohort study of 156 842 hospitalizations in 94 acute-care nonfederal hospitals for diabetic ketoacidosis (DKA), pulmonary embolism (PE), upper gastrointestinal bleeding (UGIB), and congestive heart failure (CHF) in Washington state and Maryland from 2010 to 2012. Hospitalizations for DKA, PE, UGIB, and CHF were identified from the presence of compatible International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Multilevel logistic regression models were used to determine the predicted hospital-level ICU utilization during hospitalizations for the 4 study conditions. For each condition, hospitals were ranked based on the predicted ICU utilization rate to examine the variability in ICU utilization across institutions. The primary outcomes were associations between hospital-level ICU utilization rates and risk-adjusted hospital mortality, use of invasive procedures, and hospital costs. The 94 hospitals and 156 842 hospitalizations included in the study represented 4.7% of total hospitalizations in this study. ICU admission rates ranged from 16.3% to 81.2% for DKA, 5.0% to 44.2% for PE, 11.5% to 51.2% for UGIB, and 3.9% to 48.8% for CHF. Spearman rank coefficients between DKA, PE, UGIB, and CHF showed significant correlations in ICU utilization for these 4 medical conditions among hospitals (ρ ≥ 0.90 for all comparisons; P utilization rate was not associated with hospital mortality. Use of invasive procedures and costs of hospitalization were greater in institutions with higher ICU utilization for all 4 conditions. For medical

  17. Community pharmacy and mail order cost and utilization for 90-day maintenance medication prescriptions.

    Science.gov (United States)

    Khandelwal, Nikhil; Duncan, Ian; Rubinstein, Elan; Ahmed, Tamim; Pegus, Cheryl

    2012-04-01

    each therapeutic class in the mail order channel was used to weight the results for the community pharmacy channel. Using ordinary least squares regression models, we controlled for differences between channel users with respect to the following confounding factors: age, gender, presence or absence of each of the top 11 drug-inferred conditions (e.g., asthma/chronic obstructive pulmonary disease, cardiovascular disease), drug mix, and calendar year. We calculated estimated predicted means holding all covariates at their mean values. For both 90-day dispensing channels, we calculated number of 90-day claims per member per year (PMPY) and cost per pharmacy claim, with all claims counts adjusted to 30-day equivalents (i.e., number of 90-day claims × 3). Differences were compared using t-tests for statistical significance. Of 355 PBM clients prior to exclusions, 72 unique employers covering 644,071 unique members (range of approximately 100 to more than 100,000 members per employer) were included in the analysis. On an unadjusted basis, community pharmacies represented 80.8% of 90-day market basket claims (in 30-day equivalents: 3.97 claims PMPY vs. 0.95 in mail order) and 77.2% of total allowed charges. After adjustments for therapeutic group mix and patient characteristics, predicted mean pharmacy claim counts PMPY were 4.09 for community pharmacy compared with 0.85 for mail order (P  less than  0.001). Predicted mean allowed charges per claim for community and mail order pharmacies did not significantly differ ($49.03 vs. $50.04, respectively, P = 0.202). When offered maintenance medications through community and mail order pharmacies on a benefit-equivalent basis, commercially insured employees and their dependents utilized the community pharmacy channel more frequently by a margin of more than 4 to 1 in terms of claims PMPY. Overall allowed charges per claim for community and mail order pharmacy did not significantly differ.

  18. Health Monitoring System Technology Assessments: Cost Benefits Analysis

    Science.gov (United States)

    Kent, Renee M.; Murphy, Dennis A.

    2000-01-01

    The subject of sensor-based structural health monitoring is very diverse and encompasses a wide range of activities including initiatives and innovations involving the development of advanced sensor, signal processing, data analysis, and actuation and control technologies. In addition, it embraces the consideration of the availability of low-cost, high-quality contributing technologies, computational utilities, and hardware and software resources that enable the operational realization of robust health monitoring technologies. This report presents a detailed analysis of the cost benefit and other logistics and operational considerations associated with the implementation and utilization of sensor-based technologies for use in aerospace structure health monitoring. The scope of this volume is to assess the economic impact, from an end-user perspective, implementation health monitoring technologies on three structures. It specifically focuses on evaluating the impact on maintaining and supporting these structures with and without health monitoring capability.

  19. Cost analysis and estimating tools and techniques

    CERN Document Server

    Nussbaum, Daniel

    1990-01-01

    Changes in production processes reflect the technological advances permeat­ ing our products and services. U. S. industry is modernizing and automating. In parallel, direct labor is fading as the primary cost driver while engineering and technology related cost elements loom ever larger. Traditional, labor-based ap­ proaches to estimating costs are losing their relevance. Old methods require aug­ mentation with new estimating tools and techniques that capture the emerging environment. This volume represents one of many responses to this challenge by the cost analysis profession. The Institute of Cost Analysis (lCA) is dedicated to improving the effective­ ness of cost and price analysis and enhancing the professional competence of its members. We encourage and promote exchange of research findings and appli­ cations between the academic community and cost professionals in industry and government. The 1990 National Meeting in Los Angeles, jointly spo~sored by ICA and the National Estimating Society (NES),...

  20. Report on Utilities Usage and Cost, 1980-81 to 1984-85.

    Science.gov (United States)

    Alabama State Commission on Higher Education, Montgomery.

    The consumption and cost of energy and other types of utilities by state college campuses were analyzed by the Alabama Commission on Higher Education. A focus of attention has been changes in energy usage per square foot from year to year as an indicator of the institutions' energy conservation and, over time, of the changing characteristics of…

  1. Impact of Bariatric Surgery on Healthcare Utilization and Costs among Patients with Diabetes

    Science.gov (United States)

    Bleich, Sara N.; Chang, Hsien-Yen; Lau, Bryan; Steele, Kimberly; Clark, Jeanne M.; Richards, Thomas; Weiner, Jonathan P; Wu, Albert W.; Segal, Jodi B.

    2011-01-01

    Background The effect of bariatric surgery on health care utilization and costs among individuals with type 2 diabetes remains unclear. Objective To examine healthcare utilization and costs in an insured cohort of individuals with type 2 diabetes after bariatric surgery. Research Design Cohort study derived from administrative data from 2002–2008 from 7 Blue Cross Blue Shield Plans. Subjects 7,806 individuals with type 2 diabetes who had bariatric surgery Measures Cost (inpatient, outpatient, pharmacy, other) and utilization (number of inpatient days, outpatient visits, specialist visits). Results Compared to pre-surgical costs, the ratio of hospital costs (excluding the initial surgery), among beneficiaries who had any hospital costs, was higher in years 2 through 6 of the post-surgery period and increased over time [post 1: OR = 0.58 (95% CI: 0.50, 0.67); post 6: OR = 3.43 (95% CI: 2.60, 4.53)]. In comparison to the pre-surgical period, the odds of having any healthcare costs was lower in the post-surgery period and remained relatively flat over time. Among those with hospitalizations, the adjusted ratio of inpatient days was higher after surgery [post 1: OR = 1.05 (95% CI: 0.94, 1.16); post 6: OR = 2.77 (95% CI: 1.57, 4.90)]. Among those with primary care visits, the adjusted odds ratio was lower after surgery [post 1: OR = 0.80 (95% CI: 0.78, 0.82); post 6: OR = 0.66 (95% CI: 0.57, 0.76)]. Conclusion In the six years following surgery, individuals with type 2 diabetes did not have lower healthcare costs than before surgery. PMID:22167064

  2. Multi-period Optimal Portfolio Decision with Transaction Costs and HARA Utility Function

    Directory of Open Access Journals (Sweden)

    Zhen Wang

    2013-01-01

    Full Text Available Portfolio selection problem is one of the core research fields in modern financial management. While considering the transaction costs in the long term investment makes the portfolio selection problems more complex than there are no transaction costs. In this paper, the general multi-period investment problems with HARA utility function and proportional transaction costs are investigated. By using the dynamic programming method, the indirect utility function is defined for solving the portfolio selection problem. The optimal strategies and the boundary of the no-transaction region are obtained in the explicit form. And the procedure for solving the original portfolio selection problem is given. Numerical example shows the feasibility and effectiveness of the method provided in this paper.

  3. Cost-benefit analysis of space technology

    Science.gov (United States)

    Hein, G. F.; Stevenson, S. M.; Sivo, J. N.

    1976-01-01

    A discussion of the implications and problems associated with the use of cost-benefit techniques is presented. Knowledge of these problems is useful in the structure of a decision making process. A methodology of cost-benefit analysis is presented for the evaluation of space technology. The use of the methodology is demonstrated with an evaluation of ion thrusters for north-south stationkeeping aboard geosynchronous communication satellites. A critique of the concept of consumers surplus for measuring benefits is also presented.

  4. Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review.

    Science.gov (United States)

    de la Torre-Díez, Isabel; López-Coronado, Miguel; Vaca, Cesar; Aguado, Jesús Saez; de Castro, Carlos

    2015-02-01

    A systematic review of cost-utility and cost-effectiveness research works of telemedicine, electronic health (e-health), and mobile health (m-health) systems in the literature is presented. Academic databases and systems such as PubMed, Scopus, ISI Web of Science, and IEEE Xplore were searched, using different combinations of terms such as "cost-utility" OR "cost utility" AND "telemedicine," "cost-effectiveness" OR "cost effectiveness" AND "mobile health," etc. In the articles searched, there were no limitations in the publication date. The search identified 35 relevant works. Many of the articles were reviews of different studies. Seventy-nine percent concerned the cost-effectiveness of telemedicine systems in different specialties such as teleophthalmology, telecardiology, teledermatology, etc. More articles were found between 2000 and 2013. Cost-utility studies were done only for telemedicine systems. There are few cost-utility and cost-effectiveness studies for e-health and m-health systems in the literature. Some cost-effectiveness studies demonstrate that telemedicine can reduce the costs, but not all. Among the main limitations of the economic evaluations of telemedicine systems are the lack of randomized control trials, small sample sizes, and the absence of quality data and appropriate measures.

  5. Airlift deployment analysis system life cycle cost analysis

    Energy Technology Data Exchange (ETDEWEB)

    Truett, L.F.; Das, S. (Oak Ridge National Lab., TN (USA)); Worthington, J.C. (Sybase, Inc. (USA))

    1990-08-01

    The Airlift Deployment Analysis System (ADANS) is an automated system that will provide Headquarters, Military Airlift Command (HQ MAC) with planning, scheduling, and analysis tools for peacetime and contingency airlift operations. This Life Cycle Cost (LCC) analysis identifies cost factors impacting ADANS during its life cycle. This analysis lists exact costs when known and reasonable estimates of other costs. This report states costs in fiscal year (FY) dollars for costs already expended (FY86--FY89) and in FY90 dollars for projected costs. Factors that could have a substantial impact on the ADANS life cycle development and maintenance costs are noted. The development effort will conclude in FY92. This LCC analysis covers a 15-year period from FY86--FY00. The total costs of ADANS is projected to be approximately $60 million. Of this total, about 20% is for development of functional capability, about 9% for development of the cross-cutting subsystems, and about 71% for program and system support. The total Oak Ridge National Laboratory development cost for FY86--FY92 is about $27.5 million; the total cost for HQ MAC is about 32.5 million. 32 tabs.

  6. Health care utilization and cost burden of herpes zoster in a community population.

    Science.gov (United States)

    Yawn, Barbara P; Itzler, Robbin F; Wollan, Peter C; Pellissier, James M; Sy, Lina S; Saddier, Patricia

    2009-09-01

    To conduct a population-based study to assess health care utilization (HCU) and costs associated with herpes zoster (HZ) and its complications, including postherpetic neuralgia (PHN) and nonpain complications, in adults aged 22 years and older. Medical record data on HCU were abstracted for all confirmed new cases of HZ from January 1, 1996, through December 31, 2001, among residents of Olmsted County, Minnesota. Herpes zoster-related costs were estimated by applying the Medicare Payment Fee Schedule to health care encounters and mean wholesale prices to medications. All costs were adjusted to 2006 US dollars using the medical care component of the Consumer Price Index. The HCU and cost of the 1669 incident HZ cases varied, depending on the complications involved. From 3 weeks before to 1 year after initial diagnosis, there were a mean of 1.8 outpatient visits and 3.1 prescribed medications at a cost of $720 for cases without PHN or nonpain complications compared with 7.5 outpatient visits and 14.7 prescribed medications at a cost of $3998 when complications, PHN, or nonpain complications were present. The annual medical care cost of treating incident HZ cases in the United States, extrapolated from the results of this study in Olmsted County, is estimated at $1.1 billion. Most of the costs are for the care of immunocompetent adults with HZ, especially among those 50 years and older.

  7. Electric utility capacity expansion and energy production models for energy policy analysis

    Energy Technology Data Exchange (ETDEWEB)

    Aronson, E.; Edenburn, M.

    1997-08-01

    This report describes electric utility capacity expansion and energy production models developed for energy policy analysis. The models use the same principles (life cycle cost minimization, least operating cost dispatching, and incorporation of outages and reserve margin) as comprehensive utility capacity planning tools, but are faster and simpler. The models were not designed for detailed utility capacity planning, but they can be used to accurately project trends on a regional level. Because they use the same principles as comprehensive utility capacity expansion planning tools, the models are more realistic than utility modules used in present policy analysis tools. They can be used to help forecast the effects energy policy options will have on future utility power generation capacity expansion trends and to help formulate a sound national energy strategy. The models make renewable energy source competition realistic by giving proper value to intermittent renewable and energy storage technologies, and by competing renewables against each other as well as against conventional technologies.

  8. Economic Competitiveness of U.S. Utility-Scale Photovoltaics Systems in 2015: Regional Cost Modeling of Installed Cost ($/W) and LCOE ($/kWh)

    Energy Technology Data Exchange (ETDEWEB)

    Fu, Ran; James, Ted L.; Chung, Donald; Gagne, Douglas; Lopez, Anthony; Dobos, Aron

    2015-06-14

    Utility-scale photovoltaics (PV) system growth is largely driven by the economic metrics of total installed costs and levelized cost of electricity (LCOE), which differ by region. This study details regional cost factors, including environment (wind speed and snow loads), labor costs, material costs, sales taxes, and permitting costs using a new system-level bottom-up cost modeling approach. We use this model to identify regional all-in PV installed costs for fixed-tilt and one-axis tracker systems in the United States with consideration of union and non-union labor costs in 2015. LCOEs using those regional installed costs are then modeled and spatially presented. Finally, we assess the cost reduction opportunities of increasing module conversion efficiencies on PV system costs in order to indicate the possible economic impacts of module technology advancements and help future research and development (R&D) effects in the context of U.S. SunShot targets.

  9. Parametric Cost Estimation Utilizing Development-to-Production Relationship Applied to the Advanced Amphibious Assault Vehicle

    Science.gov (United States)

    1991-12-01

    cime span between development and production to predict TFUs. The inclusion of a variable that explains time spent in development is compatible with...1971. "Cost Performance Reports", Bradley Fighting Vehicle, FMC Corp., 1980-1989. Fisher, Gene H., Cost Considerations in Systems Analysis, RAND Corp

  10. 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...

  11. An Analysis of Rocket Propulsion Testing Costs

    Science.gov (United States)

    Ramirez, Carmen; Rahman, Shamim

    2010-01-01

    The primary mission at NASA Stennis Space Center (SSC) is rocket propulsion testing. Such testing is commonly characterized as one of two types: production testing for certification and acceptance of engine hardware, and developmental testing for prototype evaluation or research and development (R&D) purposes. For programmatic reasons there is a continuing need to assess and evaluate the test costs for the various types of test campaigns that involve liquid rocket propellant test articles. Presently, in fact, there is a critical need to provide guidance on what represents a best value for testing and provide some key economic insights for decision-makers within NASA and the test customers outside the Agency. Hence, selected rocket propulsion test databases and references have been evaluated and analyzed with the intent to discover correlations of technical information and test costs that could help produce more reliable and accurate cost projections in the future. The process of searching, collecting, and validating propulsion test cost information presented some unique obstacles which then led to a set of recommendations for improvement in order to facilitate future cost information gathering and analysis. In summary, this historical account and evaluation of rocket propulsion test cost information will enhance understanding of the various kinds of project cost information; identify certain trends of interest to the aerospace testing community.

  12. Cost analysis of flood-proofing levees

    OpenAIRE

    Šuklje, Matija Jože

    2013-01-01

    In the thesis I analyzed some prices of construction works from 1950s and did a cost analysis of building a super levee. Earth and concrete dams, percolation through the core of the embankment and foundation seepage beneath the dykes are presented in details. Much attention is given to the construction and use of new types of dams such as super-levees. Furthermore, the analysis of changing prices of some construction works are presented as the costs are important in the building of levees. Th...

  13. Logistics, Costs, and GHG Impacts of Utility Scale Cofiring with 20% Biomass

    Energy Technology Data Exchange (ETDEWEB)

    Boardman, Richard D.; Cafferty, Kara G.; Nichol, Corrie; Searcy, Erin M.; Westover, Tyler; Wood, Richard; Bearden, Mark D.; Cabe, James E.; Drennan, Corinne; Jones, Susanne B.; Male, Jonathan L.; Muntean, George G.; Snowden-Swan, Lesley J.; Widder, Sarah H.

    2014-07-22

    This report presents the results of an evaluation of utility-scale biomass cofiring in large pulverized coal power plants. The purpose of this evaluation is to assess the cost and greenhouse gas reduction benefits of substituting relatively high volumes of biomass in coal. Two scenarios for cofiring up to 20% biomass with coal (on a lower heating value basis) are presented; (1) woody biomass in central Alabama where Southern Pine is currently produced for the wood products and paper industries, and (2) purpose-grown switchgrass in the Ohio River Valley. These examples are representative of regions where renewable biomass growth rates are high in correspondence with major U.S. heartland power production. While these scenarios may provide a realistic reference for comparing the relative benefits of using a high volume of biomass for power production, this evaluation is not intended to be an analysis of policies concerning renewable portfolio standards or the optimal use of biomass for energy production in the U.S.

  14. (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.

  15. Will Decreasing ART Costs Improve Utilization and Outcomes Among Minority Women?

    Science.gov (United States)

    McCarthy-Keith, Desireé M.; Schisterman, Enrique F.; Robinson, Randal D.; O’Leary, Kathleen; Lucidi, Richard S.; Armstrong, Alicia Y.

    2010-01-01

    Objective To evaluate ART utilization and outcomes in minority women seeking care at enhanced access, military ART programs. Design Retrospective cohort Setting Federal ART programs Patients 2,050 women undergoing first cycle, fresh, non-donor ART from 2000–2005 Intervention None Main outcome measure(s ): ART utilization rate, clinical pregnancy rate, live birth rate Results African American (AA) women had an almost fourfold increased utilization of ART and Hispanic women had decreased utilization. Clinical pregnancy rates were significantly lower for AA women compared to white women (46.1% vs. 52.6%, RR 0.88, 95% CI 0.78–0.99) as were live birth rates (33.7%. vs. 45.7%, RR 0.74, 95% CI 0.63–0.91). Conclusions Economics appear to influence ART utilization by AA women but not Hispanic women. Despite increased utilization by African American women, outcomes in this group were worse when compared to Caucasian women. Improving access through decreased cost may increase utilization by some, but not all minority groups. Improved access may not translate into improved outcomes in some ethnic groups. PMID:20356585

  16. Medical care utilization and costs on end-of-life cancer patients: The role of hospice care.

    Science.gov (United States)

    Chang, Hsiao-Ting; Lin, Ming-Hwai; Chen, Chun-Ku; Chen, Tzeng-Ji; Tsai, Shu-Lin; Cheng, Shao-Yi; Chiu, Tai-Yuan; Tsai, Shih-Tzu; Hwang, Shinn-Jang

    2016-11-01

    Although there are 3 hospice care programs for terminal cancer patients in Taiwan, the medical utilization and expenses for these patients by programs have not been well-explored. The aim of this study was to examine the medical utilization and expenses of terminal cancer patients under different programs of hospice care in the last 90, 30, and 14 days of life.This was a retrospective observational study by secondary data analysis. By using the National Health Insurance claim database and Hospice Shared Care Databases. We identified cancer descents from these databases and classified them into nonhospice care and hospice care groups based on different combination of hospice care received. We then analyzed medical utilization including inpatient care, outpatient care, emergency room visits, and medical expenses by patient groups in the last 90, 30, and 14 days of life.Among 118,376 cancer descents, 46.9% ever received hospice care. Patients had ever received hospice care had significantly lower average medical utilization and expenses in their last 90, 30, and 14 days of life (all P hospice care group had significantly less medical utilization and expenses in the last 90, 30, and 14 days of life (all P hospice care program have different effects on medical care utilization reduction and cost-saving at different stage of the end of life of terminal cancer patients.

  17. Flat plate vs. concentrator solar photovoltaic cells - A manufacturing cost analysis

    Science.gov (United States)

    Granon, L. A.; Coleman, M. G.

    1980-01-01

    The choice of which photovoltaic system (flat plate or concentrator) to use for utilizing solar cells to generate electricity depends mainly on the cost. A detailed, comparative manufacturing cost analysis of the two types of systems is presented. Several common assumptions, i.e., cell thickness, interest rate, power rate, factory production life, polysilicon cost, and direct labor rate are utilized in this analysis. Process sequences, cost variables, and sensitivity analyses have been studied, and results of the latter show that the most important parameters which determine manufacturing costs are concentration ratio, manufacturing volume, and cell efficiency. The total cost per watt of the flat plate solar cell is $1.45, and that of the concentrator solar cell is $1.85, the higher cost being due to the increased process complexity and material costs.

  18. Cost Analysis for Dual Source Weapon Procurement

    Science.gov (United States)

    1983-10-01

    34,- art seems to be regrettably trueý (1981: p. 52] Current uudersta~iinq of the compatitive r~pro- curement process is meagar. it would for ixam- ple be...the- art will be organized by section, according to the following major topics: ’I. Production Rates 2. Second-Source Start-Up Cost 3. Second-Source...when capaci- , ty utilization is Low. The returns earned by contractors on DOD business are measurably lower than the returns on com- marcial business

  19. Clinical utility and cost-effectiveness of CT-angiography in the diagnosis of nontraumatic subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Jabbarli, Ramazan; Shah, Mukesch; Hippchen, Beate; Velthoven, Vera van [University Hospital of Freiburg, Department of Neurosurgery, Freiburg/Breisgau (Germany); Taschner, Christian [University Hospital of Freiburg, Department of Neuroradiology, Freiburg (Germany); Kaier, Klaus [University Hospital of Freiburg, Institute for Medical Biometry and Medical Informatics, Freiburg (Germany)

    2014-10-15

    CT-angiography gains an increasing role in the initial diagnosis of patients with nontraumatic subarachnoid hemorrhage (SAH). However, the implementation of CT-angiography does not always exclude the necessity of conventional angiography. Our objective was to determine the practical utility and cost-effectiveness of CT-angiography. All patients with nontraumatic subarachnoid hemorrhage admitted to our university hospital after implementation of CT-angiography between June 1, 2011 and June 30, 2012 were retrospectively analyzed in regard to factors of treatment flow, radiation exposure, harms of contrast medium loading, and diagnostic costs. A control group of the same size was assembled from previously admitted SAH patients, who did not undergo pretreatment CT-angiography. Furthermore, cost-effectiveness analysis was performed. The final analysis consisted of 93 patients in each group. Of 93 patients with pretreatment CT-angiography, 74 had to undergo conventional angiography for diagnostic and/or therapeutic purposes. CT-angiography had significant impact on the reduction of collective effective radiation dose by 4.419 mSv per person (p = 0.0002) and was not associated with additional harms. Despite the significantly earlier detection of aneurysms with CT-angiography (p < 0.0001), there were no significant differences in the timing of aneurysm repair and duration of ICU and general hospital stay. There was an increase of diagnostic costs - the cost-effectiveness analysis showed, however, that benefits of CT-angiography in respect to radiation exposure and risk of conventional angiography-related complications justify the additional costs of CT-angiography. Although the implementation of CT-angiography in SAH diagnosis cannot completely replace conventional angiography, it can be approved in regard to radiation hygiene and cost-effectiveness. (orig.)

  20. 24 CFR 965.402 - Benefit/cost analysis.

    Science.gov (United States)

    2010-04-01

    ... that the cost of debt service (interest and amortization) of the estimated installation costs plus the... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Benefit/cost analysis. 965.402...-Owned Projects § 965.402 Benefit/cost analysis. (a) A benefit/cost analysis shall be made to determine...

  1. LIFE CYCLE COST ANALYSIS OF SOLAR PONDS

    Directory of Open Access Journals (Sweden)

    Murat ÖZTÜRK

    2008-03-01

    Full Text Available Solar ponds are the systems which collect solar energy and store it for long periods of time. For effective and efficient use of these systems in the country, concepts relating economy of solar ponds which generated hot water from the sun must be known besides their physical properties. Life cycle cost analysis is a systematic analytical method that helps identify and evaluate the environmental impacts of a specific process or competing processes. In order to quantify the costs, resource consumption, and energy use, material and energy balances are performed in a cradle-to-grave manner on the operations required to transform raw materials into useful products. In this study; life cycle cost analysis of reflecting covered and non covered solar ponds are calculated for a volume of 3.5x3.5x2 cubic meters and presented. Also the energies extractable for these solar ponds in Goller Region climatic conditions are given.

  2. Supporting analysis and assessments quality metrics: Utility market sector

    Energy Technology Data Exchange (ETDEWEB)

    Ohi, J. [National Renewable Energy Lab., Golden, CO (United States)

    1996-10-01

    In FY96, NREL was asked to coordinate all analysis tasks so that in FY97 these tasks will be part of an integrated analysis agenda that will begin to define a 5-15 year R&D roadmap and portfolio for the DOE Hydrogen Program. The purpose of the Supporting Analysis and Assessments task at NREL is to provide this coordination and conduct specific analysis tasks. One of these tasks is to prepare the Quality Metrics (QM) for the Program as part of the overall QM effort at DOE/EERE. The Hydrogen Program one of 39 program planning units conducting QM, a process begun in FY94 to assess benefits/costs of DOE/EERE programs. The purpose of QM is to inform decisionmaking during budget formulation process by describing the expected outcomes of programs during the budget request process. QM is expected to establish first step toward merit-based budget formulation and allow DOE/EERE to get {open_quotes}most bang for its (R&D) buck.{close_quotes} In FY96. NREL coordinated a QM team that prepared a preliminary QM for the utility market sector. In the electricity supply sector, the QM analysis shows hydrogen fuel cells capturing 5% (or 22 GW) of the total market of 390 GW of new capacity additions through 2020. Hydrogen consumption in the utility sector increases from 0.009 Quads in 2005 to 0.4 Quads in 2020. Hydrogen fuel cells are projected to displace over 0.6 Quads of primary energy in 2020. In future work, NREL will assess the market for decentralized, on-site generation, develop cost credits for distributed generation benefits (such as deferral of transmission and distribution investments, uninterruptible power service), cost credits for by-products such as heat and potable water, cost credits for environmental benefits (reduction of criteria air pollutants and greenhouse gas emissions), compete different fuel cell technologies against each other for market share, and begin to address economic benefits, especially employment.

  3. Life-cycle cost comparisons of advanced storage batteries and fuel cells for utility, stand-alone, and electric vehicle applications

    Energy Technology Data Exchange (ETDEWEB)

    Humphreys, K.K.; Brown, D.R.

    1990-01-01

    This report presents a comparison of battery and fuel cell economics for ten different technologies. To develop an equitable economic comparison, the technologies were evaluated on a life-cycle cost (LCC) basis. The LCC comparison involved normalizing source estimates to a standard set of assumptions and preparing a lifetime cost scenario for each technology, including the initial capital cost, replacement costs, operating and maintenance (O M) costs, auxiliary energy costs, costs due to system inefficiencies, the cost of energy stored, and salvage costs or credits. By considering all the costs associated with each technology over its respective lifetime, the technology that is most economical to operate over any given period of time can be determined. An analysis of this type indicates whether paying a high initial capital cost for a technology with low O M costs is more or less economical on a lifetime basis than purchasing a technology with a low initial capital cost and high O M costs. It is important to realize that while minimizing cost is important, the customer will not always purchase the least expensive technology. The customer may identify benefits associated with a more expensive option that make it the more attractive over all (e.g., reduced construction lead times, modularity, environmental benefits, spinning reserve, etc.). The LCC estimates presented in this report represent three end-use applications: utility load-leveling, stand-alone power systems, and electric vehicles.

  4. 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

  5. COST-BENEFIT ANALYSIS OF EDUCATION.

    Science.gov (United States)

    MOOD, ALEXANDER M.; POWERS, RICHARD

    DIFFICULTIES ARE ENCOUNTERED WHEN COST-BENEFIT ANALYSES ARE APPLIED TO EDUCATION. THERE ARE PROBLEMS IN THE ATTEMPT TO DEFINE AN EDUCATIONAL GOAL AND IN THE ANALYSIS OF EDUCATIONAL PROCESSES. THE FEDERAL GOVERNMENT IS NOW ENGAGED IN A MULTITUDE OF PROJECTS DESIGNED TO COORDINATE RESEARCH IN EDUCATIONAL IMPROVEMENT. THIS ENTAILS CONTINUED…

  6. 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.

  7. The Feasibility and Cost-Effectiveness of Utilizing Skilled Parolees in the United States Armed Forces.

    Science.gov (United States)

    1980-12-01

    those inmates at Soledad and other known prisons . The environment is not the same for each class of individual. The first time offenders at Soledad...projections utilizing Armed Forces Cost-effectiveness of parolees Military Labor in the service Criminal offenders in the military Recidivism SO...provided by the staff and inmates at the Soledad Correctional Training Facility (CTF) and the Salinas Parole Division, Salinas, California, and the

  8. Is control through utilization a cost effective Prosopis juliflora management strategy?

    Science.gov (United States)

    Wakie, Tewodros T; Hoag, Dana; Evangelista, Paul H; Luizza, Matthew; Laituri, Melinda

    2016-03-01

    The invasive tree Prosopis juliflora is known to cause negative impacts on invaded ranges. High P. juliflora eradication costs have swayed developing countries to follow a new and less expensive approach known as control through utilization. However, the net benefits of this new approach have not been thoroughly evaluated. Our objective was to assess the economic feasibility of selected P. juliflora eradication and utilization approaches that are currently practiced in one of the severely affected developing countries, Ethiopia. The selected approaches include converting P. juliflora infested lands into irrigated farms (conversion), charcoal production, and seed flour production. We estimate the costs and revenues of the selected P. juliflora eradication and utilization approaches by interviewing 19 enterprise owners. We assess the economic feasibility of the enterprises by performing enterprise, break-even, investment, sensitivity, and risk analyses. Our results show that conversion to irrigated cotton is economically profitable, with Net Present Value (NPV) of 5234 US$/ha over 10 years and an interest rate of 10% per year. Conversion greatly reduces the spread of P. juliflora on farmlands. Managing P. juliflora infested lands for charcoal production with a four-year harvest cycle is profitable, with NPV of 805 US$/ha. However, the production process needs vigilant regulation to protect native plants from exploitation and caution should be taken to prevent charcoal production sites from becoming potential seed sources. Though flour from P. juliflora pods can reduce invasions by destroying viable seeds, flour enterprises in Ethiopia are unprofitable. Conversion and charcoal production can be undertaken with small investment costs, while flour production requires high investment costs. Introducing new changes in the production and management steps of P. juliflora flour might be considered to make the enterprise profitable. Our study shows that control

  9. COST-UTILITY OF ASPIRIN AND PROTON PUMP INHIBITORS FOR PRIMARY PREVENTION

    Science.gov (United States)

    Earnshaw, Stephanie R.; Scheiman, James; Fendrick, A. Mark; McDade, Cheryl; Pignone, Michael

    2011-01-01

    Background Aspirin reduces myocardial infarction but increases gastrointestinal bleeding. Proton pump inhibitors (PPIs) may reduce upper gastrointestinal bleed. We estimate the cost-utility of aspirin treatment with or without PPI for coronary heart disease (CHD) prevention among men at different risks for CHD and gastrointestinal bleed. Methods We updated a Markov model to compare costs and outcomes of low-dose aspirin+PPI (omeprazole 20-mg daily), low-dose aspirin alone, or no treatment for CHD prevention. We performed lifetime analyses in men with different risks for cardiovascular events and gastrointestinal bleed. Aspirin reduced nonfatal myocardial infarction by 30%, increased total stroke by 6%, and increased gastrointestinal bleed risk 2-fold. Adding PPI reduced upper gastrointestinal bleed by 80%. Annual aspirin cost was $13.99; generic PPI was $200. Results In 45-year-old men with 10-year CHD risk of 10% and 0.8/1,000 annual gastrointestinal bleed risk, aspirin ($17,571 and 18.67 quality-adjusted life years [QALYs]) was more effective and less costly than no treatment ($18,483 and 18.44 QALYs). Compared with aspirin alone, aspirin+PPI ($21,037 and 18.68 QALYs) had an incremental cost/QALY of $447,077. Results were similar in 55- and 65-year-old men. The incremental cost/QALY of adding PPI was less than $50,000/QALY at annual gastrointestinal bleed probabilities greater than 4–6/1,000. Conclusion Aspirin for CHD prevention is less costly and more effective than no treatment in men over 45 with greater than 10-year, 10% CHD risks. Adding PPI is not cost-effective for men with average gastrointestinal bleed risk but may be cost-effective for selected men at increased risk for gastrointestinal bleed. PMID:21325111

  10. Costs Analysis of Iron Casts Manufacturing

    Directory of Open Access Journals (Sweden)

    S. Kukla

    2012-04-01

    Full Text Available The article presents the issues of costs analysis of iron casts manufacturing using automated foundry lines. Particular attention was paid to departmental costs, conversion costs and costs of in-plant transport. After the Pareto analysis had been carried out, it was possible to set the model area of the process and focus on improving activities related to finishing of a chosen group of casts. In order to eliminate losses, the activities realised in this domain were divided into activities with added value, activities with partially added value and activities without added value. To streamline the production flow, it was proposed to change the location of workstations related to grinding, control and machining of casts. Within the process of constant improvement of manufacturing processes, the aspect of work ergonomics at a workstation was taken into account. As a result of the undertaken actions, some activities without added value were eliminated, efficiency was increased and prime costs of manufacturing casts with regard to finishing treatment were lowered.

  11. Impact of lung function on exacerbations, health care utilization, and costs among patients with COPD

    Directory of Open Access Journals (Sweden)

    Ke X

    2016-07-01

    Full Text Available Xuehua Ke,1 Jessica Marvel,2 Tzy-Chyi Yu,2 Debra Wertz,1 Caroline Geremakis,1 Liya Wang,1 Judith J Stephenson,1 David M Mannino3 1HealthCore Inc., Wilmington, DE, 2Novartis Pharmaceuticals Corporation, East Hanover, NJ, 3University of Kentucky, Lexington, KY, USA Objective: To evaluate the impact of lung function, measured as forced expiratory volume in 1 second (FEV1 % predicted, on health care resource utilization and costs among patients with COPD in a real-world US managed-care population.Methods: This observational retrospective cohort study utilized administrative claim data augmented with medical record data. The study population consisted of patients with one or more medical claims for pre- and postbronchodilator spirometry during the intake period (July 1, 2012 to June 30, 2013. The index date was the date of the earliest medical claim for pre- and postbronchodilator spirometry. Spirometry results were abstracted from patients’ medical records. Patients were divided into two groups (low FEV1% predicted [<50%] and high FEV1% predicted [≥50%] based on the 2014 Global Initiative for Chronic Obstructive Lung Disease report. Health care resource utilization and costs were based on the prevalence and number of discrete encounters during the 12-month postindex follow-up period. Costs were adjusted to 2014 US dollars.Results: A total of 754 patients were included (n=297 low FEV1% predicted group, n=457 high FEV1% predicted group. COPD exacerbations were more prevalent in the low FEV1% predicted group compared with the high group during the 12-month pre- (52.5% vs 39.6% and postindex periods (49.8% vs 36.8%. Mean (standard deviation follow-up all-cause and COPD-related costs were $27,380 ($38,199 and $15,873 ($29,609 for patients in the low FEV1% predicted group, and $22,075 ($28,108 and $10,174 ($18,521 for patients in the high group. In the multivariable analyses, patients in the low FEV1% predicted group were more likely to have COPD

  12. Utility guidelines for reactor noise analysis: Final report

    Energy Technology Data Exchange (ETDEWEB)

    Sweeney, F.J.

    1987-02-01

    Noise analysis techniques have been extensively utilized to monitor the health and performance of nuclear power plant systems. However, few utilities have adequate programs to effectively utilize these techniques. These programs usually provide low-quality data, which can lead to misinterpretation and false alarms. The objective of this work is to provide utilities and noise analysts with guidelines for data acquisition, data analysis, and interpretation of noise analysis results for surveillance and diagnosis of reactor systems.

  13. Cutting the cost of carbon capture: a case for carbon capture and utilization.

    Science.gov (United States)

    Joos, Lennart; Huck, Johanna M; Van Speybroeck, Veronique; Smit, Berend

    2016-10-20

    A significant part of the cost for carbon capture and storage (CCS) is related to the compression of captured CO2 to its supercritical state, at 150 bar and typically 99% purity. These stringent conditions may however not always be necessary for specific cases of carbon capture and utilization (CCU). In this manuscript, we investigate how much the parasitic energy of an adsorbent-based carbon capture process may be lowered by utilizing CO2 at 1 bar and adapting the final purity requirement for CO2 from 99% to 70% or 50%. We compare different CO2 sources: the flue gases of coal-fired or natural gas-fired power plants and ambient air. We evaluate the carbon capture performance of over 60 nanoporous materials and determine the influence of the initial and final CO2 purity on the parasitic energy of the carbon capture process. Moreover, we demonstrate the underlying principles of the parasitic energy minimization in more detail using the commercially available NaX zeolite. Finally, the calculated utilization cost of CO2 is compared with the reported prices for CO2 and published costs for CCS.

  14. The Burden of Narcolepsy Disease (BOND) study: health-care utilization and cost findings.

    Science.gov (United States)

    Black, Jed; Reaven, Nancy L; Funk, Susan E; McGaughey, Karen; Ohayon, Maurice; Guilleminault, Christian; Ruoff, Chad; Mignot, Emmanuel

    2014-05-01

    The aim of this study was to characterize health-care utilization, costs, and productivity in a large population of patients diagnosed with narcolepsy in the United States. This retrospective, observational study using data from the Truven Health Analytics MarketScan Research Databases assessed 5 years of claims data (2006-2010) to compare health-care utilization patterns, productivity, and associated costs among narcolepsy patients (identified by International Classification of Diseases, Ninth Revision (ICD9) narcolepsy diagnosis codes) versus matched controls. A total of 9312 narcolepsy patients (>18 years of age, continuously insured between 2006 and 2010) and 46,559 matched controls were identified. Compared with controls, narcolepsy subjects had approximately twofold higher annual rates of inpatient admissions (0.15 vs. 0.08), emergency department (ED) visits w/o admission (0.34 vs. 0.17), hospital outpatient (OP) visits (2.8 vs. 1.4), other OP services (7.0 vs. 3.2), and physician visits (11.1 vs. 5.6; all pnarcolepsy versus controls (26.4 vs. 13.3; pnarcolepsy drugs and non-narcolepsy drugs, respectively (both pnarcolepsy compared with controls for medical services ($8346 vs. $4147; pNarcolepsy was found to be associated with substantial personal and economic burdens, as indicated by significantly higher rates of health-care utilization and medical costs in this large US group of narcolepsy patients. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. Utilization and Cost of Health Services in Individuals With Traumatic Brain Injury

    Science.gov (United States)

    Dismuke, Clara E.; Walker, Rebekah J.; Egede, Leonard E.

    2015-01-01

    Traumatic Brain Injury (TBI) has gained attention in the past decade as a “signature injury” in the conflicts in Iraq and Afghanistan. TBI is a major burden for both the military and civilian population in the US and worldwide. It is a leading cause of death and disability in the US and a major health services resource burden. We seek to answer two questions. What is the evidence regarding the association of TBI with health services utilization and costs in the US and worldwide? What is the evidence regarding racial/ethnic, gender, geographic, socio-economic and other disparities in health services utilization and cost in the US and worldwide? To attain this goal we searched several databases using key words to perform a systematic review of the literature since 2000. We found 36 articles to be eligible for inclusion in the review. The evidence demonstrates a wide variation in health services utilization and costs depending on population of study and severity of TBI. The evidence also supports the existence of racial/ethnic, gender, insurance, geographic disparities in the US as well as other unique disparities worldwide. PMID:26153156

  16. Cross-Continuum Tool Is Associated with Reduced Utilization and Cost for Frequent High-Need Users

    Directory of Open Access Journals (Sweden)

    Lauran Hardin

    2017-02-01

    Full Text Available Introduction: High-need, high-cost (HNHC patients can over-use acute care services, a pattern of behavior associated with many poor outcomes that disproportionately contributes to increased U.S. healthcare cost. Our objective was to reduce healthcare cost and improve outcomes by optimizing the system of care. We targeted HNHC patients and identified root causes of frequent healthcare utilization. We developed a crosscontinuum intervention process and a succinct tool called a Complex Care Map (CCM© that addresses fragmentation in the system and links providers to a comprehensive individualized analysis of the patient story and causes for frequent access to health services. Methods: Using a pre-/post-test design in which each subject served as his/her own historical control, this quality improvement project focused on determining if the interdisciplinary intervention called CCM© had an impact on healthcare utilization and costs for HNHC patients. We conducted the analysis between November 2012 and December 2015 at Mercy Health Saint Mary’s, a Midwestern urban hospital with greater than 80,000 annual emergency department (ED visits. All referred patients with three or more hospital visits (ED or inpatient [IP] in the 12 months prior to initiation of a CCM© (n=339 were included in the study. Individualized CCMs© were created and made available in the electronic medical record (EMR to all healthcare providers. We compared utilization, cost, social, and healthcare access variables from the EMR and cost-accounting system for 12 months before and after CCMs© implementation. We used both descriptive and limited inferential statistics. Results: ED mean visits decreased 43% (p<0.001, inpatient mean admissions decreased 44% (p<0.001, outpatient mean visits decreased 17% (p<0.001, computed tomography mean scans decreased 62% (p<0.001, and OBS/IP length of stay mean days decreased 41% (p<0.001. Gross charges decreased 45% (p<0.001, direct expenses

  17. Health care utilization and costs in Saskatchewan's registered Indian population with diabetes

    Directory of Open Access Journals (Sweden)

    Johnson Jeffrey A

    2007-08-01

    Full Text Available Abstract Background The prevalence of diabetes in North American is recognized to be higher in Aboriginal populations. The relative magnitude of health care utilization and expenditures between Aboriginal and non-Aboriginal populations is uncertain, however. Our objective was to compare health care utilization and per capita expenditures according to Registered Indian and diabetes status in the province of Saskatchewan. Methods Administrative databases from Saskatchewan Health were used to identify registered Indians and the general population diabetes cases and two controls for each diabetes case. Health care resource utilization (physician visits, hospitalizations, day surgeries and dialysis and costs for these individuals in the 2001 calendar year were determined. The odds of having used each resource category, adjusted for age and location of residence, was assessed according to Registered Indian and diabetes status. The average number of encounters for each resource category and per capita healthcare expenditures were also determined. Results Registered Indian diabetes cases were younger than general population cases (45.7 ± 14.5 versus 58.4 ± 16.4 years, p Conclusion Relative to individuals without the disease, both registered Indians and the general population with diabetes had substantially higher health care utilization and costs. Excess hospitalization and dialysis suggested that registered Indians with and without diabetes experienced greater morbidity than the general population.

  18. Divorce Costs and Marital Dissolution in a One-to-One Matching Framework With Nontransferable Utilities

    Directory of Open Access Journals (Sweden)

    Ismail Saglam

    2013-03-01

    Full Text Available In this paper, we use a two-period one-to-one matching model with incomplete information to examine the effect of changes in divorce costs on marital dissolution. Each individual who has a nontransferable expected utility about the quality of each potential marriage decides whether to marry or to remain single at the beginning of the first period. Individuals married in the first period learn the qualities of their marriages at the beginning of the second period and then decide whether to stay married or to unilaterally divorce. We show that, for any society, there exist matching environments where the probability of the marital dissolution does not reduce divorce costs under gender-optimal matching rules. In such environments, an allocation effect of divorce costs with an ambiguous sign outweighs an incentive effect that is always negative. We also show that these results may also arise under stable matching rules that are not gender optimal.

  19. Development and utilization of low-cost audio-visual aids in population communication.

    Science.gov (United States)

    1980-07-01

    One of the reasons why population information has to a certain degree failed to create demand for family planning services is that the majority of information and communication materials being used have been developed in an urban setting, resulting in their inappropriateness to the target rural audiences. Furthermore, their having been evolved in urban centers has hampered their subsequent replication, distribution, and use in rural areas due to lack of funds, production and distribution resources. For this reason, many developing countries in Asia have begun to demand population materials which are low-cost and simple, more appropriate to rural audiences and within local production resources and capabilities. In the light of this identified need, the Population Communication Unit, with the assistance of the Population Education Mobile Team and Clearing House, Unesco, has collaborated with the Population Center Foundation of the Philippines to undertake a Regional Training Workshop on the Design, Development, and Utilization of Low-Cost Audiovisual Aids in the Philippines from 21-26 July 1980. The Workshop, which will be attended by communications personnel and materials developers from Bangladesh, Indonesia, Nepal, the Philippines, Sri Lanka and Thailand, will focus on developing the capabilities of midlevel population program personnel in conceptualizing, designing, developing, testing and utilizing simple and low-cost audiovisual materials. It is hoped that with the skills acquired from the Workshop, participants will be able to increase their capability in training their own personnel in the development of low-cost materials.

  20. Cost and clinical utility of repeated syphilis screening in the third trimester in a high-risk population.

    Science.gov (United States)

    Shiber, Linda; Todia, William J

    2014-03-01

    We sought to determine the clinical utility and cost of repeating syphilis testing in the third trimester of pregnancy in a high-risk urban population. A retrospective cohort analysis was performed for patients delivering from January 1993 through December 2009 with at least 1 venereal disease research laboratory (VDRL) test sent during pregnancy. Chart review was performed for patients with confirmed syphilis to determine the temporal relationship of syphilis diagnosis to the pregnancy. For patients who seroconverted during pregnancy (no antecedent history or treatment for syphilis), newborn charts were reviewed. The costs of treating seropositive neonates and the costs of implementing additional third-trimester syphilis screening were then compared. In the 17-year cohort, 58,569 deliveries were available for analysis. In all, 113 new cases of syphilis occurred (192.9/100,000 deliveries). There were 17 detected seroconversions; 10 were not rescreened in the third trimester and tested positive at delivery. These 10 patients may have benefitted from implementing uniform VDRL testing at 28-32 weeks' gestation. All newborns were asymptomatic with a negative workup and received empiric penicillin therapy. Based on 2011 hospital charges, the cost of evaluating and treating a neonate for syphilis is $11,079. Implementing an additional VDRL screen at 28-32 weeks' gestation for each pregnant patient during the 17 years studied would cost $1,991,346. An 18-fold increase in syphilis prevalence (3500/100,000 [3.5%] deliveries) would be required for the cost of implementation of universal early third-trimester screening to be equal to the potential health care charges saved by detecting maternal seroconversion and obviating the need for neonatal therapy. In this high-risk population, additional syphilis screening in the third trimester is costly and is not clinically helpful in detecting maternal seroconversion. Copyright © 2014 Mosby, Inc. All rights reserved.

  1. Integrated analysis considered mitigation cost, damage cost and adaptation cost in Northeast Asia

    Science.gov (United States)

    Park, J. H.; Lee, D. K.; Kim, H. G.; Sung, S.; Jung, T. Y.

    2015-12-01

    Various studies show that raising the temperature as well as storms, cold snap, raining and drought caused by climate change. And variety disasters have had a damage to mankind. The world risk report(2012, The Nature Conservancy) and UNU-EHS (the United Nations University Institute for Environment and Human Security) reported that more and more people are exposed to abnormal weather such as floods, drought, earthquakes, typhoons and hurricanes over the world. In particular, the case of Korea, we influenced by various pollutants which are occurred in Northeast Asian countries, China and Japan, due to geographical meteorological characteristics. These contaminants have had a significant impact on air quality with the pollutants generated in Korea. Recently, around the world continued their effort to reduce greenhouse gas and to improve air quality in conjunction with the national or regional development goals priority. China is also working on various efforts in accordance with the international flows to cope with climate change and air pollution. In the future, effect of climate change and air quality in Korea and Northeast Asia will be change greatly according to China's growth and mitigation policies. The purpose of this study is to minimize the damage caused by climate change on the Korean peninsula through an integrated approach taking into account the mitigation and adaptation plan. This study will suggest a climate change strategy at the national level by means of a comprehensive economic analysis of the impacts and mitigation of climate change. In order to quantify the impact and damage cost caused by climate change scenarios in a regional scale, it should be priority variables selected in accordance with impact assessment of climate change. The sectoral impact assessment was carried out on the basis of selected variables and through this, to derive the methodology how to estimate damage cost and adaptation cost. And then, the methodology was applied in Korea

  2. Cost-utility of biological treatment sequences for luminal Crohn's disease in Europe.

    Science.gov (United States)

    Rencz, Fanni; Gulácsi, László; Péntek, Márta; Gecse, Krisztina B; Dignass, Axel; Halfvarson, Jonas; Gomollón, Fernando; Baji, Petra; Peyrin-Biroulet, Laurent; Lakatos, Peter L; Brodszky, Valentin

    2017-04-28

    This study aims to compare the cost-effectiveness of treatment sequences with available biologics, including adalimumab (ADA), biosimilar infliximab (bsIFX), originator infliximab (IFX) and vedolizumab (VEDO) for luminal Crohn's disease in nine European countries. A Markov-model was constructed to simulate five-year medical costs and quality-adjusted life years (QALYs). Data on clinical efficacy were obtained from randomised controlled trials. Country-specific unit costs, discount rates and a third-party payer perspective were applied. The bsIFX versus conventional therapy resulted in the most favourable incremental cost-utility ratios (ICURs) ranging from €34,580 (Hungary) to €77,062/QALY (Sweden). Compared to bsIFX, the bsIFX-ADA sequence was more cost-effective than the bsIFX-VEDO sequence with ICURs varying between €70,277 (France) and €162,069/QALY (Germany). The ICURs of the bsIFX-ADA-VEDO sequence versus the bsIFX-ADA strategy were between €206,266 (The Netherlands) and €363,232/QALY (Spain). We are the first to compare cost-effectiveness of multiple biological sequences for luminal Crohn's disease. Based on our findings, bsIFX can be recommended as a first-line treatment in patients unresponsive to conventional treatments. While biological sequences only slightly differ in their associated health gains, their costs vary greatly. The bsIFX-ADA-VEDO seems to be the most cost-effective sequence of the available biologics across Europe.

  3. Cost analysis methodology: Photovoltaic Manufacturing Technology Project

    Energy Technology Data Exchange (ETDEWEB)

    Whisnant, R.A. (Research Triangle Inst., Research Triangle Park, NC (United States))

    1992-09-01

    This report describes work done under Phase 1 of the Photovoltaic Manufacturing Technology (PVMaT) Project. PVMaT is a five-year project to support the translation of research and development in PV technology into the marketplace. PVMaT, conceived as a DOE/industry partnership, seeks to advanced PV manufacturing technologies, reduce PV module production costs, increase module performance, and expand US commercial production capacities. Under PVMaT, manufacturers will propose specific manufacturing process improvements that may contribute to the goals of the project, which is to lessen the cost, thus hastening entry into the larger scale, grid-connected applications. Phase 1 of the PVMaT project is to identify obstacles and problems associated with manufacturing processes. This report describes the cost analysis methodology required under Phase 1 that will allow subcontractors to be ranked and evaluated during Phase 2.

  4. Cost-benefit analysis of wetland restoration

    DEFF Research Database (Denmark)

    Dubgaard, Alex

    2004-01-01

    The purpose of cost-benefit analysis (CBA) is to identify value for money solutions to government policies or projects. Environmental policy appraisal is typically complicated by the fact that thre are a number of feasible solutions to a decision problem - each yielding a different mix...... of environmental services. Costs typically depend on the level of ambitions regarding the magnitude and multitude of benefits. Decision makers are therefore confronted with the questions: how can generically different benefits be measured in comparable terms and how should different levels of project costs...... be weighed against benefits? Economic valuation methods and CBA simplify the decision problem by reducing the various effects to single-valued commensurate magnitudes, which - in principle at least - facilitates the identification of a socially optimal solution. The main objective of this article...

  5. Cost-effectiveness and cost-utility of combination therapy in early rheumatoid arthritis: randomized comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone. COBRA Trial Group. Combinatietherapie Bij Reumatoïde Artritis.

    Science.gov (United States)

    Verhoeven, A C; Bibo, J C; Boers, M; Engel, G L; van der Linden, S

    1998-10-01

    Assessment of the cost-effectiveness and cost-utility of early intervention in rheumatoid arthritis (RA) patients, with combined step-down prednisolone, methotrexate and sulphasalazine, compared to sulphasalazine alone. Multicentre 56 week randomized double-blind trial with full economic analysis of direct costs and utility analysis with rating scale and standard gamble measurement techniques. The combined-treatment group included 76 patients and the sulphasalazine group 78 patients. The mean total costs per patient in the first 56 weeks of follow-up were $5519 for combined treatment and $6511 for treatment with sulphasalazine alone (P = 0.37). Out-patient care, in-patient care and non-health care each contributed about one-third to the total costs. The combined-treatment group appeared to generate savings in the length of hospital stay for RA, non-protocol drugs and costs of home help, but comparisons were not statistically significant. Protocol drugs and monitoring were slightly more expensive in the combined-treatment group. Clinical, radiographic and functional outcomes significantly favoured combined treatment at week 28 (radiography also at week 56). Utility scores also favoured combined treatment. Combined treatment is cost-effective due to enhanced efficacy at lower or equal direct costs.

  6. The Program Administrator Cost of Saved Energy for Utility Customer-Funded Energy Efficiency Programs

    Energy Technology Data Exchange (ETDEWEB)

    Billingsley, Megan A.; Hoffman, Ian M.; Stuart, Elizabeth; Schiller, Steven R.; Goldman, Charles A.; LaCommare, Kristina

    2014-03-19

    End-use energy efficiency is increasingly being relied upon as a resource for meeting electricity and natural gas utility system needs within the United States. There is a direct connection between the maturation of energy efficiency as a resource and the need for consistent, high-quality data and reporting of efficiency program costs and impacts. To support this effort, LBNL initiated the Cost of Saved Energy Project (CSE Project) and created a Demand-Side Management (DSM) Program Impacts Database to provide a resource for policy makers, regulators, and the efficiency industry as a whole. This study is the first technical report of the LBNL CSE Project and provides an overview of the project scope, approach, and initial findings, including: • Providing a proof of concept that the program-level cost and savings data can be collected, organized, and analyzed in a systematic fashion; • Presenting initial program, sector, and portfolio level results for the program administrator CSE for a recent time period (2009-2011); and • Encouraging state and regional entities to establish common reporting definitions and formats that would make the collection and comparison of CSE data more reliable. The LBNL DSM Program Impacts Database includes the program results reported to state regulators by more than 100 program administrators in 31 states, primarily for the years 2009–2011. In total, we have compiled cost and energy savings data on more than 1,700 programs over one or more program-years for a total of more than 4,000 program-years’ worth of data, providing a rich dataset for analyses. We use the information to report costs-per-unit of electricity and natural gas savings for utility customer-funded, end-use energy efficiency programs. The program administrator CSE values are presented at national, state, and regional levels by market sector (e.g., commercial, industrial, residential) and by program type (e.g., residential whole home programs, commercial new

  7. Final Report: Hydrogen Storage System Cost Analysis

    Energy Technology Data Exchange (ETDEWEB)

    James, Brian David [Strategic Analysis Inc., Arlington, VA (United States); Houchins, Cassidy [Strategic Analysis Inc., Arlington, VA (United States); Huya-Kouadio, Jennie Moton [Strategic Analysis Inc., Arlington, VA (United States); DeSantis, Daniel A. [Strategic Analysis Inc., Arlington, VA (United States)

    2016-09-30

    The Fuel Cell Technologies Office (FCTO) has identified hydrogen storage as a key enabling technology for advancing hydrogen and fuel cell power technologies in transportation, stationary, and portable applications. Consequently, FCTO has established targets to chart the progress of developing and demonstrating viable hydrogen storage technologies for transportation and stationary applications. This cost assessment project supports the overall FCTO goals by identifying the current technology system components, performance levels, and manufacturing/assembly techniques most likely to lead to the lowest system storage cost. Furthermore, the project forecasts the cost of these systems at a variety of annual manufacturing rates to allow comparison to the overall 2017 and “Ultimate” DOE cost targets. The cost breakdown of the system components and manufacturing steps can then be used to guide future research and development (R&D) decisions. The project was led by Strategic Analysis Inc. (SA) and aided by Rajesh Ahluwalia and Thanh Hua from Argonne National Laboratory (ANL) and Lin Simpson at the National Renewable Energy Laboratory (NREL). Since SA coordinated the project activities of all three organizations, this report includes a technical description of all project activity. This report represents a summary of contract activities and findings under SA’s five year contract to the US Department of Energy (Award No. DE-EE0005253) and constitutes the “Final Scientific Report” deliverable. Project publications and presentations are listed in the Appendix.

  8. Analysis on Cost and Influence of the Utilization of Sterilized Tool by Central Bank%央行运用冲销工具的成本和影响研究

    Institute of Scientific and Technical Information of China (English)

    赵先立

    2012-01-01

    央行票据冲销外汇占款的微观成本在2004-2010年为盈利,从国内角度来说,央行使用央行票据冲销流动性的微观成本高于存款准备金率的微观成本。央行票据和存款准备金率对宏观经济的影响利弊共存,但就冲销流动性的效果而言,央行票据使用更为灵活,存款准备金率的冲销力度更大。%In this paper, central bank bills and deposit reserve ratio has been studied from micro-cost and macro-economic impact. Results showed that: the central bank bills sterilized foreign exchange generate profits in 2004-2010. From a domestic point of view, the central bank use of central bank bills sterilization the cost of the micro-mobility had higher cost than the deposit reserve ratio. Central bank bills and deposit reserve rate have Positive and negative impact on the macroeconomic. But in terms of effect, central bank bills is more flexible, and the deposit reserve ratio is greater intensity.

  9. Is it really possible to build a bridge between cost-benefit analysis and cost-effectiveness analysis?

    Science.gov (United States)

    Dolan, Paul; Edlin, Richard

    2002-09-01

    Cost-benefit analysis (CBA) is a recognised as the economic evaluation technique that accords most with the underlying principles of standard welfare economic theory. However, due to problems associated with the technique, economists evaluating resources allocation decisions in health care have most often used cost-effective analysis (CEA), in which health benefits are expressed in non-monetary units. As a result, attempts have been made to build a welfare economic bridge between cost-benefit analysis (CBA) and cost-effectiveness analysis (CEA). In this paper, we develops these attempts and finds that, while assumptions can be made to facilitate a constant willingness-to-pay per unit of health outcome, these restrictions are highly unrealistic. We develop an impossibility theorem that shows it is not possible to link CBA and CEA if: (i) the axioms of expected utility theory hold; (ii) the quality-adjusted life-year (QALY) model is valid in a welfare economic sense; and (iii) illness affects the ability to enjoy consumption. We conclude that, within a welfare economic framework, it would be unwise to rely on a link between CBA and CEA in economic evaluations.

  10. Antiepileptic drugs prescription utilization behavior and direct costs of treatment in a national hospital of India

    Directory of Open Access Journals (Sweden)

    Ahsan Haroon

    2012-01-01

    Full Text Available Background and Objectives: The present study evaluated the direct costs of active epilepsy and looked at the pattern of drug prescription and utilization in epileptic patients visiting the neuroscience centre of a national hospital of India. Materials and Methods: A total of 134 epileptic patients were studied over a period of 4 months. Patients demography, commonly prescribed antiepileptic drugs (AEDs, socioeconomic status, direct costs, response ratio (RR for newer drugs, and quality of life (QOLIE-10 was evaluated. Results and Discussion: We found a higher percentage of male patients (67.9% as compared with females. Most of the patients were in the age group 11-30 years and majority of them (39.6% belonged to lower middle group. A higher percentage (68.7 of drugs was prescribed as polytherapy. Higher monthly cost was observed for some of the newer AEDs including the lamotrigine, levetiracetam, and lacosamide as compared with older drugs. Among the newer drugs, clobazam had the lowest cost. RR was calculated for 12 patients out of which 8 had a RR < −0.50. The QOL domains, following conventional or newer drugs, were not much affected. Conclusion: The study indicates an increasing trend toward clinical usage of newer AEDs, increasing trend of poly-therapy with significant escalations in the cost of therapy.

  11. DESCRIPTIVE STATISTICS IN COST RESEARCH: ANALYSIS OF XIV BRAZILIAN CONGRESS OF COSTS

    OpenAIRE

    Diehl, Carlos Alberto; UNISINOS; Souza, Marcos Antônio de; UNISINOS; Domingos, Laura Elaine Cabral

    2009-01-01

    The objective of this article is the study of the utilization of descriptive statistics in costs researches, specifically in those presented in XIV Brazilian Congress of Costs, carried out in 2007, in João Pessoa city (PB). Firstly one does a theoretical revision about descriptive statistic and the presentation of the Costs Congress, carried out since 1994, under the organization of the Brazilian Association of Costs. In the sequence the methodological aspects of the study are presented, clas...

  12. Space biology initiative program definition review. Trade study 1: Automation costs versus crew utilization

    Science.gov (United States)

    Jackson, L. Neal; Crenshaw, John, Sr.; Hambright, R. N.; Nedungadi, A.; Mcfayden, G. M.; Tsuchida, M. S.

    1989-01-01

    A significant emphasis upon automation within the Space Biology Initiative hardware appears justified in order to conserve crew labor and crew training effort. Two generic forms of automation were identified: automation of data and information handling and decision making, and the automation of material handling, transfer, and processing. The use of automatic data acquisition, expert systems, robots, and machine vision will increase the volume of experiments and quality of results. The automation described may also influence efforts to miniaturize and modularize the large array of SBI hardware identified to date. The cost and benefit model developed appears to be a useful guideline for SBI equipment specifiers and designers. Additional refinements would enhance the validity of the model. Two NASA automation pilot programs, 'The Principal Investigator in a Box' and 'Rack Mounted Robots' were investigated and found to be quite appropriate for adaptation to the SBI program. There are other in-house NASA efforts that provide technology that may be appropriate for the SBI program. Important data is believed to exist in advanced medical labs throughout the U.S., Japan, and Europe. The information and data processing in medical analysis equipment is highly automated and future trends reveal continued progress in this area. However, automation of material handling and processing has progressed in a limited manner because the medical labs are not affected by the power and space constraints that Space Station medical equipment is faced with. Therefore, NASA's major emphasis in automation will require a lead effort in the automation of material handling to achieve optimal crew utilization.

  13. Analysis of Low-Temperature Utilization of Geothermal Resources

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, Brian

    2015-06-30

    Full realization of the potential of what might be considered “low-grade” geothermal resources will require that we examine many more uses for the heat than traditional electricity generation. To demonstrate that geothermal energy truly has the potential to be a national energy source we will be designing, assessing, and evaluating innovative uses for geothermal-produced water such as hybrid biomass-geothermal cogeneration of electricity and district heating and efficiency improvements to the use of cellulosic biomass in addition to utilization of geothermal in district heating for community redevelopment projects. The objectives of this project were: 1) to perform a techno-economic analysis of the integration and utilization potential of low-temperature geothermal sources. Innovative uses of low-enthalpy geothermal water were designed and examined for their ability to offset fossil fuels and decrease CO2 emissions. 2) To perform process optimizations and economic analyses of processes that can utilize low-temperature geothermal fluids. These processes included electricity generation using biomass and district heating systems. 3) To scale up and generalize the results of three case study locations to develop a regionalized model of the utilization of low-temperature geothermal resources. A national-level, GIS-based, low-temperature geothermal resource supply model was developed and used to develop a series of national supply curves. We performed an in-depth analysis of the low-temperature geothermal resources that dominate the eastern half of the United States. The final products of this study include 17 publications, an updated version of the cost estimation software GEOPHIRES, and direct-use supply curves for low-temperature utilization of geothermal resources. The supply curves for direct use geothermal include utilization from known hydrothermal, undiscovered hydrothermal, and near-hydrothermal EGS resources and presented these results at the Stanford

  14. Effect of coal quality on maintenance costs at utility plants. Final report. [Effect of ash and sulfur content of coal

    Energy Technology Data Exchange (ETDEWEB)

    Holt, E.C. Jr.

    1980-06-01

    In an attempt to determine if correlation exists between coal quality, as measured by its ash and sulfur contents, and the maintenance cost at utility plants, an examination was made of the actual maintenance cost experience of selected portions of five TVA coal-fired power plants as a function of the fuel quality consumed during an extended period of time. The results indicate that, according to our decision rules developed in compliance with accepted statistical practices, correlation does exist in many portions of the coal-fired plants for which sufficient maintenance cost records were available. The degree of correlation varies significantly among the individual portions of a particular plant as well as among the various plants. However, the indicators are sufficient to confirm that a change (within the design constraints of the unit) in the ash and/or sulfur content of the coal being consumed by a utility boiler will have a proportionate effect on the maintenance cost at the plant. In the cases examined, each percent variation in ash content could have a monetary effect of from $0.05 to $0.10 per ton of coal consumed. Similarly, each percent variation in sulfur content could influence maintenance costs from $0.30 to $0.50 per ton of coal. Since these values are based on preliminary analysis of limited data, they must be approached with caution and not removed from the context in which they are presented. However, if borne out by further study, the potential magnitude of such savings may be sufficient to justify the acquisition of superior coal supplies, either by changing the source and/or using preparation to obtain a lower ash and sulfur fuel.

  15. Quality demand, raw material utilization and costs at a marked increase in the use of forest fuels; Kvalitetskrav, raavaruutnyttjande och kostnader vid kraftigt oekad anvaendning av skogsbraensle

    Energy Technology Data Exchange (ETDEWEB)

    Arlinger, John; Brunberg, Bengt; Eriksson, Mats; Thor, Magnus [Forestry Research Inst. of Sweden, Uppsala (Sweden)

    2001-03-01

    The work has been carried on in three steps: (1) Mapping of the present quality of forest fuels at heating and cogeneration utilities and pellets producers, (2) Calculation of gross supply of forest fuels in three forestry administrations at AssiDomaen in southern, central and northern Sweden, and (3) Analysis of costs and raw material utilization in three forestry administrations at AssiDomaen in southern, central and northern Sweden. A very detailed description of the results is given in three appendixes.

  16. Low cost real time interactive analysis system

    Science.gov (United States)

    Stetina, F.

    1988-01-01

    Efforts continue to develop a low cost real time interactive analysis system for the reception of satellite data. A multi-purpose ingest hardware software frame formatter was demonstrated for GOES and TIROS data and work is proceeding on extending the capability to receive GMS data. A similar system was proposed as an archival and analysis system for use with INSAT data and studies are underway to modify the system to receive the planned SeaWiFS (ocean color) data. This system was proposed as the core of a number of international programs in support of U.S. AID activities. Systems delivered or nearing final testing are listed.

  17. LanroNET, a non-interventional, prospective study to assess the resource utilization and cost of lanreotide autogel 120 mg in Polish patients with neuroendocrine tumors - results of interim analysis.

    Science.gov (United States)

    Orlewska, Ewa; Bednarczuk, Tomasz; Kaminski, Grzegorz; Kos-Kudla, Beata

    2014-01-01

    To examine characteristics and treatment patterns of symptomatic neuroendocrine tumors (NETs) patients who received lanreotide Autogel 120 mg (ATG120) administered as part of routine clinical practice. Lanro-NET is a national, multicenter, non-interventional, observational study in the population of adult patients with symptomatic NETs treated with ATG120 for at least three months before inclusion. Data on demographic and clinical characteristics of the population, dosing interval regimen and aspects of administration were collected prospectively during 12 months. Costs were calculated from the perspective of public payer for the year 2014. Fifty-two patients were enrolled in the study. Primary tumors were located predominantly in gastrointestinal tract (51.2%), all tumors were metastatic. The most commonly reported disease symptoms were flushing and diarrhea (55.8% of patients). 86% of patients had undergone surgery, chemotherapy and radioisotope therapy were used in 11.6% and 46.5% of patients, respectively. During the 12-months observation 12 (28%) patients received ATG120 at an extended dosing interval (> 4 weeks), the mean number of days between injections was 31.75 (SD 6.74). The cost of ATG12 was estimated at 4273.17 PLN patient/month. In all patients ATG120 was administered by nurse, 51.6% of injections in out-patient setting, 48.4% - in hospital. This study presents the current use of ATG120 in the population of Polish NETs patients in a realistic clinical settings. Finding that 28% of patients could be treated with extended dose intervals supports the potential for ATG120 of reducing treatment burden.

  18. LanroNET, a non-interventional, prospective study to assess the resource utilization and cost of lanreotide autogel 120 mg in Polish patients with neuroendocrine tumors – results of interim analysis

    Science.gov (United States)

    Bednarczuk, Tomasz; Kaminski, Grzegorz; Kos-Kudla, Beata

    2014-01-01

    Aim of the study To examine characteristics and treatment patterns of symptomatic neuroendocrine tumors (NETs) patients who received lanreotide Autogel 120 mg (ATG120) administered as part of routine clinical practice. Material and methods Lanro-NET is a national, multicenter, non-interventional, observational study in the population of adult patients with symptomatic NETs treated with ATG120 for at least three months before inclusion. Data on demographic and clinical characteristics of the population, dosing interval regimen and aspects of administration were collected prospectively during 12 months. Costs were calculated from the perspective of public payer for the year 2014. Results Fifty-two patients were enrolled in the study. Primary tumors were located predominantly in gastrointestinal tract (51.2%), all tumors were metastatic. The most commonly reported disease symptoms were flushing and diarrhea (55.8% of patients). 86% of patients had undergone surgery, chemotherapy and radioisotope therapy were used in 11.6% and 46.5% of patients, respectively. During the 12-months observation 12 (28%) patients received ATG120 at an extended dosing interval (> 4 weeks), the mean number of days between injections was 31.75 (SD 6.74). The cost of ATG12 was estimated at 4273.17 PLN patient/month. In all patients ATG120 was administered by nurse, 51.6% of injections in out-patient setting, 48.4% – in hospital. Conclusions This study presents the current use of ATG120 in the population of Polish NETs patients in a realistic clinical settings. Finding that 28% of patients could be treated with extended dose intervals supports the potential for ATG120 of reducing treatment burden. PMID:25784845

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

    Directory of Open Access Journals (Sweden)

    Milne Ruairidh

    2001-10-01

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

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

    Science.gov (United States)

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

    2017-03-01

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

  1. Putting the ‘Q’ in QALY in cost-utility analyses

    DEFF Research Database (Denmark)

    Oddershede, Lars

    Resources are scare and healthcare systems must, therefore, prioritize which new technologies should be funded, and which should be rejected. To aid decision makers in their choice, economic evaluations can be conducted to assess the cost-effectiveness of the new technologies. The present thesis...... argues that two problems could be solved by updating the Danish guideline for economic evaluations to include a stated preference for measuring effectiveness in terms of quality adjusted life-years (QALYs). Firstly, it would be possible to compare the cost-effectiveness of new technologies across...... conditions. Secondly, it would make it possible to capture both effects and side effects of new technologies in a single outcome measure. Therefore, the present thesis explores how to procure optimal estimates of quality of life, i.e. utility, for QALY calculations in different situations, depending on which...

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

    NARCIS (Netherlands)

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

    2005-01-01

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

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

    NARCIS (Netherlands)

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

    2005-01-01

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

  4. Cost-utility of molecular adsorbent recirculating system treatment in acute liver failure

    Institute of Scientific and Technical Information of China (English)

    Taru; Kantola; Suvi; Mklin; Anna-Maria; Koivusalo; Pirjo; Rsnen; Anne; Rissanen; Risto; Roine; Harri; Sintonen; Krister; Hckerstedt; Helena; Isoniemi

    2010-01-01

    AIM:To determine the short-term cost-utility of mo-lecular adsorbent recirculating system(MARS) treatment in acute liver failure(ALF).METHODS:A controlled retrospective study was conducted with 90 ALF patients treated with MARS from 2001 to 2005.Comparisons were made with a historical control group of 17 ALF patients treated from 2000 to 2001 in the same intensive care unit(ICU) specializing in liver diseases.The 3-year outcomes and number of liver transplantations were recorded.All direct liver disease-rel...

  5. Utilization and cost of a new model of care for managing acute knee injuries: the Calgary acute knee injury clinic

    Directory of Open Access Journals (Sweden)

    Lau Breda HF

    2012-12-01

    Full Text Available Abstract Background Musculoskeletal disorders (MSDs affect a large proportion of the Canadian population and present a huge problem that continues to strain primary healthcare resources. Currently, the Canadian healthcare system depicts a clinical care pathway for MSDs that is inefficient and ineffective. Therefore, a new inter-disciplinary team-based model of care for managing acute knee injuries was developed in Calgary, Alberta, Canada: the Calgary Acute Knee Injury Clinic (C-AKIC. The goal of this paper is to evaluate and report on the appropriateness, efficiency, and effectiveness of the C-AKIC through healthcare utilization and costs associated with acute knee injuries. Methods This quasi-experimental study measured and evaluated cost and utilization associated with specific healthcare services for patients presenting with acute knee injuries. The goal was to compare patients receiving care from two clinical care pathways: the existing pathway (i.e. comparison group and a new model, the C-AKIC (i.e. experimental group. This was accomplished through the use of a Healthcare Access and Patient Satisfaction Questionnaire (HAPSQ. Results Data from 138 questionnaires were analyzed in the experimental group and 136 in the comparison group. A post-hoc analysis determined that both groups were statistically similar in socio-demographic characteristics. With respect to utilization, patients receiving care through the C-AKIC used significantly less resources. Overall, patients receiving care through the C-AKIC incurred 37% of the cost of patients with knee injuries in the comparison group and significantly incurred less costs when compared to the comparison group. The total aggregate average cost for the C-AKIC group was $2,549.59 compared to $6,954.33 for the comparison group (p Conclusions The Calgary Acute Knee Injury Clinic was able to manage and treat knee injured patients for less cost than the existing state of healthcare delivery. The

  6. Evaluating the cost utility of racecadotril for the treatment of acute watery diarrhea in children: the RAWD model

    Directory of Open Access Journals (Sweden)

    Rautenberg TA

    2012-04-01

    Full Text Available Tamlyn Anne Rautenberg1,2, Ute Zerwes1, Douglas Foerster3,4, Rick Aultman51Assessment in Medicine GmbH, Lörrach, Germany; 2Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; 3Abbott Products Operations AG, Allschwil, Switzerland; 4University of Bielefeld, School of Public Health, Bielefeld, Germany; 5Semalytics, Arizona, United States of AmericaBackground: The safety and efficacy of racecadotril to treat acute watery diarrhea (AWD in children is well established, however its cost effectiveness for infants and children in Europe has not yet been determined.Objective: To evaluate the cost utility of racecadotril adjuvant with oral rehydration solution (ORS compared to ORS alone for the treatment of AWD in children younger than 5 years old. The analysis is performed from a United Kingdom National Health Service (NHS perspective.Methods: A decision tree model has been developed in Microsoft® Excel. The model is populated with the best available evidence. Deterministic and probabilistic sensitivity analyses (PSA have been performed. Health effects are measured as quality-adjusted life years (QALYs and the model output is cost (2011 GBP per QALY. The uncertainty in the primary outcome is explored by probabilistic analysis using 1000 iterations of a Monte Carlo simulation.Results: Deterministic analysis results in a total incremental cost of –£379 in favor of racecadotril and a total incremental QALY gain in favor of racecadotril of +0.0008. The observed cost savings with racecadotril arise from the reduction in primary care reconsultation and secondary referral. The difference in QALYs is largely attributable to the timely resolution of symptoms in the racecadotril arm. Racecadotril remains dominant when base case parameters are varied. Monte Carlo simulation and PSA confirm that racecadotril is the dominant treatment strategy and is almost certainly cost effective, under the central assumptions of the model, at a

  7. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement.

    Science.gov (United States)

    Snow, Richard; Granata, Jaymes; Ruhil, Anirudh V S; Vogel, Karen; McShane, Michael; Wasielewski, Ray

    2014-10-01

    Health-care costs following acute hospital care have been identified as a major contributor to regional variation in Medicare spending. This study investigated the associations of preoperative physical therapy and post-acute care resource use and its effect on the total cost of care during primary hip or knee arthroplasty. Historical claims data were analyzed using the Centers for Medicare & Medicaid Services Limited Data Set files for Diagnosis Related Group 470. Analysis included descriptive statistics of patient demographic characteristics, comorbidities, procedures, and post-acute care utilization patterns, which included skilled nursing facility, home health agency, or inpatient rehabilitation facility, during the ninety-day period after a surgical hospitalization. To evaluate the associations, we used bivariate and multivariate techniques focused on post-acute care use and total episode-of-care costs. The Limited Data Set provided 4733 index hip or knee replacement cases for analysis within the thirty-nine-county Medicare hospital referral cluster. Post-acute care utilization was a significant variable in the total cost of care for the ninety-day episode. Overall, 77.0% of patients used post-acute care services after surgery. Post-acute care utilization decreased if preoperative physical therapy was used, with only 54.2% of the preoperative physical therapy cohort using post-acute care services. However, 79.7% of the non-preoperative physical therapy cohort used post-acute care services. After adjusting for demographic characteristics and comorbidities, the use of preoperative physical therapy was associated with a significant 29% reduction in post-acute care use, including an $871 reduction of episode payment driven largely by a reduction in payments for skilled nursing facility ($1093), home health agency ($527), and inpatient rehabilitation ($172). The use of preoperative physical therapy was associated with a 29% decrease in the use of any post-acute care

  8. Financial Analysis of Incentive Mechanisms to Promote Energy Efficiency: Case Study of a Prototypical Southwest Utility

    Energy Technology Data Exchange (ETDEWEB)

    Cappers, Peter; Goldman, Charles; Chait, Michele; Edgar, George; Schlegel, Jeff; Shirley, Wayne

    2009-03-04

    alternative incentive approaches on utility shareholders and customers if energy efficiency is implemented under various utility operating, cost, and supply conditions.We used and adapted a spreadsheet-based financial model (the Benefits Calculator) which was developed originally as a tool to support the National Action Plan for Energy Efficiency (NAPEE). The major steps in our analysis are displayed graphically in Figure ES- 1. Two main inputs are required: (1) characterization of the utility which includes its initial financial and physical market position, a forecast of the utility?s future sales, peak demand, and resource strategy to meet projected growth; and (2) characterization of the Demand-Side Resource (DSR) portfolio ? projected electricity and demand savings, costs and economic lifetime of a portfolio of energy efficiency (and/or demand response) programs that the utility is planning or considering implementing during the analysis period. The Benefits Calculator also estimates total resource costs and benefits of the DSR portfolio using a forecast of avoided capacity and energy costs. The Benefits Calculator then uses inputs provided in the Utility Characterization to produce a ?business-as usual? base case as well as alternative scenarios that include energy efficiency resources, including the corresponding utility financial budgets required in each case. If a decoupling and/or a shareholder incentive mechanism are instituted, the Benefits Calculator model readjusts the utility?s revenue requirement and retail rates accordingly. Finally, for each scenario, the Benefits Calculator produces several metrics that provides insights on how energy efficiency resources, decoupling and/or a shareholder incentive mechanism impacts utility shareholders (e.g. overall earnings, return on equity), ratepayers (e.g., average customer bills and rates) and society (e.g. net resource benefits).

  9. 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

  10. Nuclear Power Plant Module, NPP-1: Nuclear Power Cost Analysis.

    Science.gov (United States)

    Whitelaw, Robert L.

    The purpose of the Nuclear Power Plant Modules, NPP-1, is to determine the total cost of electricity from a nuclear power plant in terms of all the components contributing to cost. The plan of analysis is in five parts: (1) general formulation of the cost equation; (2) capital cost and fixed charges thereon; (3) operational cost for labor,…

  11. Modelling User-Costs in Life Cycle Cost-Benefit (LCCB) analysis

    DEFF Research Database (Denmark)

    Thoft-Christensen, Palle

    2008-01-01

    The importance of including user's costs in Life-Cycle Cost-Benefit analysis of structures is discussed in this paper. This is especially for bridges of great importance. Repair or/and failure of a bridge will usually result in user costs greater than the repair or replacement costs of the bridge...

  12. Utility green pricing programs: A statistical analysis of program effectiveness

    Energy Technology Data Exchange (ETDEWEB)

    Wiser, Ryan; Olson, Scott; Bird, Lori; Swezey, Blair

    2004-02-01

    Development of renewable energy. Such programs have grown in number in recent years. The design features and effectiveness of these programs varies considerably, however, leading a variety of stakeholders to suggest specific marketing and program design features that might improve customer response and renewable energy sales. This report analyzes actual utility green pricing program data to provide further insight into which program features might help maximize both customer participation in green pricing programs and the amount of renewable energy purchased by customers in those programs. Statistical analysis is performed on both the residential and non-residential customer segments. Data comes from information gathered through a questionnaire completed for 66 utility green pricing programs in early 2003. The questionnaire specifically gathered data on residential and non-residential participation, amount of renewable energy sold, program length, the type of renewable supply used, program price/cost premiums, types of consumer research and program evaluation performed, different sign-up options available, program marketing efforts, and ancillary benefits offered to participants.

  13. Telemedicine-based diabetic retinopathy screening programs: an evaluation of utility and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Cuadros JA

    2015-06-01

    Full Text Available Jorge A Cuadros Optometry/Vision Science, University of California, Berkeley, CA, USA Abstract: Diabetes is the main cause of blindness among working age adults, although treatment is highly effective in preventing vision loss. Eye examinations are recommended on a yearly basis for most patients for timely detection of retinal disease. Telemedicine-based diabetic retinopathy screening (TMDRS programs have been developed to identify patients with sight-threatening diabetic eye disease because patients are often noncompliant with recommended live eye examinations. This article reviews the cost-effectiveness of the various forms of TMDRS. A review of relevant articles, mostly published since 2008, shows that societal benefits generally outweigh the costs of TMDRS. However, advances in technology to improve efficacy, lower costs, and broaden screening to other sight-threatening conditions, such as glaucoma and refractive error, are necessary to improve the sustainability of TMDRS within health care organizations. Patient satisfaction with these telemedicine programs is generally high. New models of shared care with primary care providers and staff are emerging to improve patient engagement and follow-up care when individuals are found to have sight-threatening eye disease. TMDRS programs are growing and provide valuable clinical benefit. The cost-utility is currently well proven in locations with limited access to regular eye care services, such as rural areas, poor communities, and prison systems; however, improvements over time are necessary for these programs to be cost-effective in mainstream medical settings in the future. Keywords: telemedicine, diabetes, retinopathy, retinal imaging

  14. Integrating Primary Care Into Community Mental Health Centers: Impact on Utilization and Costs of Health Care.

    Science.gov (United States)

    Krupski, Antoinette; West, Imara I; Scharf, Deborah M; Hopfenbeck, James; Andrus, Graydon; Joesch, Jutta M; Snowden, Mark

    2016-11-01

    This evaluation was designed to assess the impact of providing integrated primary and mental health care on utilization and costs for outpatient medical, inpatient hospital, and emergency department treatment among persons with serious mental illness. Two safety-net, community mental health centers that received a Substance Abuse and Mental Health Services Administration Primary and Behavioral Health Care Integration (PBHCI) grant were the focus of this study. Clinic 1 had a ten-year history of providing integrated services whereas clinic 2 began integrated services with the PBHCI grant. Difference-in-differences (DID) analyses were used to compare individuals enrolled in the PBHCI programs (N=373, clinic 1; N=389, clinic 2) with propensity score-matched comparison groups of equal size at each site by using data obtained from medical records. Relative to the comparison groups, a higher proportion of PBHCI clients used outpatient medical services at both sites following program enrollment (p<.003, clinic 1; p<.001, clinic 2). At clinic 1, PBHCI was also associated with a reduction in the proportion of clients with an inpatient hospital admission (p=.04) and a trend for a reduction in inpatient hospital costs per member per month of $217.68 (p=.06). Hospital-related cost savings were not observed for PBHCI clients at clinic 2 nor were there significant differences between emergency department use or costs for PBHCI and comparison groups at either clinic. Investments in PBHCI can improve access to outpatient medical care for persons with severe mental illness and may also curb hospitalizations and associated costs in more established programs.

  15. Heliostat production evaluation and cost analysis

    Energy Technology Data Exchange (ETDEWEB)

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

    1979-12-01

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

  16. Cost-benefit considerations in regulatory analysis

    Energy Technology Data Exchange (ETDEWEB)

    Mubayi, V.; Sailor, V.; Anandalingam, G.

    1995-10-01

    Justification for safety enhancements at nuclear facilities, e.g., a compulsory backfit to nuclear power plants, requires a value-impact analysis of the increase in overall public protection versus the cost of implementation. It has been customary to assess the benefits in terms of radiation dose to the public averted by the introduction of the safety enhancement. Comparison of such benefits with the costs of the enhancement then requires an estimate of the monetary value of averted dose (dollars/person rem). This report reviews available information on a variety of factors that affect this valuation and assesses the continuing validity of the figure of $1000/person-rem averted, which has been widely used as a guideline in performing value-impact analyses. Factors that bear on this valuation include the health risks of radiation doses, especially the higher risk estimates of the BEIR V committee, recent calculations of doses and offsite costs by consequence codes for hypothesized severe accidents at U.S. nuclear power plants under the NUREG-1150 program, and recent information on the economic consequences of the Chernobyl accident in the Soviet Union and estimates of risk avoidance based on the willingness-to-pay criterion. The report analyzes these factors and presents results on the dollars/person-rem ratio arising from different assumptions on the values of these factors.

  17. Cost Benefit Analysis of Boat Lifts

    Science.gov (United States)

    2014-09-01

    to avoid the potential of mishaps due to jumping across open water to reach both sides of the lift. With the life expectancy of a boat ramp...to jumping across open water to reach both sides of the lift. Cost Benefit Analysis of Boat Lifts 11 UNCLAS//Public | CG-926 R&DC | B. Fike...equipment from boats and craft that have been corrosion problems in the past. such as wire rope and non-stainless steel hardware. Corrosion is a function

  18. UPDG: Utilities package for data analysis of Pooled DNA GWAS

    Directory of Open Access Journals (Sweden)

    Ho Daniel WH

    2012-01-01

    Full Text Available Abstract Background Despite being a well-established strategy for cost reduction in disease gene mapping, pooled DNA association study is much less popular than the individual DNA approach. This situation is especially true for pooled DNA genomewide association study (GWAS, for which very few computer resources have been developed for its data analysis. This motivates the development of UPDG (Utilities package for data analysis of Pooled DNA GWAS. Results UPDG represents a generalized framework for data analysis of pooled DNA GWAS with the integration of Unix/Linux shell operations, Perl programs and R scripts. With the input of raw intensity data from GWAS, UPDG performs the following tasks in a stepwise manner: raw data manipulation, correction for allelic preferential amplification, normalization, nested analysis of variance for genetic association testing, and summarization of analysis results. Detailed instructions, procedures and commands are provided in the comprehensive user manual describing the whole process from preliminary preparation of software installation to final outcome acquisition. An example dataset (input files and sample output files is also included in the package so that users can easily familiarize themselves with the data file formats, working procedures and expected output. Therefore, UPDG is especially useful for users with some computer knowledge, but without a sophisticated programming background. Conclusions UPDG provides a free, simple and platform-independent one-stop service to scientists working on pooled DNA GWAS data analysis, but with less advanced programming knowledge. It is our vision and mission to reduce the hindrance for performing data analysis of pooled DNA GWAS through our contribution of UPDG. More importantly, we hope to promote the popularity of pooled DNA GWAS, which is a very useful research strategy.

  19. Lean Cost Management Analysis on Food Processing Enterprise

    Directory of Open Access Journals (Sweden)

    Jing Ma

    2014-06-01

    Full Text Available The aim of this study is to introduce Lean Cost Management (LCM that tries to create creating value for customers and performs whole cost management in enterprise’s entire life cycle under structure of target cost, cost sustaining and cost improvement guided by reverse thinking into food processing enterprise to construct LCM system from aspects of external value chain analysis as well as internal cost management. Dynamic pricing game model was used to provide cost improvement on food enterprise value chain so as to minimize whole cost. The target cost was divided into each part in design phase supported by cost programming, cost reduction and cost improving. Case study shows that such cost suppressing method can reduce cost of food processing enterprises and improve long-term competitiveness.

  20. Cost Analysis of Selected Patient Categories Within A Dermatology Department Using an ABC Approach.

    Science.gov (United States)

    Papadaki, Šárka; Popesko, Boris

    2015-11-17

    Present trends in hospital management are facilitating the utilization of more accurate costing methods, which potentially results in superior cost-related information and improved managerial decision-making. However, the Activity-Based Costing method (ABC), which was designed for cost allocation purposes in the 1980s, is not widely used by healthcare organizations. This study analyzes costs related to selected categories of patients, those suffering from psoriasis, varicose ulcers, eczema and other conditions, within a dermatology department at a Czech regional hospital. The study was conducted in a hospital department where both inpatient and outpatient care are offered. Firstly, the diseases treated at the department were identified. Further costs were determined for each activity using ABC. The study utilized data from managerial and financial accounting, as well as data obtained through interviews with departmental staff. Using a defined cost-allocation procedure makes it possible to determine the cost of an individual patient with a given disease more accurately than via traditional costing procedures. The cost analysis focused on the differences between the costs related to individual patients within the selected diagnoses, variations between inpatient and outpatient treatments and the costs of activities performed by the dermatology department. Furthermore, comparing the costs identified through this approach and the revenue stemming from the health insurance system is an option. Activity-Based Costing is more accurate and relevant than the traditional costing method. The outputs of ABC provide an abundance of additional information for managers. The benefits of this research lie in its practically-tested outputs, resulting from calculating the costs of hospitalization, which could prove invaluable to persons involved in hospital management and decision-making. The study also defines the managerial implications of the performed cost analysis for the

  1. The potential to forgo social welfare gains through overrelianceon cost effectiveness/cost utility analyses in the evidence base for public health.

    Science.gov (United States)

    Cohen, D R; Patel, N

    2009-01-01

    Economic evaluations of clinical treatments most commonly take the form of cost effectiveness or cost utility analyses. This is appropriate since the main-sometimes the only-benefit of such interventions is increased health. The majority of economic evaluations in public health, however, have also been assessed using these techniques when arguably cost benefit analyses would in many cases have been more appropriate, given its ability to take account of nonhealth benefits as well. An examination of the nonhealth benefits from a sample of studies featured in a recent review of economic evaluations in public health illustrates how overfocusing on cost effectiveness/cost utility analyses may lead to forgoing potential social welfare gains from programmes in public health. Prior to evaluation, programmes should be considered in terms of the potential importance of nonhealth benefits and where these are considerable would be better evaluated by more inclusive economic evaluation techniques.

  2. Analysis of Comprehensive Utilization of Coconut Waste

    Institute of Scientific and Technical Information of China (English)

    Kan; ZHENG; Dong; LIANG; Xirui; ZHANG

    2013-01-01

    This paper describes and analyzes the coconut cultivation in China,and the current comprehensive utilization of waste resources generated during cultivation and processing of coconut.The wastes generated in the process of cultivation include old coconut tree trunk,roots,withered coconut leaves,coconut flower and fallen cracking coconut,mainly used for biogas extraction,direct combustion and power generation,brewing,pharmacy,and processing of building materials;the wastes generated during processing include coconut water,coconut coat,coconut shell and coconut meal,mainly used for processing beverages,pharmaceutical products,activated carbon,medium and feed.This paper analyzes and explores some problems in the process of comprehensive utilization of coconut waste in China,such as insufficient understanding,inadequate development and lack of research efforts,and finally puts forth the corresponding development countermeasures.

  3. Determinants of utilization and cost of VHA care by OEF/OIF Veterans screened for mild traumatic brain injury.

    Science.gov (United States)

    Amara, Jomana; Pogoda, Terri K; Krengel, Maxine; Iverson, Katherine M; Baker, Errol; Hendricks, Ann

    2014-09-01

    To determine the demographic and service characteristics that differentially impact utilization and cost of Veterans Health Administration (VHA) services for Operation Enduring Freedom and Operation Iraq Freedom (OEF/OIF) Veterans screened or evaluated for traumatic brain injury (TBI). We examined Department of Defense (DoD) and VHA administrative records of OEF/OIF Veterans who were screened or evaluated for TBI. Our study population was OEF/OIF Veterans who separated from DoD in Fiscal Years 2003-2009 and who were screened or evaluated in VHA for TBI between October 2008 and July 2009. We describe the demographics and service characteristics of separated Veterans and those who accessed the VHA. We report the cost of VHA utilization and estimate a probit regression model to assess determinants of VHA utilization and costs by OEF/OIF Veterans screened and evaluated for TBI by VHA. Females and Veterans older than 37 years utilize VHA services more intensely. Across all services, the Reserve Components utilize health services more than the Active Components placing more demand on VHA for services. VHA utilization and costs is impacted by the demographic and service characteristics of Veterans. The variation in Veteran groups incurring higher costs and utilization indicates different usage patterns of VHA services by each group with implications for patient load as the DoD deploys higher numbers of females and the Reserve Components. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

  4. Association between oral 5-ASA adherence and health care utilization and costs among patients with active ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Mitra Debanjali

    2012-09-01

    Full Text Available Abstract Background Observational cohort study to assess the association between adherence to oral 5-aminosalicylates (5-ASAs and all-cause costs and health care utilization among patients with active ulcerative colitis (UC in the United States. Methods Retrospective analysis of insurance claims from June 1997 to August 2006 in the LifeLink Database. Patient criteria: aged 18 or older with one or more claim(s between June 1997 and August 2005 for a UC diagnosis and at least one oral 5-ASA prescription on or after the first observed UC diagnosis; continuous enrollment for at least 6 months prior to and 12 months following 5-ASA initiation (index date. As a proxy for active disease, patients needed to have at least two UC-specific non-pharmacy claims, at least 30 days of 5-ASA treatment and at least one corticosteroid prescription within the 12-month post-index period. Cumulative exposure to oral 5-ASAs over the 12-month period was calculated using the medication possession ratio (MPR. Patients with an MPR of at least 0.80 were classified as adherent. All-cause medical and pharmacy resource utilization and costs were computed over the 12-month post-index period and compared between adherent and nonadherent patients. Results 1,693 UC patients met study inclusion criteria: 72% were nonadherent to 5-ASA treatment (n = 1,217 and 28% were adherent (n = 476 in the 12-month study period. Compared with nonadherent patients, adherent patients had 31% fewer hospitalizations (P = 0.0025 and 34% fewer emergency department admissions (P = 0.0016. Adherent patients had 25% more pharmacy prescriptions overall (P P P = 0.0002. After adjusting for covariates, total all-cause costs were 29% higher for nonadherent patients than for adherent patients (mean [95% confidence interval]: $13,465 [$13,094, $13,835] vs $17,339 [$17,033, $17,645]. Conclusions Approximately three-quarters of patients with active UC were not adherent with their

  5. 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.

  6. Reliability and cost/worth evaluation of generating systems utilizing wind and solar energy

    Science.gov (United States)

    Bagen

    The utilization of renewable energy resources such as wind and solar energy for electric power supply has received considerable attention in recent years due to adverse environmental impacts and fuel cost escalation associated with conventional generation. At the present time, wind and/or solar energy sources are utilized to generate electric power in many applications. Wind and solar energy will become important sources for power generation in the future because of their environmental, social and economic benefits, together with public support and government incentives. The wind and sunlight are, however, unstable and variable energy sources, and behave far differently than conventional sources. Energy storage systems are, therefore, often required to smooth the fluctuating nature of the energy conversion system especially in small isolated applications. The research work presented in this thesis is focused on the development and application of reliability and economic benefits assessment associated with incorporating wind energy, solar energy and energy storage in power generating systems. A probabilistic approach using sequential Monte Carlo simulation was employed in this research and a number of analyses were conducted with regards to the adequacy and economic assessment of generation systems containing wind energy, solar energy and energy storage. The evaluation models and techniques incorporate risk index distributions and different operating strategies associated with diesel generation in small isolated systems. Deterministic and probabilistic techniques are combined in this thesis using a system well-being approach to provide useful adequacy indices for small isolated systems that include renewable energy and energy storage. The concepts presented and examples illustrated in this thesis will help power system planners and utility managers to assess the reliability and economic benefits of utilizing wind energy conversion systems, solar energy conversion

  7. Cost and Utilization of Retail Clinics vs. Other Providers for Treatment of Pediatric Acute Otitis Media.

    Science.gov (United States)

    Duncan, Ian; Clark, Kara; Wang, Stacy

    2016-10-01

    A common acute condition seen by providers in retails clinics is the evaluation and treatment of acute otitis media (AOM) in children younger than age 20. Annual direct treatment costs for AOM were US $5.3 billion in 1998 dollars. Based on the experience of a large retail pharmacy employer, the authors compared AOM episodes in covered dependents younger than age 20 in retail clinic states to those in states without retail clinic access. Relative costs as well as frequency of visits and antibiotic prescriptions were analyzed for both retail clinic-based, and non-retail clinic-based episodes. Rates of AOM episodes were lower in retail clinic than in non-retail clinic states (62.5 vs. 76.9 per 1000 members per year; P retail clinic and non-retail clinic states (1.417 vs. 1.430, respectively; P = 0.657), suggesting that retail clinics do not result in an increase in overall utilization. On a risk-adjusted basis, retail clinic episodes cost approximately $30-$130 less than community episodes, depending on year. In retail clinic states, the antibiotic prescription fill rate was 95.4% for retail clinic episodes and 82.8% for community episodes, consistent with rates in the literature. This study confirms results of earlier studies that retail clinics are a less costly setting than the community for the treatment of episodes of otitis media There also is little evidence that retail clinics lead to duplication of services (patients receiving follow-up care in other settings).

  8. Prostate tumor alignment and continuous, real-time adaptive radiation therapy using electromagnetic fiducials: clinical and cost-utility analyses.

    Science.gov (United States)

    Quigley, Martin M; Mate, Timothy P; Sylvester, John E

    2009-01-01

    To evaluate the accuracy, utility, and cost effectiveness of a new electromagnetic patient positioning and continuous, real-time monitoring system, which uses permanently implanted resonant transponders in the target (Calypso 4D Localization System and Beacon transponders, Seattle, WA) to continuously monitor tumor location and movement during external beam radiation therapy of the prostate. This clinical trial studied 43 patients at 5 sites. All patients were implanted with 3 transponders each. In 41 patients, the system was used for initial alignment at each therapy session. Thirty-five patients had continuous monitoring during their radiation treatment. Over 1,000 alignment comparisons were made to a commercially available kV X-ray positioning system (BrainLAB ExacTrac, Munich, Germany). Using decision analysis and Markov processes, the outcomes of patients were simulated over a 5-year period and measured in terms of costs from a payer's perspective and quality-adjusted life years (QALYs). All patients had satisfactory transponder implantations for monitoring purposes. In over 75% of the treatment sessions, the correction to conventional positioning (laser and tattoos) directed by an electromagnetic patient positioning and monitoring system was greater than 5 mm. Ninety-seven percent (34/35) of the patients who underwent continuous monitoring had target motion that exceeded preset limits at some point during the course of their radiation therapy. Exceeding preset thresholds resulted in user intervention at least once during the therapy in 80% of the patients (28/35). Compared with localization using ultrasound, electronic portal imaging devices (EPID), or computed tomography (CT), localization with the electromagnetic patient positioning and monitoring system yielded superior gains in QALYs at comparable costs. Most patients positioned with conventional tattoos and lasers for prostate radiation therapy were found by use of the electromagnetic patient positioning

  9. Implications of workforce and financing changes for primary care practice utilization, revenue, and cost: a generalizable mathematical model for practice management.

    Science.gov (United States)

    Basu, Sanjay; Landon, Bruce E; Song, Zirui; Bitton, Asaf; Phillips, Russell S

    2015-02-01

    Primary care practice transformations require tools for policymakers and practice managers to understand the financial implications of workforce and reimbursement changes. To create a simulation model to understand how practice utilization, revenues, and expenses may change in the context of workforce and financing changes. We created a simulation model estimating clinic-level utilization, revenues, and expenses using user-specified or public input data detailing practice staffing levels, salaries and overhead expenditures, patient characteristics, clinic workload, and reimbursements. We assessed whether the model could accurately estimate clinic utilization, revenues, and expenses across the nation using labor compensation, medical expenditure, and reimbursements databases, as well as cost and revenue data from independent practices of varying size. We demonstrated the model's utility in a simulation of how utilization, revenue, and expenses would change after hiring a nurse practitioner (NP) compared with hiring a part-time physician. Modeled practice utilization and revenue closely matched independent national utilization and reimbursement data, disaggregated by patient age, sex, race/ethnicity, insurance status, and ICD diagnostic group; the model was able to estimate independent revenue and cost estimates, with highest accuracy among larger practices. A demonstration analysis revealed that hiring an NP to work independently with a subset of patients diagnosed with diabetes or hypertension could increase net revenues, if NP visits involve limited MD consultation or if NP reimbursement rates increase. A model of utilization, revenue, and expenses in primary care practices may help policymakers and managers understand the implications of workforce and financing changes.

  10. Econometric estimation of investment utilization, adjustment costs, and technical efficiency in Danish pig farms using hyperbolic distance functions

    DEFF Research Database (Denmark)

    Henningsen, Arne; Fabricius, Ole; Olsen, Jakob Vesterlund

    2014-01-01

    Based on a theoretical microeconomic model, we econometrically estimate investment utilization, adjustment costs, and technical efficiency in Danish pig farms based on a large unbalanced panel dataset. As our theoretical model indicates that adjustment costs are caused both by increased inputs...

  11. Asthma control cost-utility randomized trial evaluation (ACCURATE: the goals of asthma treatment

    Directory of Open Access Journals (Sweden)

    Honkoop Persijn J

    2011-11-01

    Full Text Available Abstract Background Despite the availability of effective therapies, asthma remains a source of significant morbidity and use of health care resources. The central research question of the ACCURATE trial is whether maximal doses of (combination therapy should be used for long periods in an attempt to achieve complete control of all features of asthma. An additional question is whether patients and society value the potential incremental benefit, if any, sufficiently to concur with such a treatment approach. We assessed patient preferences and cost-effectiveness of three treatment strategies aimed at achieving different levels of clinical control: 1. sufficiently controlled asthma 2. strictly controlled asthma 3. strictly controlled asthma based on exhaled nitric oxide as an additional disease marker Design 720 Patients with mild to moderate persistent asthma from general practices with a practice nurse, age 18-50 yr, daily treatment with inhaled corticosteroids (more then 3 months usage of inhaled corticosteroids in the previous year, will be identified via patient registries of general practices in the Leiden, Nijmegen, and Amsterdam areas in The Netherlands. The design is a 12-month cluster-randomised parallel trial with 40 general practices in each of the three arms. The patients will visit the general practice at baseline, 3, 6, 9, and 12 months. At each planned and unplanned visit to the general practice treatment will be adjusted with support of an internet-based asthma monitoring system supervised by a central coordinating specialist nurse. Patient preferences and utilities will be assessed by questionnaire and interview. Data on asthma control, treatment step, adherence to treatment, utilities and costs will be obtained every 3 months and at each unplanned visit. Differences in societal costs (medication, other (health care and productivity will be compared to differences in the number of limited activity days and in quality adjusted

  12. Solar and geothermal energy utilization n SF-2: a sensitivity analysis

    Energy Technology Data Exchange (ETDEWEB)

    Davitian, H.; LaSala, R.; Marcuse, W.

    1977-04-05

    A sensitivity analysis was conducted of the utilization levels for Solar, Geothermal, and Advanced Energy Systems (ASGA) technologies during the 1985-2000 time period. In particular, the sensitivity of the utilization levels was tested with respet to both analytical techniques and to specific parameter assumptions. The sensitivity to analytical techniques was examined insofar as certain criteria were examined to elucidate their importance in determining the level of use of the ASGA technologies. The criteria incorporated consideration of such factors as total cost of the energy system, environmental impacts, and resource use patterns. The parameter assumptions studied included costs of ASGA costs of ASGA technologies, costs of non-renewable resources, and limitations on the use of technologies and resources. (MHR)

  13. A Healthcare Utilization Analysis Framework for Hot Spotting and Contextual Anomaly Detection

    Science.gov (United States)

    Hu, Jianying; Wang, Fei; Sun, Jimeng; Sorrentino, Robert; Ebadollahi, Shahram

    2012-01-01

    Patient medical records today contain vast amount of information regarding patient conditions along with treatment and procedure records. Systematic healthcare resource utilization analysis leveraging such observational data can provide critical insights to guide resource planning and improve the quality of care delivery while reducing cost. Of particular interest to providers are hot spotting: the ability to identify in a timely manner heavy users of the systems and their patterns of utilization so that targeted intervention programs can be instituted, and anomaly detection: the ability to identify anomalous utilization cases where the patients incurred levels of utilization that are unexpected given their clinical characteristics which may require corrective actions. Past work on medical utilization pattern analysis has focused on disease specific studies. We present a framework for utilization analysis that can be easily applied to any patient population. The framework includes two main components: utilization profiling and hot spotting, where we use a vector space model to represent patient utilization profiles, and apply clustering techniques to identify utilization groups within a given population and isolate high utilizers of different types; and contextual anomaly detection for utilization, where models that map patient’s clinical characteristics to the utilization level are built in order to quantify the deviation between the expected and actual utilization levels and identify anomalies. We demonstrate the effectiveness of the framework using claims data collected from a population of 7667 diabetes patients. Our analysis demonstrates the usefulness of the proposed approaches in identifying clinically meaningful instances for both hot spotting and anomaly detection. In future work we plan to incorporate additional sources of observational data including EMRs and disease registries, and develop analytics models to leverage temporal relationships among

  14. Utilization Management of High-Cost Imaging in an Outpatient Setting in a Large Stable Patient and Provider Cohort over 7 Years.

    Science.gov (United States)

    Weilburg, Jeffrey B; Sistrom, Christopher L; Rosenthal, Daniel I; Stout, Markus B; Dreyer, Keith J; Rockett, Helaine R; Baron, Jason M; Ferris, Timothy G; Thrall, James H

    2017-09-01

    Purpose To quantify the effect of a comprehensive, long-term, provider-led utilization management (UM) program on high-cost imaging (computed tomography, magnetic resonance imaging, nuclear imaging, and positron emission tomography) performed on an outpatient basis. Materials and Methods This retrospective, 7-year cohort study included all patients regularly seen by primary care physicians (PCPs) at an urban academic medical center. The main outcome was the number of outpatient high-cost imaging examinations per patient per year ordered by the patient's PCP or by any specialist. The authors determined the probability of a patient undergoing any high-cost imaging procedure during a study year and the number of examinations per patient per year (intensity) in patients who underwent high-cost imaging. Risk-adjusted hierarchical models were used to directly quantify the physician component of variation in probability and intensity of high-cost imaging use, and clinicians were provided with regular comparative feedback on the basis of the results. Observed trends in high-cost imaging use and provider variation were compared with the same measures for outpatient laboratory studies because laboratory use was not subject to UM during this period. Finally, per-member per-year high-cost imaging use data were compared with statewide high-cost imaging use data from a major private payer on the basis of the same claim set. Results The patient cohort steadily increased in size from 88 959 in 2007 to 109 823 in 2013. Overall high-cost imaging utilization went from 0.43 examinations per year in 2007 to 0.34 examinations per year in 2013, a decrease of 21.33% (P utilization decreased by less than half that rate (9.4%, P utilization in this cohort decreased 28%, compared with a 20% decrease in statewide utilization (P = .0023). Conclusion Analysis of high-cost imaging utilization in a stable cohort of patients cared for by PCPs during a 7-year period showed that comprehensive UM can

  15. Economic methods for valuing the outcomes of genetic testing: beyond cost-effectiveness analysis.

    Science.gov (United States)

    Grosse, Scott D; Wordsworth, Sarah; Payne, Katherine

    2008-09-01

    Genetic testing in health care can provide information to help with disease prediction, diagnosis, prognosis, and treatment. Assessing the clinical utility of genetic testing requires a process to value and weight different outcomes. This article discusses the relative merits of different economic measures and methods to inform recommendations relative to genetic testing for risk of disease, including cost-effectiveness analysis and cost-benefit analysis. Cost-effectiveness analyses refer to analyses that calculate the incremental cost per unit of health outcomes, such as deaths prevented or life-years saved because of some intervention. Cost-effectiveness analyses that use preference-based measures of health state utility such as quality-adjusted life-years to define outcomes are referred to as cost-utility analyses. Cost-effectiveness analyses presume that health policy decision makers seek to maximize health subject to resource constraints. Cost-benefit analyses can incorporate monetary estimates of willingness-to-pay for genetic testing, including the perceived value of information independent of health outcomes. These estimates can be derived from contingent valuation or discrete choice experiments. Because important outcomes of genetic testing do not fit easily within traditional measures of health, cost-effectiveness analyses do not necessarily capture the full range of outcomes of genetic testing that are important to decision makers and consumers. We recommend that health policy decision makers consider the value to consumers of information and other nonhealth attributes of genetic testing strategies.

  16. Analysis and modeling of rail maintenance costs

    Directory of Open Access Journals (Sweden)

    Amir Ali Bakhshi

    2012-01-01

    Full Text Available Railroad maintenance engineering plays an important role on availability of roads and reducing the cost of railroad incidents. Rail is of the most important parts of railroad industry, which needs regular maintenance since it covers a significant part of total maintenance cost. Any attempt on optimizing total cost of maintenance could substantially reduce the cost of railroad system and it can reduce total cost of the industry. The paper presents a new method to estimate the cost of rail failure using different cost components such as cost of inspection and cost of risk associated with possible accidents. The proposed model of this paper is used for a real-world case study of railroad transportation of Tehran region and the results have been analyzed.

  17. The JPL Cost Risk Analysis Approach that Incorporates Engineering Realism

    Science.gov (United States)

    Harmon, Corey C.; Warfield, Keith R.; Rosenberg, Leigh S.

    2006-01-01

    This paper discusses the JPL Cost Engineering Group (CEG) cost risk analysis approach that accounts for all three types of cost risk. It will also describe the evaluation of historical cost data upon which this method is based. This investigation is essential in developing a method that is rooted in engineering realism and produces credible, dependable results to aid decision makers.

  18. The JPL Cost Risk Analysis Approach that Incorporates Engineering Realism

    Science.gov (United States)

    Harmon, Corey C.; Warfield, Keith R.; Rosenberg, Leigh S.

    2006-01-01

    This paper discusses the JPL Cost Engineering Group (CEG) cost risk analysis approach that accounts for all three types of cost risk. It will also describe the evaluation of historical cost data upon which this method is based. This investigation is essential in developing a method that is rooted in engineering realism and produces credible, dependable results to aid decision makers.

  19. Cost-Effectiveness of Dental Implants: A Utility Analysis.

    Science.gov (United States)

    Jacobson, J.; And Others

    1990-01-01

    A measure of dental patients' values and preferences was used to assess attitudes of 92 edentulous patients receiving implant and other dental reconstructive therapies. The implant group tended to be younger and better educated and to rate implant reconstruction as more desirable than the nonimplant denture group. (DB)

  20. Cost-Effectiveness of Dental Implants: A Utility Analysis.

    Science.gov (United States)

    Jacobson, J.; And Others

    1990-01-01

    A measure of dental patients' values and preferences was used to assess attitudes of 92 edentulous patients receiving implant and other dental reconstructive therapies. The implant group tended to be younger and better educated and to rate implant reconstruction as more desirable than the nonimplant denture group. (DB)

  1. Utilization and costs of glucose lowering therapies following health technology assessment for the new reimbursement scheme in Sweden.

    Science.gov (United States)

    Pettersson, Billie; Hoffmann, Mikael; Andersson, David; Wändell, Per; Levin, Lars-Åke

    2012-12-01

    A new reimbursement scheme (RS) for glucose lowering therapies (GLT) was implemented in Sweden on March 1, 2010. Products on the market were retained, restricted, excluded or excluded for new courses in the new RS. The aim of this study was to compare utilization and costs of GLT for type 2 diabetes Mellitus (T2DM) before and after the implementation of the changed RS. This was a quasi-experimental study using data on dispensed GLT and costs from a database on dispensed individual based prescriptions in Sweden. Segmented regression analyses were used to assess utilization and costs. Following the changed reimbursement status, there was an accelerated increasing trend in number of patients treated with restricted (P=0.0007) or retained (P=0.0021) insulins, as well as in costs for insulin based GLT (P=0.0014). No impact was detected in the total number of patients treated with oral GLT, but a slightly negative trend in total costs for oral GLT was detected following the intervention (P=0.0177). The new reimbursement scheme had a minor impact on utilization and costs of oral GLT. Despite restricted reimbursement for patients with T2DM, the utilization of insulin based GLT and related costs increased faster following the intervention. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  2. Impact of a new reimbursement program on hepatitis B antiviral medication cost and utilization in Beijing, China.

    Directory of Open Access Journals (Sweden)

    Qian Qiu

    Full Text Available BACKGROUND: Hepatitis B virus (HBV infection is a significant clinical and financial burden for chronic hepatitis B (CHB patients. In Beijing, China, partial reimbursement on antiviral agents was first implemented for the treatment of CHB patients in July 1, 2011. AIMS: In this study, we describe the medical cost and utilization rates of antiviral therapy for CHB patients to explore the impact of the new partial reimbursement policy on the medical care cost, the composition, and antivirals utilization. METHODS: Clinical and claims data of a retrospective cohort of 92,776 outpatients and 2,774 inpatients with non-cirrhotic CHB were retrieved and analyzed from You'an Hospital, Beijing between February 14, 2008 and December 31, 2012. The propensity score matching was used to adjust factors associated with the annual total cost, including age, gender, medical insurance type and treatment indicator. RESULTS: Compared to patients who paid out-of-pocket, medical cost, especially antiviral costs increased greater among patients with medical insurance after July 1, 2011, the start date of reimbursement policy. Outpatients with medical insurance had 16% more antiviral utilization; usage increased 3% among those who paid out-of-pocket after the new partial reimbursement policy was implemented. CONCLUSIONS: Direct medical costs and antiviral utilization rates of CHB patients with medical insurance were higher than those from paid out-of-pocket payments, even after adjusting for inflation and other factors. Thus, a new partial reimbursement program may positively optimize the cost and standardization of antiviral treatment.

  3. Study of drug utilization, morbidity pattern and cost of hypolipidemic agents in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Kamlesh P. Patel

    2013-08-01

    Full Text Available Background: Data on the extent of use and costs of lipid-lowering agents are not widely available. Our aim was to study the drug utilization and morbidity pattern, cost of different hypolipidemic drugs along with the risk assessment for coronary heart disease. Methods: After approval of protocol by the Institutional Review Board, an observational, prospective study was carried out in 300 patients using NCEP and ATP III Guidelines-2002 for evaluation of presence or absence of risk factors for coronary heart diseases. Data were analysed using SPSS software version 16.0and WHO Core Drug Prescribing Indicators. Results: Patient’s morbidity pattern revealed that 62%, 49.3%, 28% suffered from ischemic heart disease, hypertension and type 2 diabetes mellitus respectively. On risk assessment, 48%, 13.3% patients had borderline and high level of total cholesterol respectively; 42%, 22.7% had borderline and high triglyceride levels respectively; 71.1% men and 62% women had low HDL cholesterol levels while 17.3%, 6% and 2.7% patients had borderline high, high and very high level of LDL cholesterol levels respectively. Frequency of prescriptions was atorvastatin (82%, rosuvastatin (9.3% and simvastatin (4.7% among the most frequently prescribed statins drug group. The mean number of drugs per prescription was 7.34. Drugs prescribed by generic name and from essential drugs list was 24.96% and 71.81% respectively. Mean cost of hypolipidemic agents/prescription/day was 10.74 (±1.96 Indian Rupees with rosuvastatin being the costliest. Conclusion: Rational use of hypolipidemic agents with an increasing trend of statins prescriptions will significantly reduce the morbidity and mortality from coronary heart diseases. [Int J Basic Clin Pharmacol 2013; 2(4.000: 470-475

  4. Exploring the cost-utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups.

    Science.gov (United States)

    Whitehurst, David G T; Bryan, Stirling; Lewis, Martyn; Hill, Jonathan; Hay, Elaine M

    2012-11-01

    Stratified management for low back pain according to patients' prognosis and matched care pathways has been shown to be an effective treatment approach in primary care. The aim of this within-trial study was to determine the economic implications of providing such an intervention, compared with non-stratified current best practice, within specific risk-defined subgroups (low-risk, medium-risk and high-risk). Within a cost-utility framework, the base-case analysis estimated the incremental healthcare cost per additional quality-adjusted life year (QALY), using the EQ-5D to generate QALYs, for each risk-defined subgroup. Uncertainty was explored with cost-utility planes and acceptability curves. Sensitivity analyses were performed to consider alternative costing methodologies, including the assessment of societal loss relating to work absence and the incorporation of generic (ie, non-back pain) healthcare utilisation. The stratified management approach was a cost-effective treatment strategy compared with current best practice within each risk-defined subgroup, exhibiting dominance (greater benefit and lower costs) for medium-risk patients and acceptable incremental cost to utility ratios for low-risk and high-risk patients. The likelihood that stratified care provides a cost-effective use of resources exceeds 90% at willingness-to-pay thresholds of £4000 (≈ 4500; $6500) per additional QALY for the medium-risk and high-risk groups. Patients receiving stratified care also reported fewer back pain-related days off work in all three subgroups. Compared with current best practice, stratified primary care management for low back pain provides a highly cost-effective use of resources across all risk-defined subgroups.

  5. Cost Accounting and Analysis for University Libraries.

    Science.gov (United States)

    Leimkuhler, Ferdinand F.; Cooper, Michael D.

    The approach to library planning studied in this report is the use of accounting models to measure library costs and implement program budgets. A cost-flow model for a university library is developed and listed with historical data from the Berkeley General Library. Various comparisons of an exploratory nature are made of the unit costs for…

  6. 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.

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

    Directory of Open Access Journals (Sweden)

    Lim JU

    2017-09-01

    costs were obtained from the Health Insurance Review and Assessment Service and were compared with the data of patients with COPD with FEV1 ≥60% from the Korean COPD Subtype Study (KOCOSS cohort.Results: Based on EuroQol 5-dimension questionnaire index scores of 0.9±0.14, we found that patients with COPD from the KNHANES group showed few symptoms compared to those from the KOCOSS cohort. In 2007, among the patients with COPD with an FEV1 value of ≥60%, only 3.6% from the KNHANES group and 30% from the KOCOSS cohort visited medical facilities. Total medical cost per person per year increased from 264.37±663.41 US Dollars (USD in 2007 to 797.00±2,724.21 USD in 2012 for the KNHANES group. In 2012, only 20.7% of the patients from KNHANES database received long-acting muscarinic agonists (LAMA, whereas 78.7% of the patients from KOCOSS database received LAMA.Conclusion: Medical resource utilization and medical costs per person for patients with early COPD in Korea increased. However, asymptomatic patients with COPD represented by the KNHANES group do not receive adequate long-term treatment compared to relatively symptomatic patients, and require more clinical attention from physicians. Keywords: early COPD, medical cost, medical utilization 

  8. Analysis of energy and utility service demands

    Energy Technology Data Exchange (ETDEWEB)

    1978-10-01

    The collection, analysis, and review of existing data on a community's service requirements are documented. The research focused on the analysis of energy-using activities including both micro activities such as space heating, cooking, lighting, and transportation; and macro activities such as providing shelter, health care, education, etc. The technical report describes the analytical framework developed for community description; describes an indexing system by which a catalog of services can be accessed; illustrates the application of the data to an existing community; and provides ancillary information on data availability. A catalog of data is presented which includes several sets of indices which facilitate access of data using various keys. Abstracts of 48 data sources are analyzed. Each abstract includes a description and evaluation of the data, a sampling of that data, an assessment as to how that data may be applied to other analyses, and a reference where the user can secure additional data. (MCW)

  9. Cost-utility of angiotensin-converting enzyme inhibitor-based treatment compared with thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as comorbidity.

    Science.gov (United States)

    Chowdhury, Enayet K; Ademi, Zanfina; Moss, John R; Wing, Lindon M H; Reid, Christopher M

    2015-03-01

    The objective of this study was to examine the cost-effectiveness of angiotensin-converting enzyme inhibitor (ACEI)-based treatment compared with thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as an outcome along with cardiovascular outcomes from the Australian government's perspective.We used a cost-utility analysis to estimate the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained. Data on cardiovascular events and new onset of diabetes were used from the Second Australian National Blood Pressure Study, a randomized clinical trial comparing diuretic-based (hydrochlorothiazide) versus ACEI-based (enalapril) treatment in 6083 elderly (age ≥65 years) hypertensive patients over a median 4.1-year period. For this economic analysis, the total study population was stratified into 2 groups. Group A was restricted to participants diabetes free at baseline (n = 5642); group B was restricted to participants with preexisting diabetes mellitus (type 1 or type 2) at baseline (n = 441). Data on utility scores for different events were used from available published literatures; whereas, treatment and adverse event management costs were calculated from direct health care costs available from Australian government reimbursement data. Costs and QALYs were discounted at 5% per annum. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty around utilities and cost data.After a treatment period of 5 years, for group A, the ICER was Australian dollars (AUD) 27,698 (&OV0556; 18,004; AUD 1-&OV0556; 0.65) per QALY gained comparing ACEI-based treatment with diuretic-based treatment (sensitive to the utility value for new-onset diabetes). In group B, ACEI-based treatment was a dominant strategy (both more effective and cost-saving). On probabilistic sensitivity analysis, the ICERs per QALY gained were always below AUD 50,000 for group B; whereas for group A, the

  10. Utility planning using least-cost principles and the role of externalities - staff report on a Keystone policy dialogue

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-05-01

    For over two years, The Keystone Center facilitated a two-phase dialogue on Utility Planning Using Least-Cost Principles and, in the second phase, on the role of Externalities. The intent of this report is to assist policy-makers faced with decisions about changes to traditional utility regulation and planning. This report is not a consensus document, rather it is staff written summary of two years of discussion on the issues. As a concept, least-cost planning has been discussed since the 1970`s and many states have implemented such programs since the mid-1980`s. Yet, the actual goals and objectives of least-cost planning remain a source of controversy between affected interest groups. Some industry observers believe that least-cost planning can help reconcile the often conflicting demands between increased capacity requirements and concerns about the external costs of power production. In traditional utility regulation practices, capital investments are rewarded and revenue is a direct function of sales. However, a number state public utility commissions have altered their practices to allow for returns on investments in more efficient end-use equipment (also known as ratebasing conservation) and adjusting revenues to account for sales lost due to utility conservation programs. Other states are planning these types of changes. Still others are observing the impacts of the changes before they commit.

  11. Comparative financial analysis of electricity utilities in West Africa

    Energy Technology Data Exchange (ETDEWEB)

    Fritsch, Remi, E-mail: fritschr@afd.fr [Centre d' Etudes Financieres, Economiques et Bancaires (CEFEB), BP 33401, 13567 Marseille cedex 02 (France)

    2011-10-15

    Access to electricity is a major issue in West Africa. Governments have a difficult equation to solve. They naturally seek to offer their people a cheap kWh. But they are constrained by a production based largely on oil and therefore highly volatile production costs. How to fix an acceptable tariff, taking into account the investment needs required to expand the network and increase production? This analysis should provide some answers. The study presented in this paper provides a financial analysis of electricity utilities in West Africa. It allows a comparison of performances on a number of key financial ratios related to operations (Earning Before Interest Taxes Debt and Amortization/sales, working capital requirement/sales, days of receivables or payables), investment (net fixed assets/gross fixed assets), bank financing (financial structure, debt/EBITDA, interest expense/EBITDA) and economic and financial returns (Return On Capital Employed, Return On Equity). The conclusion focuses on the growth opportunity that the electricity sector could represent for each country. But this opportunity may only materialize if the EBITDA margins are restored. The available options appear limited and must be assessed taking into account the context of each country: tariff increase, improvement of technical losses or diversification into means of production no longer based primarily on oil or gas. - Highlights: > The study provides a financial analysis of electricity distribution companies in West Africa. > The study highlights generally insufficient EBITDA margins. > The study raises the question of tariffs and contribution to Gross Domestic Product of the electricity sector. > The conclusion focuses on the growth opportunity that the electricity sector could represent for each country.

  12. 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

  13. Exergy and exergoeconomic analysis of a petroleum refinery utilities plant using the condensing to power method

    Energy Technology Data Exchange (ETDEWEB)

    Mendes da Silva, Julio Augusto; Pellegrini, Luiz Felipe; Oliveira Junior, Silvio [Polytechnic School of the University of Sao Paulo, SP (Brazil)], e-mails: jams@usp.br, luiz.pellegrini@usp.br, soj@usp.br; Plaza, Claudio; Rucker, Claudio [Petrobras - Petroleo Brasileiro S.A., Rio de Janeiro, RJ (Brazil)], e-mails: claudioplaza@petrobras.com.br, rucker@petrobras.com.br

    2010-07-01

    In this paper a brief description of the main processes present in a modern high capacity refinery is done. The methodology used to evaluate, through exergy analysis, the performance of the refinery's utilities plant since it is responsible for a very considerable amount of the total exergy destruction in a refinery is presented. The utilities plant products: steam, electricity, shaft power and high pressure water had their exergy unit cost determined using exergoeconomic approach. A simple and effective method called condensing to power was used to define the product of the condensers in exergy basis. Using this method it is possible to define the product of the condenser without the use of negentropy concept nor the aggregation of condensers to the steam turbines. By using this new approach, the costs obtained for the plant's products are exactly the same costs obtained when the condenser is aggregated to the steam turbine but with the advantage that the information about the stream between condenser and the steam turbine is not lost and the condenser can be evaluated singly. The analysis shows that the equipment where attention and resources should be focused are the boilers followed by the gas turbine, that together, are responsible for 80% of total exergy destruction in the utilities plant. The total exergy efficiency found for the utilities plant studied is 35% while more than 280 MW of exergy is destroyed in the utilities processes. (author)

  14. The cost and performance of utility commercial lighting programs. A report from the Database on Energy Efficiency Programs (DEEP) project

    Energy Technology Data Exchange (ETDEWEB)

    Eto, J.; Vine, E.; Shown, L.; Sonnenblick, R.; Payne, C. [Lawrence Berkeley Lab., CA (United States). Energy and Environment Div.

    1994-05-01

    The objective of the Database on Energy Efficiency Programs (DEEP) is to document the measured cost and performance of utility-sponsored, energy-efficiency, demand-side management (DSM) programs. Consistent documentation of DSM programs is a challenging goal because of problems with data consistency, evaluation methodologies, and data reporting formats that continue to limit the usefulness and comparability of individual program results. This first DEEP report investigates the results of 20 recent commercial lighting DSM programs. The report, unlike previous reports of its kind, compares the DSM definitions and methodologies that each utility uses to compute costs and energy savings and then makes adjustments to standardize reported program results. All 20 programs were judged cost-effective when compared to avoided costs in their local areas. At an average cost of 3.9{cents}/kWh, however, utility-sponsored energy efficiency programs are not ``too cheap to meter.`` While it is generally agreed upon that utilities must take active measures to minimize the costs and rate impacts of DSM programs, the authors believe that these activities will be facilitated by industry adoption of standard definitions and reporting formats, so that the best program designs can be readily identified and adopted.

  15. [Cost analysis of patient blood management].

    Science.gov (United States)

    Kleinerüschkamp, A G; Zacharowski, K; Ettwein, C; Müller, M M; Geisen, C; Weber, C F; Meybohm, P

    2016-06-01

    Patient blood management (PBM) is a multidisciplinary approach focusing on the diagnosis and treatment of preoperative anaemia, the minimisation of blood loss, and the optimisation of the patient-specific anaemia reserve to improve clinical outcomes. Economic aspects of PBM have not yet been sufficiently analysed. The aim of this study is to analyse the costs associated with the clinical principles of PBM and the project costs associated with the implementation of a PBM program from an institutional perspective. Patient-related costs of materials and services were analysed at the University Hospital Frankfurt for 2013. Personnel costs of all major processes were quantified based on the time required to perform each step. Furthermore, general project costs of the implementation phase were determined. Direct costs of transfusing a single unit of red blood cells can be calculated to a minimum of €147.43. PBM-associated costs varied depending on individual patient requirements. The following costs per patient were calculated: diagnosis of preoperative anaemia €48.69-123.88; treatment of preoperative anaemia (including iron-deficiency anaemia and megaloblastic anaemia) €12.61-127.99; minimising perioperative blood loss (including point-of-care diagnostics, coagulation management and cell salvage) €3.39-1,901.81; and costs associated with the optimisation of the tolerance to anaemia (including patient monitoring and volume therapy) €28.62. General project costs associated with the implementation of PBM were €24,998.24. PBM combines various alternatives to the transfusion of red blood cells and improves clinical outcome. Costs of PBM vary from institution to institution and depend on the extent to which different aspects of PBM have been implemented. The quantification of costs associated with PBM is essential in order to assess the economic impact of PBM, and thereby, to efficiently re-allocate health care resources. Costs were determined at a single

  16. 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

  17. Automated Sequence Selection and Cost Calculation for Maintenance and Rehabilitation in Highway Life-Cycle Cost Analysis (LCCA

    Directory of Open Access Journals (Sweden)

    Changmo Kim

    2015-03-01

    Full Text Available Life-Cycle Cost Analysis (LCCA for highway projects is an analytical technique that uses economic principles to evaluate long-term alternative investment options, especially for comparing the values of alternative pavement design structures and construction strategies. Several approaches and software have been adopted to undertake LCCA by many transportation agencies in the United States over the last decade. In 2007, the California Department of Transportation (Caltrans adopted RealCost, the LCCA software, developed by the U.S. Federal Highway Administration (FHWA. The California implementation incorporates major user interface enhancements and customization. This paper introduces the Caltrans LCCA procedure and describes the functions and improvements of the enhanced California version of RealCost software (RealCost 2.5CA. Automated functions were developed to select efficient and adequate sequences for future maintenance and rehabilitation (M&R for comparing alternatives. The graphical user interface integrates service life, maintenance frequency, and agency cost of each maintenance activity with given project constraints, such as climate region, final pavement surface, and design life. The automated cost calculation modules estimate future M&R costs based on each construction scope and pavement type. The main focus of the California LCCA enhancement is to improve the efficiency of LCCA procedures with automatic data selection and computations. The RealCost 2.5CA program has been adopted as an official LCCA tool to comply with regulatory requirements for California state highway projects. Utilization of this California-customized LCCA software helps Caltrans to achieve substantial economic benefits (agency cost and road user cost savings for highway projects.

  18. Economic analysis of the cost of Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Mazetas D.

    2014-04-01

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

  19. Brain network analysis: separating cost from topology using cost-integration.

    Directory of Open Access Journals (Sweden)

    Cedric E Ginestet

    Full Text Available A statistically principled way of conducting brain network analysis is still lacking. Comparison of different populations of brain networks is hard because topology is inherently dependent on wiring cost, where cost is defined as the number of edges in an unweighted graph. In this paper, we evaluate the benefits and limitations associated with using cost-integrated topological metrics. Our focus is on comparing populations of weighted undirected graphs that differ in mean association weight, using global efficiency. Our key result shows that integrating over cost is equivalent to controlling for any monotonic transformation of the weight set of a weighted graph. That is, when integrating over cost, we eliminate the differences in topology that may be due to a monotonic transformation of the weight set. Our result holds for any unweighted topological measure, and for any choice of distribution over cost levels. Cost-integration is therefore helpful in disentangling differences in cost from differences in topology. By contrast, we show that the use of the weighted version of a topological metric is generally not a valid approach to this problem. Indeed, we prove that, under weak conditions, the use of the weighted version of global efficiency is equivalent to simply comparing weighted costs. Thus, we recommend the reporting of (i differences in weighted costs and (ii differences in cost-integrated topological measures with respect to different distributions over the cost domain. We demonstrate the application of these techniques in a re-analysis of an fMRI working memory task. We also provide a Monte Carlo method for approximating cost-integrated topological measures. Finally, we discuss the limitations of integrating topology over cost, which may pose problems when some weights are zero, when multiplicities exist in the ranks of the weights, and when one expects subtle cost-dependent topological differences, which could be masked by cost-integration.

  20. Fracture analysis for engineering geological utilization

    Energy Technology Data Exchange (ETDEWEB)

    Choi, H.I.; Choi, P.Y.; Hong, S.H.; Chi, K.H.; Kim, J.Y.; Lee, S.R.; Lee, S.G.; Park, D.W.; Han, J.G. [Korea Institute of Geology Mining and Materials, Taejon (Korea, Republic of)

    1997-12-01

    The problem of geological hazards (earthquakes) and water or thermal resources urges us to understand the regional tectonic setting or recent tectonics. The Uisong Subbasin is located in one of the seismicity zones in Korea. Because the reactivity of the Gaeum Fault System is an important problem focussing on these faults, we studied their whole extension and timing of faulting in terms of tectonics. Fault tectonic analysis is so effective as to easily reconstruct the tectonic sequence and each stress state at each site, eventually in a region. One can get insights for faulting timing in terms of the restored tectonic sequence, and discriminating the active faults or the faults active in the last (present) tectonics. Examining the filling materials in tension gashes, one can get raw knowledge regarding the thermal states at each site. For this study, we first analyzed the topographic textures (lineament, drainage and circular structures) on the relief map produced based on the topographic maps of 1:100,000 scale. Through investigations of susceptible area along the faults, their existence and movement modes were studied, and we can get information about movement history and whole extension of the faults belonging to the WNW-ESE trending Gaeum Fault System. In order to reconstruct the tectonic sequence, we measured fault slip data, tension gashes and dikes, from which fault populations were classified and stress (and thermal) states were determined. Seven compressional tectonic events and six extensional events were reconstructed. Because coaxial events partially coexisted, we bundled these events in one, finally we get seven tectonic events. Determining the types of minerals filling the tension gashes, we suggested the possibility of investigation of geothermal resources with less efforts. (author). 162 refs., 14 tabs., 51 figs.

  1. Analysis of Unit Process Cost for an Engineering-Scale Pyroprocess Facility Using a Process Costing Method in Korea

    National Research Council Canada - National Science Library

    Sungki Kim; Wonil Ko; Sungsig Bang

    2015-01-01

    ...) metal ingots in a high-temperature molten salt phase. This paper provides the unit process cost of a pyroprocess facility that can process up to 10 tons of pyroprocessing product per year by utilizing the process costing method...

  2. Social cost benefit analysis and energy policy

    NARCIS (Netherlands)

    De Nooij, M.

    2012-01-01

    Most research into the reliability of electricity supply focuses on the suppliers. Reductions in the number of power interruptions will often be possible, but also very costly. These costs will eventually be borne by the electricity users. This paper studies the value of supply security in order to

  3. Cost Differential Analysis--Phase 2

    Science.gov (United States)

    Wystrom, Dennis C.; And Others

    1974-01-01

    The cost system designed as a sub-system of the Management Information System, to record and report cost data for occupational courses funded by the Illinois Division of Vocational and Technical Education, can stand alone if necessary, providing the flexibility essential to the success of the total system. (Flow chart included.) (Author/SA)

  4. Fundamental Cost Analysis of Cold Spray

    Science.gov (United States)

    Stier, O.

    2014-01-01

    The cost structure of the cold spray (CS) process is analyzed using a generic cost model applicable to all present types of CS systems ("high pressure," "low pressure," KM™, "kinetic spraying," etc.) and kinds of application (coating, restoration, additive manufacturing, near-net forming). The cost model has originally been developed at SIEMENS and is easy to use, while being sufficiently accurate to support decisions. The dependence of the process costs on the gas stagnation properties is discussed. It is shown (i) that high pressure is generally favorable, (ii) that He-N2 blends possess economic potential, and (iii) that He recovery saves costs in high volume production, even when He-N2 blends are used. The cost model allows for the determination of the cost-optimal He concentration of the propellant gas for a given application. CS is, among others, suited to spray bond coatings on gas turbine blades and offers cost-saving potential, as shown in a case study.

  5. Department of the Army Cost Analysis Manual

    Science.gov (United States)

    2001-05-01

    SECTION I - AUTOMATED COST ESTIMATING INTEGRATED TOOLS ( ACEIT ) ................................................................179 SECTION II - AUTOMATED...Management & Comptroller) endorsed the Automated Cost Estimating Integrated Tools ( ACEIT ) model and since it is widely used to prepare POEs, CCAs and...CRB IPT (in ACEIT ) will be the basis for information contained in the CAB. Any remaining unresolved issues from the IPT process will be raised at the

  6. Low-Cost High-Concentration Photovoltaic Systems for Utility Power Generation

    Energy Technology Data Exchange (ETDEWEB)

    McConnell, R.; Garboushian, V.; Gordon, R.; Dutra, D.; Kinsey, G.; Geer, S.; Gomez, H.; Cameron, C.

    2012-03-31

    Under DOE's Technology Pathway Partnership (TPP) program, Amonix, Inc. developed a new generation of high-concentration photovoltaic systems using multijunction technology and established the manufacturing capacity needed to supply multi-megawatt power plants buing using the new Amonix 7700-series solar energy systems. For this effort, Amonix Collaborated with a variety of suppliers and partners to complete project tasks. Subcontractors included: Evonik/Cyro; Hitek; the National Renewable Energy Laboratory (NREL); Raytech; Spectrolab; UL; University of Nevada, Las Vegas; and TUV Rheinland PTL. The Amonix TPP tasks included: Task 1: Multijunction Cell Optimization for Field Operation, Task 2: Fresnel Lens R&D, Task 3: Cell Package Design & Production, Task 4: Standards Compliance and Reliability Testing, Task 5: Receiver Plate Production, Task 6: MegaModule Performance, Task 7: MegaModule Cost Reduction, Task 8: Factory Setup and MegaModule Production, Task 9: Tracker and Tracking Controller, Task 10: Installation and Balance of System (BOS), Task 11: Field Testing, and Task 12: Solar Advisor Modeling and Market Analysis. Amonix's TPP addressed nearly the complete PV value chain from epitaxial layer design and wafer processing through system design, manufacturing, deployment and O&M. Amonix has made progress toward achieving these reduced costs through the development of its 28%+ efficient MegaModule, reduced manufacturing and installation cost through design for manufacturing and assembly, automated manufacturing processes, and reduced O&M costs. Program highlights include: (1) Optimized multijunction cell and cell package design to improve performance by > 10%; (2) Updated lens design provided 7% increased performance and higher concentration; (3) 28.7% DC STC MegaModule efficiency achieved in Phase II exceeded Phase III performance goal; (4) New 16' focal length MegaModule achieved target materials and manufacturing cost reduction; (5) Designed and

  7. Use of intravenous immunoglobulin in the Department of Neurology at Ninewells Hospital, 2008-2009: Indications for utilization and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    O′ Riordan Jonathan

    2010-01-01

    Full Text Available This study was designed to identify the indications for prescription of intravenous immunoglobulin (IVIg in neurology and the cost effectiveness of this therapy. Objectives: IVIg is a relatively costly therapy and the annual budget spent on providing this therapy for various indications at Ninewells Hospital was close to £1.5 million. In today′s economic times, a cost-benefit analysis of all therapies is prudent. This is of relevance to countries in the developing world as well where perhaps not everybody could afford such cost-intensive therapy. Materials and Methods: We audited 2 time periods over 12 months each in 2004-2005 and 2008-2009 to look at the patterns of utilization of IVIg over these periods. We searched the literature for alternative and cost-effective therapies for the most common indications for use of IVIg. Results: Fiscal costs on prescription of IVIg have rocketed up by almost 300% in this Neurology Department comparing data from 2004-2005 vs 2008-2009 and this is disproportionate to the increase in the annual admission rate (bed usage, partly because of the soaring costs of the drug available in the market and also because of the increased prescription of IVIg for numerous indications where clinical trials data are yet not so robust. Conclusion: We have looked at the cost of alternative therapies and offer some proposals that if implemented could potentially save £330,000 annually from the health budget at this NHS Trust. Perhaps similar models could evolve for better cost-effective utilization of IVIg in countries in the developing world where health budgeting is more acutely relevant.

  8. New antiepileptic drugs, cost-efficacy analysis

    Directory of Open Access Journals (Sweden)

    P. N. Vlasov

    2012-01-01

    Full Text Available Objective: to optimize pharmacotherapy in patients with epilepsy and to evaluate the clinical and cost-effectiveness of its therapy with the new antiepileptic drugs (AED: levetiracetam, lamotrigine, topiramate, and oxcarbazepine.Patients and methods. The study enrolled 134 patients (women, 69.03%; men, 30.97% with different types of seizures, who had previously received antiepileptic therapy. The patients visited their physician at least twice; after correcting therapy by an epileptologist, the mono- or polytherapy regimen included new AEDs. The patients' mean age was 29.8±8.7 years; disease duration was 13.01±6.7 years; mean age at onset was 16.8±8.5 years. In the groups of working and nonworking patients with different types of seizures, the authors calculated the cost of epilepsy therapy, by taking into account the use of new AEDs and the pharmacoeconomic index "cost-benefit" before and after therapy optimization.Results. When the new AEDs were incorporated into the therapy, the low incidence rate of seizures following a year averaged 75 to 92%. The index cost-effectiveness was decreased by 2—3 times in all types of seizures when the new AEDs were used despite the increased direct cost of treatment. Also, there was a significant reduction in the cost of epilepsy treatment in practically all the groups under study. The findings suggest that the index cost-efficacy directly depends on the rational choice of an AED in an adequate dose. Rational therapy with the new AEDs makes it possible to reduce not only the total cost of epilepsy treatment, but also to lower the index cost-efficacy.

  9. Educational Benefit-Cost Analysis and the Problem of Scale.

    Science.gov (United States)

    Welty, Gordon A.

    Benefit-cost analysis consists of establishing ratios of benefits to costs for a set of project variants. The decision rule is to select that project variant where the ratio is a maximum. This paper argues that specification and estimation errors can contribute to findings for large-scale systems of benefit-cost ratios approximating zero. The…

  10. Utilization of Paneer Whey Waste for Cost-Effective Production of Rhamnolipid Biosurfactant.

    Science.gov (United States)

    Patowary, Rupshikha; Patowary, Kaustuvmani; Kalita, Mohan Chandra; Deka, Suresh

    2016-10-01

    The present study aimed at isolating rhamnolipid biosurfactant-producing bacteria that could utilize paneer whey, an abundant waste source as sole medium for the production purpose. Pseudomonas aeruginosa strain, SR17, was isolated from hydrocarbon-contaminated soil that could efficiently utilize paneer whey for rhamnolipid production and reduce surface tension of the medium from 52 to 26.5 mN/m. The yield of biosurfactant obtained was 2.7 g/l, upgraded to 4.8 g/l when supplemented with 2 % glucose and mineral salts. Biochemical, FTIR, and LC-MS analysis revealed that extracted biosurfactant is a combination of both mono and di-rhamnolipid congeners. The critical micelle concentration (CMC) was measured to be 110 mg/l. Emulsification activity of the biosurfactant against n-hexadecane, olive oil, kerosene, diesel oil, engine oil, and crude oil were found to be 83, 88, 81, 92, 86, and 100 %, respectively. The rhamnolipid was detected to be non-toxic against mouse fibroblastic cell line L292.

  11. Analysis of plug-in hybrid electric vehicle utility factors

    Science.gov (United States)

    Bradley, Thomas H.; Quinn, Casey W.

    Plug-in hybrid electric vehicles (PHEVs) are hybrid electric vehicles that can be fueled from both conventional liquid fuels and grid electricity. To represent the total contribution of both of these fuels to the operation, energy use, and environmental impacts of PHEVs, researchers have developed the concept of the utility factor. As standardized in documents such as SAE J1711 and SAE J2841, the utility factor represents the proportion of vehicle distance travelled that can be allocated to a vehicle test condition so as to represent the real-world driving habits of a vehicle fleet. These standards must be used with care so that the results are understood within the context of the assumptions implicit in the standardized utility factors. This study analyzes and derives alternatives to the standard utility factors from the 2001 National Highway Transportation Survey, so as to understand the sensitivity of PHEV performance to assumptions regarding charging frequency, vehicle characteristics, driver characteristics, and means of defining the utility factor. Through analysis of these alternative utility factors, this study identifies areas where analysis, design, and policy development for PHEVs can be improved by alternative utility factor calculations.

  12. Association of antipsychotic polypharmacy with health service cost: a register-based cost analysis

    DEFF Research Database (Denmark)

    Baandrup, Lone; Lublin, Henrik Kai Francis; Nordentoft, Merete

    2012-01-01

    OBJECTIVE: To investigate the association of antipsychotic polypharmacy in schizophrenia with cost of primary and secondary health service use. METHOD: Comparative analysis of health service cost for patients prescribed antipsychotic polypharmacy versus antipsychotic monotherapy. Resource......, disease duration, psychiatric inpatient admissions, and treatment site as covariates. RESULTS: The sample consisted of 736 outpatients with a diagnosis in the schizophrenia spectrum. Antipsychotic polypharmacy was associated with significantly higher total health service costs compared with monotherapy...... (2007: 25% higher costs; 2008: 17% higher costs) when adjusting for potential confounders and risk factors. A subgroup analysis suggested that the excessive costs associated with antipsychotic polypharmacy were partly accounted for by the functional level of the patients. CONCLUSION: The results...

  13. Cost Analysis in Shoulder Arthroplasty Surgery

    Directory of Open Access Journals (Sweden)

    Matthew J. Teusink

    2012-01-01

    Full Text Available Cost in shoulder surgery has taken on a new focus with passage of the Patient Protection and Affordable Care Act. As part of this law, there is a provision for Accountable Care Organizations (ACOs and the bundled payment initiative. In this model, one entity would receive a single payment for an episode of care and distribute funds to all other parties involved. Given its reproducible nature, shoulder arthroplasty is ideally situated to become a model for an episode of care. Currently, there is little research into cost in shoulder arthroplasty surgery. The current analyses do not provide surgeons with a method for determining the cost and outcomes of their interventions, which is necessary to the success of bundled payment. Surgeons are ideally positioned to become leaders in ACOs, but in order for them to do so a methodology must be developed where accurate costs and outcomes can be determined for the episode of care.

  14. A Cost Analysis of Space Available Travel

    Science.gov (United States)

    2014-06-14

    baggage conveyors . Therefore, the researcher has opted to not include these costs in the overall cost assessment as they would be difficult to... currently collecting the $10 fee. AMC (formerly MAC) disagreed with this fee and requested that the issue be considered by the Joint Chiefs of Staff...fee and Federal Inspection Service fee. The current charges per Space-A passenger are shown below: Table 4: Space-A Head Tax and Federal Inspection

  15. Analysis of Logistics Costs of the Ukrainian Semiconductor Industry

    OpenAIRE

    Popova Viktoriya D.

    2014-01-01

    The goal of the article is analysis of logistics costs in production of semiconductor materials using example of two Ukrainian enterprises. The article studies influence of logistics management and logistics costs upon formation of the final cost value (price) of a commodity (service). It gives an assessment of logistics costs of Ukrainian semiconductor enterprises and establishes its structure by types of main expenditure items: material, transport, production and storehouse. It establishes ...

  16. Cost-effectiveness and cost-utility of cognitive therapy, rational emotive behavioral therapy, and fluoxetine (Prozac) in treating depression: a randomized clinical trial.

    Science.gov (United States)

    Sava, Florin A; Yates, Brian T; Lupu, Viorel; Szentagotai, Aurora; David, Daniel

    2009-01-01

    Cost-effectiveness and cost-utility of cognitive therapy (CT), rational emotive behavioral therapy (REBT), and fluoxetine (Prozac) for major depressive disorder (MDD) were compared in a randomized clinical trial with a Romanian sample of 170 clients. Each intervention was offered for 14 weeks, plus three booster sessions. Beck Depression Inventory (BDI) scores were obtained prior to intervention, 7 and 14 weeks following the start of intervention, and 6 months following completion of intervention. CT, REBT, and fluoxetine did not differ significantly in changes in the BDI, depression-free days (DFDs), or Quality-Adjusted Life Years (QALYs). Average BDI scores decreased from 31.1 before treatment to 9.7 six months following completion of treatment. Due to lower costs, both psychotherapies were more cost-effective, and had better cost-utility, than pharmacotherapy: median $26.44/DFD gained/month for CT and $23.77/DFD gained/month for REBT versus $34.93/DFD gained/month for pharmacotherapy, median $/QALYs=$1,638, $1,734, and $2,287 for CT, REBT, and fluoxetine (Prozac), respectively.

  17. Are decisions using cost-utility analyses robust to choice of SF-36/SF-12 preference-based algorithm?

    Directory of Open Access Journals (Sweden)

    Walton Surrey M

    2005-03-01

    Full Text Available Abstract Background Cost utility analysis (CUA using SF-36/SF-12 data has been facilitated by the development of several preference-based algorithms. The purpose of this study was to illustrate how decision-making could be affected by the choice of preference-based algorithms for the SF-36 and SF-12, and provide some guidance on selecting an appropriate algorithm. Methods Two sets of data were used: (1 a clinical trial of adult asthma patients; and (2 a longitudinal study of post-stroke patients. Incremental costs were assumed to be $2000 per year over standard treatment, and QALY gains realized over a 1-year period. Ten published algorithms were identified, denoted by first author: Brazier (SF-36, Brazier (SF-12, Shmueli, Fryback, Lundberg, Nichol, Franks (3 algorithms, and Lawrence. Incremental cost-utility ratios (ICURs for each algorithm, stated in dollars per quality-adjusted life year ($/QALY, were ranked and compared between datasets. Results In the asthma patients, estimated ICURs ranged from Lawrence's SF-12 algorithm at $30,769/QALY (95% CI: 26,316 to 36,697 to Brazier's SF-36 algorithm at $63,492/QALY (95% CI: 48,780 to 83,333. ICURs for the stroke cohort varied slightly more dramatically. The MEPS-based algorithm by Franks et al. provided the lowest ICUR at $27,972/QALY (95% CI: 20,942 to 41,667. The Fryback and Shmueli algorithms provided ICURs that were greater than $50,000/QALY and did not have confidence intervals that overlapped with most of the other algorithms. The ICUR-based ranking of algorithms was strongly correlated between the asthma and stroke datasets (r = 0.60. Conclusion SF-36/SF-12 preference-based algorithms produced a wide range of ICURs that could potentially lead to different reimbursement decisions. Brazier's SF-36 and SF-12 algorithms have a strong methodological and theoretical basis and tended to generate relatively higher ICUR estimates, considerations that support a preference for these algorithms over the

  18. Can postoperative process of care utilization or complication rates explain the volume-cost relationship for cancer surgery?

    Science.gov (United States)

    Ho, Vivian; Short, Marah N; Aloia, Thomas A

    2017-08-01

    Past studies identify an association between provider volume and outcomes, but less is known about the volume-cost relationship for cancer surgery. We analyze the volume-cost relationship for 6 cancer operations and explore whether it is influenced by the occurrence of complications and/or utilization of processes of care. Medicare hospital and inpatient claims for the years 2005 through 2009 were analyzed for 6 cancer resections: colectomy, rectal resection, pulmonary lobectomy, pneumonectomy, esophagectomy, and pancreatic resection. Regressions were first estimated to quantify the association of provider volume with costs, excluding measures of complications and processes of care as explanatory variables. Next, these variables were added to the regressions to test whether they weakened any previously observed volume-cost relationship. Higher hospital volume is associated with lower patient costs for esophagectomy but not for other operations. Higher surgeon volume reduces costs for most procedures, but this result weakens when processes of care are added to the regressions. Processes of care that are frequently implemented in response to adverse events are associated with 14% to 34% higher costs. Utilization of these processes is more prevalent among low-volume versus high-volume surgeons. Processes of care implemented when complications occur explain much of the surgeon volume-cost relationship. Given that surgeon volume is readily observed, better outcomes and lower costs may be achieved by referring patients to high-volume surgeons. Increasing patient access to surgeons with lower rates of complications may be the most effective strategy for avoiding costly processes of care, controlling expenditure growth. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Epidural Steroids for Lumbosacral Radicular Syndrome Compared to Usual Care : Quality of Life and Cost Utility in General Practice

    NARCIS (Netherlands)

    Spijker-Huiges, Antje; Vermeulen, Karin; Winters, Jan C.; van Wijhe, Marten; van der Meer, Klaas

    Objective: To investigate the effect of adding segmental epidural steroid injections (SESIs) to usual care compared with usual care alone on quality of life and cost utility in lumbosacral radicular syndrome (LRS) in general practice. Design: A pragmatic randomized controlled trial. Results were

  20. Systematic review of model-based analyses reporting the cost-effectiveness and cost-utility of cardiovascular disease management programs.

    Science.gov (United States)

    Maru, Shoko; Byrnes, Joshua; Whitty, Jennifer A; Carrington, Melinda J; Stewart, Simon; Scuffham, Paul A

    2015-02-01

    The reported cost effectiveness of cardiovascular disease management programs (CVD-MPs) is highly variable, potentially leading to different funding decisions. This systematic review evaluates published modeled analyses to compare study methods and quality. Articles were included if an incremental cost-effectiveness ratio (ICER) or cost-utility ratio (ICUR) was reported, it is a multi-component intervention designed to manage or prevent a cardiovascular disease condition, and it addressed all domains specified in the American Heart Association Taxonomy for Disease Management. Nine articles (reporting 10 clinical outcomes) were included. Eight cost-utility and two cost-effectiveness analyses targeted hypertension (n=4), coronary heart disease (n=2), coronary heart disease plus stoke (n=1), heart failure (n=2) and hyperlipidemia (n=1). Study perspectives included the healthcare system (n=5), societal and fund holders (n=1), a third party payer (n=3), or was not explicitly stated (n=1). All analyses were modeled based on interventions of one to two years' duration. Time horizon ranged from two years (n=1), 10 years (n=1) and lifetime (n=8). Model structures included Markov model (n=8), 'decision analytic models' (n=1), or was not explicitly stated (n=1). Considerable variation was observed in clinical and economic assumptions and reporting practices. Of all ICERs/ICURs reported, including those of subgroups (n=16), four were above a US$50,000 acceptability threshold, six were below and six were dominant. The majority of CVD-MPs was reported to have favorable economic outcomes, but 25% were at unacceptably high cost for the outcomes. Use of standardized reporting tools should increase transparency and inform what drives the cost-effectiveness of CVD-MPs. © The European Society of Cardiology 2014.

  1. Present-value analysis: A systems approach to public decisionmaking for cost effectiveness

    Science.gov (United States)

    Herbert, T. T.

    1971-01-01

    Decision makers within Governmental agencies and Congress must evaluate competing (and sometimes conflicting) proposals which seek funding and implementation. Present value analysis can be an effective decision making tool by enabling the formal evaluation of the effects of competing proposals on efficient national resource utilization. A project's costs are not only its direct disbursements, but its social costs as well. How much does it cost to have those funds diverted from their use and economic benefit by the private sector to the public project? Comparisons of competing projects' social costs allow decision makers to expand their decision bases by quantifying the projects' impacts upon the economy and the efficient utilization of the country's limited national resources. A conceptual model is established for the choosing of the appropriate discount rate to be used in evaluation decisions through the technique.

  2. City-scale analysis of water-related energy identifies more cost-effective solutions.

    Science.gov (United States)

    Lam, Ka Leung; Kenway, Steven J; Lant, Paul A

    2017-02-01

    Energy and greenhouse gas management in urban water systems typically focus on optimising within the direct system boundary of water utilities that covers the centralised water supply and wastewater treatment systems, despite a greater energy influence by the water end use. This work develops a cost curve of water-related energy management options from a city perspective for a hypothetical Australian city. It is compared with that from the water utility perspective. The curves are based on 18 water-related energy management options that have been implemented or evaluated in Australia. In the studied scenario, the cost-effective energy saving potential from a city perspective (292 GWh/year) is far more significant than that from a utility perspective (65 GWh/year). In some cases, for similar capital cost, if regional water planners invested in end use options instead of utility options, a greater energy saving potential at a greater cost-effectiveness could be achieved in urban water systems. For example, upgrading a wastewater treatment plant for biogas recovery at a capital cost of $27.2 million would save 31 GWh/year with a marginal cost saving of $63/MWh, while solar hot water system rebates at a cost of $28.6 million would save 67 GWh/year with a marginal cost saving of $111/MWh. Options related to hot water use such as water-efficient shower heads, water-efficient clothes washers and solar hot water system rebates are among the most cost-effective city-scale opportunities. This study demonstrates the use of cost curves to compare both utility and end use options in a consistent framework. It also illustrates that focusing solely on managing the energy use within the utility would miss substantial non-utility water-related energy saving opportunities. There is a need to broaden the conventional scope of cost curve analysis to include water-related energy and greenhouse gas at the water end use, and to value their management from a city perspective. This

  3. Costo-utilidad de la vacuna contra el virus de papiloma humano en mujeres peruanas Cost- utility of the vaccine against the human papiloma virus in peruvian women

    Directory of Open Access Journals (Sweden)

    Alfonso Gutiérrez-Aguado

    2011-09-01

    Full Text Available Objetivos. Estimar el costo-utilidad de la vacuna contra el Virus de Papiloma Humano (VPH en las mujeres peruanas luego de la aplicación de la vacuna cuando tenían 10 años de edad. Materiales y métodos. Se realizó un análisis de costo-utilidad empleando el modelo oculto de Markov en una cohorte hipotética de mujeres peruanas, basado en la información de parámetros epidemiológicos, costos asociados al Cáncer de cuello uterino (CCU y la eficacia y los costos de la vacunación contra el VPH. Los costos de la vacunación se estimaron desde la perspectiva del Ministerio de Salud de Perú y se compararon con los años de vida ajustados por calidad (AVAC utilizando una tasa de descuento del 5 %. Resultados. El costo anual de la vacunación fue de USD 16 861 490, para el tamizaje con Papanicolau fue de USD 3 060 793 y los costos asociados al CCU fueron de USD 15 580 000. La razón de costo-utilidad incremental (RCUI fue de 6775 USD/AVAC. Conclusiones. La vacunación contra el VPH puede resultar costo-útil comparada con el no vacunar.Objetives. To estimate the cost-utility of the vaccine against the Human Papiloma Virus (HPV in peruvian women after the application of the vaccine at 10 years of age. Materials and methods. A cost-utility analysis was performed using the Markov´s hidden model in a hypothetical cohort of peruvian women, based on the information on epidemiological parameters, costs associated to uterine cervical cancer (UCC and the efficacy and costs of the vaccine against the HPV. The vaccination costs were estimated from the Peruvian Ministry of Health perspective and were compared against the quality-adjusted life years (QALYs, using a discount rate of 5%. Results. The annual cost of the vaccination was USD 16’861,490, for the Papanicoau screening it was USD 3’060,793 and the costs associated to the UCC were USD 15’580,000. The incremental cost utility ratio (ICUR was 6,775 USD/QALY. Conclusions. Vaccination against HPV

  4. Counting the Costs of Acquisitions: Using Cost-Benefit Analysis in a Seminary and University Library

    Directory of Open Access Journals (Sweden)

    Verena Getahun

    2009-11-01

    Full Text Available This essay considers how cost-benefit analysis may be used in a small to mid-sized library to identify cost-savings in the acquisitions of monographs. The essay highlights parallel studies conducted at Luther Seminary Library and Bethel University Library which compared prices, discounts, and time costs across a range of vendor types to identify whether searching for the best price per item is cost-effective, and how much this strategy could save yearly in acquisitions. Both libraries found that substantial potential savings were identified through this study.

  5. 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

  6. Educational Cost Analysis in Action: Case Studies for Planners -- II.

    Science.gov (United States)

    Coombs, Philip H.; Hallak, Jacques

    This document is the second in a series of three documents, which together contain 27 case studies on the uses of cost analysis in educational planning. The case studies are presented to help planners and administrators see how cost analysis can be used to improve the efficiency of their educational systems, or to get the best value existing…

  7. Educational Cost Analysis in Action: Case Studies for Planners -- III.

    Science.gov (United States)

    Coombs, Philip H.; Hallak, Jacques

    This document is the third in a series of three documents, which together contain 27 case studies on the uses of cost analysis in educational planning. The case studies have been presented to help planners and administrators see how cost analysis can be used to improve the efficiency of their educational systems, and to get the best value from…

  8. Educational Cost Analysis in Action: Case Studies for Planners -- I.

    Science.gov (United States)

    Coombs, Philip H.; Hallak, Jacques

    This document is the first in a series of three documents, which together contains 27 case studies on the uses of cost analysis in educational planning. The case studies have been presented to help planners and administrators see how cost analysis can be used to improve the efficiency of their educational systems, or how to get the best value from…

  9. Mirror Fusion Test Facility: Superconducting magnet system cost analysis

    Energy Technology Data Exchange (ETDEWEB)

    1977-07-01

    At the request of Victor Karpenko, Project manager for LLL`s Mirror Fusion Test Facility, EG&G has prepared this independent cost analysis for the proposed MFTF Superconducting Magnet System. The analysis has attempted to show sufficient detail to provide adequate definition for a basis of estimating costs.

  10. 7 CFR 550.47 - Cost and price analysis.

    Science.gov (United States)

    2010-01-01

    ..., market prices and similar indicia, together with discounts. Cost analysis is the review and evaluation of... 7 Agriculture 6 2010-01-01 2010-01-01 false Cost and price analysis. 550.47 Section 550.47 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE,...

  11. Cost Benefit Analysis of Consumer Product Safety Standards

    Science.gov (United States)

    Smith, Betty F.; Dardis, Rachel

    1977-01-01

    This paper investigates the role of cost-benefit analysis in evaluating consumer product safety standards and applys such analysis to an evaluation of flammability standards for children's sleepwear. (Editor)

  12. A cost function analysis of child health services in four districts in Malawi.

    Science.gov (United States)

    Johns, Benjamin; Munthali, Spy; Walker, Damian G; Masanjala, Winford; Bishai, David

    2013-05-10

    Recent analyses show that donor funding for child health is increasing, but little information is available on actual costs to deliver child health care services. Understanding how unit costs scale with service volume in Malawi can help planners allocate budgets as health services expand. Data on facility level inputs and outputs were collected at 24 health centres in four districts of Malawi visiting a random sample of government and a convenience sample of Christian Health Association of Malawi (CHAM) health centres. In the cost function, total outputs, quality, facility ownership, average salaries and case mix are used to predict total cost. Regression analysis identifies marginal cost as the coefficient relating cost to service volume intensity. The marginal cost per patient seen for all health centres surveyed was US$ 0.82 per additional patient visit. Average cost was US$ 7.16 (95% CI: 5.24 to 9.08) at government facilities and US$ 10.36 (95% CI: 4.92 to 15.80) at CHAM facilities per child seen for any service. The first-line anti-malarial drug accounted for over 30% of costs, on average, at government health centres. Donors directly financed 40% and 21% of costs at government and CHAM health centres, respectively. The regression models indicate higher total costs are associated with a greater number of outpatient visits but that many health centres are not providing services at optimal volume given their inputs. They also indicate that CHAM facilities have higher costs than government facilities for similar levels of utilization. We conclude by discussing ways in which efficiency may be improved at health centres. The first option, increasing the total number of patients seen, appears difficult given existing high levels of child utilization; increasing the volume of adult patients may help spread fixed and semi-fixed costs. A second option, improving the quality of services, also presents difficulties but could also usefully improve performance.

  13. Comparison of Cement-Based and Polymer-Based Concrete Pipes for Analysis of Cost Assessment

    Directory of Open Access Journals (Sweden)

    Orhan Bozkurt

    2013-01-01

    Full Text Available As the variety of materials utilized in construction industry has expanded, new techniques have been used in order to optimize the quality and efficiency of output. Therefore, recent innovations taking place in the construction industry led researchers to increase the mechanical efficiency of the output more than the cost effectiveness of it. However, especially professionals experiencing in the industry look into the cost effectiveness of the work. In other words, they also want researchers to justify the innovative techniques economically. The aim of this study is to provide a comparative analysis of the cost efficiency of polymer concrete used to manufacture durable and long-lasting reinforced concrete structures.

  14. Cost Benefit and Alternatives Analysis of Distribution Systems with Energy Storage Systems: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Harris, Tom; Nagarajan, Adarsh; Baggu, Murali; Bialek, Tom

    2017-06-27

    This paper explores monetized and non-monetized benefits from storage interconnected to distribution system through use cases illustrating potential applications for energy storage in California's electric utility system. This work supports SDG&E in its efforts to quantify, summarize, and compare the cost and benefit streams related to implementation and operation of energy storage on its distribution feeders. This effort develops the cost benefit and alternatives analysis platform, integrated with QSTS feeder simulation capability, and analyzed use cases to explore the cost-benefit of implementation and operation of energy storage for feeder support and market participation.

  15. Cost analysis of continuous flight auger piles construction in Egypt

    Directory of Open Access Journals (Sweden)

    Hossam E. Hosny

    2016-09-01

    Full Text Available Continuous Flight Auger (CFA piling is widely used in the Egyptian construction industry. There is a dramatic fluctuation in pricing of executing this work package within short periods as a result of unsteady changes in supply-demand equilibrium. Consequently, there is an urgent need for the use of a scientific approach in estimating construction costs. Accordingly, it is crucial to consider the different cost elements of CFA piling construction as a step to reach an accurate and realistic cost estimate to be used by contractors in tendering. This research aims to study these cost elements based on an expert judgment, site observations and statistical analysis in order to develop an effective tool to estimate the total construction cost of the CFA piles in any future project. Expert survey was performed to draw detailed information to construct a cost breakdown structure (CBS that was used as a basis for developing the proposed cost model. The developed cost model is then validated through the application on fifty two projects. Such projects were carefully selected in different sizes, purposes and locations. Then the collected data were exposed to statistical analysis techniques. An average percentage error of 4.1% was observed upon comparing the estimated costs with the actual costs of these projects. A sensitivity analysis was then performed to recognize the most effective cost factors. The developed recommended model was used by some experienced contractors in the Egyptian market who expressed their satisfaction with the model.

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

    African Journals Online (AJOL)

    2012-07-02

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

  17. Processing Cost Analysis for Biomass Feedstocks

    Energy Technology Data Exchange (ETDEWEB)

    Badger, P.C.

    2002-11-20

    The receiving, handling, storing, and processing of woody biomass feedstocks is an overlooked component of biopower systems. The purpose of this study was twofold: (1) to identify and characterize all the receiving, handling, storing, and processing steps required to make woody biomass feedstocks suitable for use in direct combustion and gasification applications, including small modular biopower (SMB) systems, and (2) to estimate the capital and operating costs at each step. Since biopower applications can be varied, a number of conversion systems and feedstocks required evaluation. In addition to limiting this study to woody biomass feedstocks, the boundaries of this study were from the power plant gate to the feedstock entry point into the conversion device. Although some power plants are sited at a source of wood waste fuel, it was assumed for this study that all wood waste would be brought to the power plant site. This study was also confined to the following three feedstocks (1) forest residues, (2) industrial mill residues, and (3) urban wood residues. Additionally, the study was confined to grate, suspension, and fluidized bed direct combustion systems; gasification systems; and SMB conversion systems. Since scale can play an important role in types of equipment, operational requirements, and capital and operational costs, this study examined these factors for the following direct combustion and gasification system size ranges: 50, 20, 5, and 1 MWe. The scope of the study also included: Specific operational issues associated with specific feedstocks (e.g., bark and problems with bridging); Opportunities for reducing handling, storage, and processing costs; How environmental restrictions can affect handling and processing costs (e.g., noise, commingling of treated wood or non-wood materials, emissions, and runoff); and Feedstock quality issues and/or requirements (e.g., moisture, particle size, presence of non-wood materials). The study found that over the

  18. Hypergolic Propellant Destruction Evaluation Cost Benefit Analysis

    Science.gov (United States)

    Kessel, Kurt

    2010-01-01

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

  19. Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis

    Directory of Open Access Journals (Sweden)

    Baskerville Neill

    2005-03-01

    Full Text Available Abstract Background Outreach facilitation has been proven successful in improving the adoption of clinical preventive care guidelines in primary care practice. The net costs and savings of delivering such an intensive intervention need to be understood. We wanted to estimate the proportion of a facilitation intervention cost that is offset and the potential for savings by reducing inappropriate screening tests and increasing appropriate screening tests in 22 intervention primary care practices affecting a population of 90,283 patients. Methods A cost-consequences analysis of one successful outreach facilitation intervention was done, taking into account the estimated cost savings to the health system of reducing five inappropriate tests and increasing seven appropriate tests. Multiple data sources were used to calculate costs and cost savings to the government. The cost of the intervention and costs of performing appropriate testing were calculated. Costs averted were calculated by multiplying the number of tests not performed as a result of the intervention. Further downstream cost savings were determined by calculating the direct costs associated with the number of false positive test follow-ups avoided. Treatment costs averted as a result of increasing appropriate testing were similarly calculated. Results The total cost of the intervention over 12 months was $238,388 and the cost of increasing the delivery of appropriate care was $192,912 for a total cost of $431,300. The savings from reduction in inappropriate testing were $148,568 and from avoiding treatment costs as a result of appropriate testing were $455,464 for a total savings of $604,032. On a yearly basis the net cost saving to the government is $191,733 per year (2003 $Can equating to $3,687 per physician or $63,911 per facilitator, an estimated return on intervention investment and delivery of appropriate preventive care of 40%. Conclusion Outreach facilitation is more expensive

  20. Comparing Aging in Place to Home Health Care: Impact of Nurse Care Coordination On Utilization and Costs.

    Science.gov (United States)

    Popejoy, Lori L; Galambos, Colleen; Stetzer, Frank; Popescu, Mihail; Hicks, Lanis; Khalilia, Mohammed A; Rantz, Marilyn J; Marek, Karen D

    2015-01-01

    The goal of this study was to compare utilization and cost outcomes of patients who received long-term care coordination in an Aging in Place program to patients who received care coordination as a routine service in home health care. This research offered the unique opportunity to compare two groups of patients who received services from a single home health care agency, using the same electronic health record, to identify the impact of long-term and routine care coordination on utilization and costs to Medicare and Medicaid programs. This study supports that long-term care coordination supplied by nurses outside of a primary medical home can positively influence functional, cognitive, and health care utilization for frail older people. The care coordinators in this study practiced nursing by routinely assessing and educating patients and families, assuring adequate service delivery, and communicating with the multidisciplinary health care team. Care coordination managed by registered nurses can influence utilization and cost outcomes, and impact health and functional abilities.

  1. Constellation Program Life-cycle Cost Analysis Model (LCAM)

    Science.gov (United States)

    Prince, Andy; Rose, Heidi; Wood, James

    2008-01-01

    The Constellation Program (CxP) is NASA's effort to replace the Space Shuttle, return humans to the moon, and prepare for a human mission to Mars. The major elements of the Constellation Lunar sortie design reference mission architecture are shown. Unlike the Apollo Program of the 1960's, affordability is a major concern of United States policy makers and NASA management. To measure Constellation affordability, a total ownership cost life-cycle parametric cost estimating capability is required. This capability is being developed by the Constellation Systems Engineering and Integration (SE&I) Directorate, and is called the Lifecycle Cost Analysis Model (LCAM). The requirements for LCAM are based on the need to have a parametric estimating capability in order to do top-level program analysis, evaluate design alternatives, and explore options for future systems. By estimating the total cost of ownership within the context of the planned Constellation budget, LCAM can provide Program and NASA management with the cost data necessary to identify the most affordable alternatives. LCAM is also a key component of the Integrated Program Model (IPM), an SE&I developed capability that combines parametric sizing tools with cost, schedule, and risk models to perform program analysis. LCAM is used in the generation of cost estimates for system level trades and analyses. It draws upon the legacy of previous architecture level cost models, such as the Exploration Systems Mission Directorate (ESMD) Architecture Cost Model (ARCOM) developed for Simulation Based Acquisition (SBA), and ATLAS. LCAM is used to support requirements and design trade studies by calculating changes in cost relative to a baseline option cost. Estimated costs are generally low fidelity to accommodate available input data and available cost estimating relationships (CERs). LCAM is capable of interfacing with the Integrated Program Model to provide the cost estimating capability for that suite of tools.

  2. Changes in healthcare utilization and costs associated with sildenafil therapy for pulmonary arterial hypertension: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel

    2012-12-01

    Full Text Available Abstract Background Little is known concerning the degree to which initiation of sildenafil for pulmonary arterial hypertension (PAH impacts patterns of healthcare utilization and costs. Methods Using a large US health insurance claims database, we identified all patients with evidence of PAH (ICD-9-CM diagnosis codes 416.0, 416.8 who received sildenafil between 1/1/2005 and 9/30/2008. Date of the first-noted prescription for sildenafil was designated the “index date,” and claims data were compiled for all study subjects for 6 months prior to their index date (“pretreatment” and 6 months thereafter (“follow-up”; patients with incomplete data during either of these periods were excluded. Healthcare utilization and costs were then compared between pretreatment and follow-up for all study subjects. Results A total of 567 PAH patients were identified who began therapy with sildenafil and met all other study entry criteria. Mean (SD age was 52 (10 years; 73% were women. Healthcare utilization was largely unchanged between pretreatment and follow-up, the only exceptions being decreases in the mean number of emergency department visits (from 0.7 to 0.5 per patient; p  Conclusions The cost of sildenafil therapy may be partially offset by reductions in other healthcare costs.

  3. Cost analysis of ground-water supplies in the North Atlantic region, 1970

    Science.gov (United States)

    Cederstrom, Dagfin John

    1973-01-01

    report includes an analysis of test drilling costs leading to a production well field. The discussion shows that test drilling is a relatively low cost item and that more than a minimum of test holes in a previously unexplored area is, above all, simple insurance in keeping down costs and may easily result in final lower costs for the system. Use of the jet drill for testing is considered short sighted and may result in higher total costs and possibly failure to discover good aquifers. Economic development of ground water supplies will depend on obtaining qualified hydrologic and engineering advice, on carrying out adequate test drilling, and on utilizing high-quality (at times, more costly) material.

  4. Utilizing Problem-Based Learning in Qualitative Analysis Lab Experiments

    Science.gov (United States)

    Hicks, Randall W.; Bevsek, Holly M.

    2012-01-01

    A series of qualitative analysis (QA) laboratory experiments utilizing a problem-based learning (PBL) module has been designed and implemented. The module guided students through the experiments under the guise of cleaning up a potentially contaminated water site as employees of an environmental chemistry laboratory. The main goal was the…

  5. Is vaccination good value for money? A review of cost-utility analyses of vaccination strategies in eight European countries

    Directory of Open Access Journals (Sweden)

    Marco Barbieri

    2016-12-01

    Full Text Available Objective: The objective of this study is to review published cost-utility analyses of vaccination strategies in eight European countries and to assess whether there are differences in cost-effectiveness terms among countries and vaccinations. Methods: A systematic search of the literature was conducted using the National Health Service Economic Evaluation Database and the PubMed database. Cost-utility analyses of any type of vaccination that used quality-adjusted life years (QALYs as measure of benefit and conducted in Belgium, France, Germany, Italy, Spain, Sweden, the Netherlands or the UK were included. Results: A total of 94 studies were identified. As a result of our search methodology, the vast majority of studies were conducted in the Netherlands or UK (33 and 30 studies, respectively. The most frequent vaccination types were against Human papillomavirus (HPV with 23 studies, followed by vaccination against pneumococcal infections (19 studies. The analysed vaccinations were generally cost-effective but with high variability. Considering an incremental cost effectiveness ratio (ICER of 40,000€/QALY, we noticed that the following vaccinations studies are below this threshold, i.e. all varicella and influenza (with one outlier studies, 90% of the studies for HPV and 75% of the studies for pneumococcal vaccinations. Rotavirus vaccination was considered as not cost-effective, with only 30% of studies below the threshold of 40,000€/QALY. There was no clear trend for vaccinations being more cost-effective in some countries. Conclusions: The published literature has shown that vaccination strategies are generally cost-effective in European countries. High heterogeneity in the results among studies and countries was found.

  6. Accuracy of self-reports of mental health care utilization and calculated costs compared to hospital records.

    Science.gov (United States)

    Heinrich, Sven; Deister, Arno; Birker, Thomas; Hierholzer, Cornelia; Weigelt, Ina; Zeichner, Dirk; Angermeyer, Matthias C; Roick, Christiane; König, Hans-Helmut

    2011-01-30

    Assessments of service utilization is often based on self-reports. Concerns regarding the accuracy of self-reports are raised especially in mental health care. The purpose of this study was to analyze the accuracy of self-reports and calculated costs of mental health services. In a prospective cohort study in Germany, self-reports regarding psychiatric inpatient and day-care use collected by telephone interviews based on the Client Socio-Demographic and Service Receipt Inventory (CSSRI) as well as calculated costs were compared to computerized hospital records. The sample consisted of patients with mental and behavioral disorders resulting from alcohol (ICD-10 F10, n=84), schizophrenia, schizophrenic and delusional disturbances (F2, n=122) and affective disorders (F3, n=124). Agreement was assessed using the concordance correlation coefficient (CCC), mean difference (95% confidence intervals (CI)) and the 95% limits of agreement. Predictors for disagreement were derived. Overall agreement of mean total costs was excellent (CCC=0.8432). Costs calculated based on self-reports were higher than costs calculated based on hospital records (15 EUR (95% CI -434 to 405)). Overall agreement of total costs for F2 patients was CCC=0.8651, for F3 CCC=0.7850 and for F10 CCC=0.6180. Depending on type of service, measure of service utilization and costs agreement ranged from excellent to poor and varied substantially between individuals. The number of admissions documented in hospital records was significantly associated with disagreement. Telephone interviews can be an accurate data collection method for calculating mean total costs in mental health care. In the future more standardization is needed.

  7. Meetings with Costly Participation: An Empirical Analysis

    OpenAIRE

    Turner, Matthew; Weninger, Quinn

    2005-01-01

    Using data from the Mid-Atlantic surf clam and ocean quahog fishery, we find that firms with a preference for extreme, rather than moderate, policies are much more likely to participate in public meetings where regulation is determined. We also find that participation rates are higher for larger, closer, and more influential firms. These results; (1) improve our understanding of a very common institution for resource allocation, 'meetings with costly participation', (2) they refine our intuit...

  8. Health care resource utilization and costs of California Medicaid patients with schizophrenia treated with paliperidone palmitate once monthly or atypical oral antipsychotic treatment.

    Science.gov (United States)

    Pesa, Jacqueline A; Doshi, Dilesh; Wang, Li; Yuce, Huseyin; Baser, Onur

    2017-04-01

    To compare all-cause health care utilization and costs between patients with schizophrenia treated with once monthly paliperidone palmitate (PP1M; Invega Sustenna (1) ) and atypical oral antipsychotic therapy (OAT). This was a retrospective claims-based analysis among adult California Medicaid (Medi-Cal) patients with schizophrenia having ≥2 claims for PP1M or OAT from 1 July 2009 to 31 December 2013 and continuous health plan enrollment for ≥1 year pre- and post-index date (PP1M or OAT initiation date). Baseline characteristics were reported descriptively. Propensity score matching with a 1:1 greedy match method was used to create two matched cohorts. Treatment patterns, all-cause health care utilization, and costs for the 12 month follow-up period were compared between the two matched cohorts. Two well matched cohorts of 722 patients were produced with similar baseline characteristics. During the 12 month follow-up period, PP1M patients were significantly less likely to discontinue treatment (30.6% vs. 39.5%, p costs ($5060 vs. $10,880, p costs were significantly higher in the PP1M cohort ($16,347 vs. $9115, p costs were not significantly different between the matched cohorts ($25,546 vs. $25,307, p = 0.853). Patients with schizophrenia treated with PP1M had significantly fewer inpatient hospitalizations and associated costs with no significant difference in the total costs between the two cohorts. This study is subject to limitations associated with claims data such as miscoding, inability to examine clinical severity, etc.

  9. Many Miles to Go: A Systematic Review of the State of Cost-Utility Analyses in Brazil.

    Science.gov (United States)

    Campolina, Alessandro G; Rozman, Luciana M; Decimoni, Tassia C; Leandro, Roseli; Novaes, Hillegonda M D; De Soárez, Patrícia Coelho

    2017-04-01

    Little is known about the quality and quantity of cost-utility analyses (CUAs) in Brazil. The objective of this study was to provide a systematic review of published CUAs of healthcare technologies in Brazil. We performed a systematic review of economic evaluations studies published in MEDLINE, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), NHS EED (National Health Service Economic Evaluation Database), HTA (Health Technology Assessment) Database, Web of Science, Scopus, Bireme (Biblioteca Regional de Medicina), BVS ECOS (Health Economics database of the Brazilian Virtual Library of Health), and SISREBRATS (Sistema de Informação da Rede Brasileira de Avaliação de Tecnologias em Saúde [Brazilian Network for the Evaluation of Health Technologies]) from 1980 to 2013. Articles were included if they were CUAs according to the classification devised by Drummond et al. Two independent reviewers screened articles for relevance and carried out data extraction. Disagreements were resolved through discussion or through consultation with a third reviewer. We performed a qualitative narrative synthesis. Of the 535 health economic evaluations (HEEs) relating to Brazil, only 40 were CUAs and therefore included in the analysis. Most studies adhered to methodological guidelines for quality of reporting and 77.5% used quality-adjusted life-years (QALYs) as the health outcome. Of these studies, 51.6% did not report the population used to elicit preferences for outcomes and 45.2% used a specific population such as expert opinion. The preference elicitation method was not reported in 58.1% of these studies. The majority (80.6%) of studies did not report the instrument used to derive health state valuations and no publication reported whether tariffs (or preference weights) were national or international. No study mentioned the methodology used to estimate QALYs. Many published Brazilian cost-utility studies

  10. Impact of Predicting Health Care Utilization Via Web Search Behavior: A Data-Driven Analysis.

    Science.gov (United States)

    Agarwal, Vibhu; Zhang, Liangliang; Zhu, Josh; Fang, Shiyuan; Cheng, Tim; Hong, Chloe; Shah, Nigam H

    2016-09-21

    By recent estimates, the steady rise in health care costs has deprived more than 45 million Americans of health care services and has encouraged health care providers to better understand the key drivers of health care utilization from a population health management perspective. Prior studies suggest the feasibility of mining population-level patterns of health care resource utilization from observational analysis of Internet search logs; however, the utility of the endeavor to the various stakeholders in a health ecosystem remains unclear. The aim was to carry out a closed-loop evaluation of the utility of health care use predictions using the conversion rates of advertisements that were displayed to the predicted future utilizers as a surrogate. The statistical models to predict the probability of user's future visit to a medical facility were built using effective predictors of health care resource utilization, extracted from a deidentified dataset of geotagged mobile Internet search logs representing searches made by users of the Baidu search engine between March 2015 and May 2015. We inferred presence within the geofence of a medical facility from location and duration information from users' search logs and putatively assigned medical facility visit labels to qualifying search logs. We constructed a matrix of general, semantic, and location-based features from search logs of users that had 42 or more search days preceding a medical facility visit as well as from search logs of users that had no medical visits and trained statistical learners for predicting future medical visits. We then carried out a closed-loop evaluation of the utility of health care use predictions using the show conversion rates of advertisements displayed to the predicted future utilizers. In the context of behaviorally targeted advertising, wherein health care providers are interested in minimizing their cost per conversion, the association between show conversion rate and predicted

  11. Terminal patients in Belgian nursing homes: a cost analysis.

    Science.gov (United States)

    Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Vanden Berghe, Paul; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

    2013-06-01

    Policy makers and health care payers are concerned about the costs of treating terminal patients. This study was done to measure the costs of treating terminal patients during the final month of life in a sample of Belgian nursing homes from the health care payer perspective. Also, this study compares the costs of palliative care with those of usual care. This multicenter, retrospective cohort study enrolled terminal patients from a representative sample of nursing homes. Health care costs included fixed nursing home costs, medical fees, pharmacy charges, other charges, and eventual hospitalization costs. Data sources consisted of accountancy and invoice data. The analysis calculated costs per patient during the final month of life at 2007/2008 prices. Nineteen nursing homes participated in the study, generating a total of 181 patients. Total mean nursing home costs amounted to 3,243 € per patient during the final month of life. Total mean nursing home costs per patient of 3,822 € for patients receiving usual care were higher than costs of 2,456 € for patients receiving palliative care (p = 0.068). Higher costs of usual care were driven by higher hospitalization costs (p < 0.001). This study suggests that palliative care models in nursing homes need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients.

  12. Electric-utility DSM-program costs and effects, 1991 to 2001

    Energy Technology Data Exchange (ETDEWEB)

    Hirst, E.

    1993-05-01

    For the past three years (1989, 1990, and 1991), all US electric utilities that sell more than 120 GWh/year have been required to report to the Energy Information Administration data on their demand-side management (DSM) programs. These data provide a rich and uniquely comprehensive picture of electric-utility DSM programs in the United States. Altogether, 890 utilities (of about 3250 in the United States) ran DSM programs in 1991; of these, 439 sold more than 120 GWh and reported details on their DSM programs. These 439 utilities represent more than 80% of total US electricity sales and revenues. Altogether, these utilities spent almost $1.8 billion on DSM programs in 1991, equal to 1.0% of total utility revenues that year. In return for these (and prior-year) expenditures, utility DSM programs cut potential peak demand by 26,700 MW (4.8% of the national total) and cut annual electricity use by 23,300 GWh (0.9% of the national total). These 1991 numbers represent substantial increases over the 1989 and 1990 numbers on utility DSM programs. Specifically, utility DSM expenditures doubled, energy savings increased by almost 50%, and demand reductions increased by one-third between 1989 and 1991. Utilities differed enormously in their DSM-program expenditures and effects. Almost 12% of the reporting utilities spent more than 2% of total revenues on DSM programs in 1991, while almost 60% spent less than 0.5% of revenues on DSM. Utility estimates of future DSM-program expenditures and benefits show continuing growth. By the year 2001, US utilities expect to spend 1.2% of revenues on DSM and to cut demand by 8.8% and annual sales by 2.7%. Here, too, expectations vary by region. Utilities in the West and Northwest plan to spend more than 2% of revenues on DSM that year, while utilities in the Mid-Atlantic, Midwest, Southwest, Central, and North Central regions plan to spend less than 1% of revenues on DSM.

  13. Why does Existential Threat Promote Intergroup Violence? Examining the Role of Retributive Justice and Cost-Benefit Utility Motivations.

    Science.gov (United States)

    Hirschberger, Gilad; Pyszczynski, Tom; Ein-Dor, Tsachi

    2015-01-01

    The current research examined the role of retributive justice and cost-benefit utility motivations in the process through which mortality salience increases support for violent responses to intergroup conflict. Specifically, previous research has shown that mortality salience often encourages political violence, especially when perceptions of retributive justice are activated. The current research examined whether mortality salience directly activates a justice mindset over a cost-benefit utility mindset, and whether this justice mindset is associated with support for political violence. In Study 1 (N = 209), mortality salience was manipulated among Israeli participants who then read about a Hamas attack on Israel with either no casualties or many casualties, after which justice and utility motivations for retribution were assessed. Study 2 (N = 112), examined whether the link between death primes and support for an Israeli preemptive strike on Iran's nuclear facilities is mediated by justice or cost-benefit utility considerations. Results of both studies revealed that primes of death increased justice-related motivations, and these motives, rather than utility motives, were associated with support for violence. Findings suggest that existential concerns often fuel violent intergroup conflict because they increase desire for retributive justice, rather than increase belief that violence is an effective strategy. These findings expand our knowledge on the motivations for intergroup violence, and shed experimental light on real-life eruptions of violent conflict indicating that when existential concerns are salient, as they often are during violent conflict, the decision to engage in violence often disregards the utility of violence, and leads to the preference for violent solutions to political problems - even when these solutions make little practical sense.

  14. Why Does Existential Threat Promote Intergroup Violence? Examining the Role of Retributive Justice and Cost-Benefit Utility Motivations

    Directory of Open Access Journals (Sweden)

    Gilad eHirschberger

    2015-11-01

    Full Text Available The current research examined the role of retributive justice and cost-benefit utility motivations in the process through which mortality salience increases support for violent responses to intergroup conflict. Specifically, previous research has shown that mortality salience often encourages political violence, especially when perceptions of retributive justice are activated. The current research examined whether mortality salience directly activates a justice mindset over a cost-benefit utility mindset, and whether this justice mindset is associated with support for political violence. In Study 1 (N=209, mortality salience was manipulated among Israeli participants who then read about a Hamas attack on Israel with either no casualties or many casualties, after which justice and utility motivations for retribution were assessed. Study 2 (N=112, examined whether the link between death primes and support for an Israeli preemptive strike on Iran’s nuclear facilities is mediated by justice or cost-benefit utility considerations. Results of both studies revealed that primes of death increased justice-related motivations, and these motives, rather than utility motives, were associated with support for violence. Findings suggest that existential concerns often fuel violent intergroup conflict because they increase desire for retributive justice, rather than increase belief that violence is an effective strategy. These findings expand our knowledge on the motivations for intergroup violence, and shed experimental light on real-life eruptions of violent conflict indicating that when existential concerns are salient, as they often are during violent conflict, the decision to engage in violence often disregards the utility of violence, and leads to the preference for violent solutions to political problems – even when these solutions make little practical sense.

  15. Evaluation of Cost Models and Needs & Gaps Analysis

    DEFF Research Database (Denmark)

    Kejser, Ulla Bøgvad

    2014-01-01

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

  16. Concentrated photovoltaics system costs and learning curve analysis

    Science.gov (United States)

    Haysom, Joan E.; Jafarieh, Omid; Anis, Hanan; Hinzer, Karin

    2013-09-01

    An extensive set of costs in /W for the installed costs of CPV systems has been amassed from a range of public sources, including both individual company prices and market reports. Cost reductions over time are very evident, with current prices for 2012 in the range of 3.0 ± 0.7 /W and a predicted cost of 1.5 /W for 2020. Cost data is combined with deployment volumes in a learning curve analysis, providing a fitted learning rate of either 18.5% or 22.3% depending on the methodology. This learning rate is compared to that of PV modules and PV installed systems, and the influence of soft costs is discussed. Finally, if an annual growth rate of 39% is assumed for deployed volumes, then, using the learning rate of 20%, this would predict the achievement of a cost point of 1.5 /W by 2016.

  17. Incremental Cost-Effectiveness Analysis of Gestational Diabetes Mellitus Screening Strategies in Singapore.

    Science.gov (United States)

    Chen, Pin Yu; Finkelstein, Eric A; Ng, Mor Jack; Yap, Fabian; Yeo, George S H; Rajadurai, Victor Samuel; Chong, Yap Seng; Gluckman, Peter D; Saw, Seang Mei; Kwek, Kenneth Y C; Tan, Kok Hian

    2016-01-01

    The objective of this study was to conduct an incremental cost-effectiveness analysis from the payer's perspective in Singapore of 3 gestational diabetes mellitus screening strategies: universal, targeted, or no screening. A decision tree model assessed the primary outcome: incremental cost per quality-adjusted life year (QALY) gained. Probabilities, costs, and utilities were derived from the literature, the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study, and the KK Women's and Children's Hospital's database. Relative to targeted screening using risk factors, universal screening generates an incremental cost-effectiveness ratio (ICER) of $USD10,630/QALY gained. Sensitivity analyses show that disease prevalence rates and intervention effectiveness of glycemic management have the biggest impacts on the ICERs. Based on the model and best available data, universal screening is a cost-effective approach for reducing the complications of gestational diabetes mellitus in Singapore as compared with the targeted screening approach or no screening.

  18. Econometric estimation of investment utilization, adjustment costs, and technical efficiency in Danish pig farms using hyperbolic distance functions

    DEFF Research Database (Denmark)

    Henningsen, Arne; Fabricius, Ole; Olsen, Jakob Vesterlund

    2014-01-01

    and by reduced outputs, we estimate hyperbolic distance functions that account for reduced technical efficiency both in terms of increased inputs and reduced outputs. We estimate these hyperbolic distance functions as “efficiency effect frontiers” with the Translog functional form and a dynamic specification......Based on a theoretical microeconomic model, we econometrically estimate investment utilization, adjustment costs, and technical efficiency in Danish pig farms based on a large unbalanced panel dataset. As our theoretical model indicates that adjustment costs are caused both by increased inputs...

  19. Analysis on Resources Utilization of Thermal Power Industry

    Institute of Scientific and Technical Information of China (English)

    Mi Jianhua

    2005-01-01

    Based on the analysis and comparison of coal, oil and water consumptions in thermal power plants, thispaper introduces the present state of resources utilization in thermal power industry, and points out that the poten-tial of resources saving lies mainly in cutting down coal consumption and increasing the ratio of large-sized thermalunits. Measures and suggestions for upgrading resources utilization are put forward, such as to optimize coal-firedthermal power structure, develop cogeneration, clean coal combustion techniques and gas-steam combined cycletechniques. The existing thermal power plants shall execute technical retrofits and popularize water saving techniques.

  20. 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.

  1. Battery life-cycle cost analysis

    Energy Technology Data Exchange (ETDEWEB)

    Brown, D.R.; Humphreys, K.K.

    1988-07-01

    Life-cycle cost (LCC) estimates have been prepared for 17 combinations of battery or fuel-cell technologies and load-levelling, stand-alone power system, or electric vehicle applications. In addition, LCCs for gas-fired turbine, compressed-air energy storage, pumped hydro energy storage, and internal combustion engine technologies were estimated for comparative purposes. The objectives in preparing the estimates were to determine the relative economics among alternative battery systems and to compare battery systems economics with competing energy technologies.

  2. Development of hospital data warehouse for cost analysis of DPC based on medical costs.

    Science.gov (United States)

    Muranaga, F; Kumamoto, I; Uto, Y

    2007-01-01

    To develop a data warehouse system for cost analysis, based on the categories of the diagnosis procedure combination (DPC) system, in which medical costs were estimated by DPC category and factors influencing the balance between costs and fees. We developed a data warehouse system for cost analysis using data from the hospital central data warehouse system. The balance data of patients who were discharged from Kagoshima University Hospital from April 2003 to March 2005 were determined in terms of medical procedure, cost per day and patient admission in order to conduct a drill-down analysis. To evaluate this system, we analyzed cash flow by DPC category of patients who were categorized as having malignant tumors and whose DPC category was reevaluated in 2004. The percentages of medical expenses were highest in patients with acute leukemia, non-Hodgkin's lymphoma, and particularly in patients with malignant tumors of the liver and intrahepatic bile duct. Imaging tests degraded the percentages of medical expenses in Kagoshima University Hospital. These results suggested that cost analysis by patient is important for hospital administration in the inclusive evaluation system using a case-mix index such as DPC.

  3. Methodology for cost analysis of film-based and filmless portable chest systems

    Science.gov (United States)

    Melson, David L.; Gauvain, Karen M.; Beardslee, Brian M.; Kraitsik, Michael J.; Burton, Larry; Blaine, G. James; Brink, Gary S.

    1996-05-01

    Many studies analyzing the costs of film-based and filmless radiology have focused on multi- modality, hospital-wide solutions. Yet due to the enormous cost of converting an entire large radiology department or hospital to a filmless environment all at once, institutions often choose to eliminate film one area at a time. Narrowing the focus of cost-analysis may be useful in making such decisions. This presentation will outline a methodology for analyzing the cost per exam of film-based and filmless solutions for providing portable chest exams to Intensive Care Units (ICUs). The methodology, unlike most in the literature, is based on parallel data collection from existing filmless and film-based ICUs, and is currently being utilized at our institution. Direct costs, taken from the perspective of the hospital, for portable computed radiography chest exams in one filmless and two film-based ICUs are identified. The major cost components are labor, equipment, materials, and storage. Methods for gathering and analyzing each of the cost components are discussed, including FTE-based and time-based labor analysis, incorporation of equipment depreciation, lease, and maintenance costs, and estimation of materials costs. Extrapolation of data from three ICUs to model hypothetical, hospital-wide film-based and filmless ICU imaging systems is described. Performance of sensitivity analysis on the filmless model to assess the impact of anticipated reductions in specific labor, equipment, and archiving costs is detailed. A number of indirect costs, which are not explicitly included in the analysis, are identified and discussed.

  4. Evaluation of Cost Models and Needs & Gaps Analysis

    DEFF Research Database (Denmark)

    Kejser, Ulla Bøgvad

    2014-01-01

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

  5. Utilization of contribution margin in the costing system in production of components for wood working machines

    Directory of Open Access Journals (Sweden)

    Marek Potkány

    2009-06-01

    Full Text Available The aim of this paper is to propose optimization of costing method for planning a production-sales programme of the chosen engineering enterprise dealing with the production of components for wood working machines. This engineering company uses the calculation pattern methodology in the comprehensive cost accounting system. All costs components are absorbed by individual outputs in this cost calculation. The results of this calculation are not available for decision-making tasks. In order to solve the decision tasks relating to output assortment optimization, it is necessary to show separately variable costs influenced by changes in production volume and fixed costs not influenced by changes in production volume. For these reasons we propose a specific application of retrograde costing as a necessary condition for effective system of decision-making on the basis of contribution margin calculation. The contribution margin/standard hour is the criteria for the calculation in a critical place of production and this is very important information for developing an optimal production-sales programme.

  6. 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

  7. Cost analysis of periodontitis management in public sector specialist dental clinics.

    Science.gov (United States)

    Mohd-Dom, Tuti; Ayob, Rasidah; Mohd-Nur, Amrizal; Abdul-Manaf, Mohd R; Ishak, Noorlin; Abdul-Muttalib, Khairiyah; Aljunid, Syed M; Ahmad-Yaziz, Yuhaniz; Abdul-Aziz, Hanizah; Kasan, Noordin; Mohd-Asari, Ahmad S

    2014-05-20

    The objective of this paper is to quantify the cost of periodontitis management at public sector specialist periodontal clinic settings and analyse the distribution of cost components. Five specialist periodontal clinics in the Ministry of Health represented the public sector in providing clinical and cost data for this study. Newly-diagnosed periodontitis patients (N = 165) were recruited and followed up for one year of specialist periodontal care. Direct and indirect costs from the societal viewpoint were included in the cost analysis. They were measured in 2012 Ringgit Malaysia (MYR) and estimated from the societal perspective using activity-based and step-down costing methods, and substantiated by clinical pathways. Cost of dental equipment, consumables and labour (average treatment time) for each procedure was measured using activity-based costing method. Meanwhile, unit cost calculations for clinic administration, utilities and maintenance used step-down approach. Patient expenditures and absence from work were recorded via diary entries. The conversion from MYR to Euro was based on the 2012 rate (1€ = MYR4). A total of 2900 procedures were provided, with an average cost of MYR 2820 (€705) per patient for the study year, and MYR 376 (€94) per outpatient visit. Out of this, 90% was contributed by provider cost and 10% by patient cost; 94% for direct cost and 4% for lost productivity. Treatment of aggressive periodontitis was significantly higher than for chronic periodontitis (t-test, P = 0.003). Higher costs were expended as disease severity increased (ANOVA, P = 0.022) and for patients requiring surgeries (ANOVA, P economic burden of periodontitis management and performing economic evaluation of the specialist periodontal programme.

  8. Identifying airline cost economies: An econometric analysis of the factors affecting aircraft opeerating costs

    NARCIS (Netherlands)

    J. Zuidberg

    2014-01-01

    This paper provides the results of an econometric analysis of the influences of airline characteristics on the average operating costs per aircraft movement. The analysis combines a comprehensive selection of airline-output variables, airline-fleet variables, and airline-market variables. The result

  9. Identifying airline cost economies: An econometric analysis of the factors affecting aircraft opeerating costs

    NARCIS (Netherlands)

    Zuidberg, J.

    2014-01-01

    This paper provides the results of an econometric analysis of the influences of airline characteristics on the average operating costs per aircraft movement. The analysis combines a comprehensive selection of airline-output variables, airline-fleet variables, and airline-market variables. The

  10. Infrastructures and Life-Cycle Cost-Benefit Analysis

    DEFF Research Database (Denmark)

    Thoft-Christensen, Palle

    2012-01-01

    Design and maintenance of infrastructures using Life-Cycle Cost-Benefit analysis is discussed in this paper with special emphasis on users costs. This is for several infrastructures such as bridges, highways etc. of great importance. Repair or/and failure of infrastructures will usually result in...

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

    Science.gov (United States)

    Tunis, Sandra L

    2009-01-01

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

  12. Gestão de custos florestais: um estudo de caso utilizando o Activity-Based Costing Forest management costs: a case study utilizing Activity-Based Costing

    Directory of Open Access Journals (Sweden)

    Alcir Ribeiro Carneiro de Almeida

    1999-08-01

    Full Text Available No atual cenário de industrialização globalizada, tornou-se fundamental a eficácia no gerenciamento dos custos considerados inevitavelmente necessários. Programas convencionais de redução dos custos não consideram o grau de agregação de valor das atividades de rotina pela distorção dos sistemas contábeis atuais. No presente estudo, apresentam-se os principais motivos da falta de relevância das informações de custo, comenta-se sobre o problema da redução de desperdícios florestais e suas conseqüências. A partir de um estudo de caso em uma empresa do setor florestal, demonstra-se uma simulação do Activity Based Costing (ABC em uma determinada área da empresa, concluindo-se que a adoção de sistemas de custeio mais aprimorados, tal como o ABC, devem fazer parte de programas que busquem o aumento da competitividade do setor florestal.In the current view of globalized industrialization, it has become fundamental to manage essential costs effectively. Conventional programs for reducing costs, do no consider the value agregation grade of routine activities because of the distortion of current accounting systems. This study, presents the main reasons for the lack of relevance of the cost information, commenting on the problem of the reduction of forest waste and its consequences. Using a case study in a company from the forest sector, a simulation of Activity Based Costing (ABC is demonstrated in a determined area of the company it is concluded that the adoption of a more refined cost system, such as the ABC, should be included in programs, that seek to increase the competitiveness of the forest sector.

  13. Learning Together; part 2: training costs and health gain - a cost analysis.

    Science.gov (United States)

    Cullen, Katherine; Riches, Wendy; Macaulay, Chloe; Spicer, John

    2017-01-01

    Learning Together is a complex educational intervention aimed at improving health outcomes for children and young people. There is an additional cost as two doctors are seeing patients together for a longer appointment than a standard general practice (GP) appointment. Our approach combines the impact of the training clinics on activity in South London in 2014-15 with health gain, using NICE guidance and standards to allow comparison of training options. Activity data was collected from Training Practices hosting Learning Together. A computer based model was developed to analyse the costs of the Learning Together intervention compared to usual training in a partial economic evaluation. The results of the model were used to value the health gain required to make the intervention cost effective. Data were returned for 363 patients booked into 61 clinics across 16 Training Practices. Learning Together clinics resulted in an increase in costs of £37 per clinic. Threshold analysis illustrated one child with a common illness like constipation needs to be well for two weeks, in one Practice hosting four training clinics for the clinics to be considered cost effective. Learning Together is of minimal training cost. Our threshold analysis produced a rubric that can be used locally to test cost effectiveness at a Practice or Programme level.

  14. Utility-Borne Costs of Thermal Standards for the Mississippi and Missouri Rivers in the Map Geographical Area,

    Science.gov (United States)

    1979-09-01

    relatively low turbine back pressure, and the corresponding heat rejection rate is known for an existing open-cycle cooling system; 2. the existing...Capital and operating costs of once-through cooling systems are based on the assumption that the unit is operating at low turbine back pressures. 7. All...use once-through cooling. It is assumed that all power plants utilizing once-through cooling will operate at low turbine back pressures. The energy

  15. System Analysis on Absorption Chiller Utilizing Intermediate Wasted Heat

    Science.gov (United States)

    Yamada, Miki; Suzuki, Hiroshi; Usui, Hiromoto

    A system analysis has been performed for the multi-effect absorption chiller (MEAC) applied as a bottoming system of 30kW class hybrid system including micro gas turbine (MGT) and solid oxide fuel cell (SOFC) hybrid system. In this paper, an intermediate wasted heat utilization (IWHU) system is suggested for lifting up the energy efficiency of the whole system and coefficient of performance (COP) of MEAC. From the results, the suggested IWHU system was found to show the very high energy efficiency compared with a terminal wasted heat utilization (TWHU) system that uses only the heat exhausted from the terminal of MGT/SOFC system. When TWHU system is applied for MEAC, the utilized heat from the MGT/SOFC system is found to remain low because the temperature difference between the high temperature generator and the wasted heat becomes small. Then, the energy efficiency does not become high in spite of high COP of MEAC. On the other hand, the IWHU system could increase the utilized heat for MEAC as performs effectively. The exergy efficiency of IWHU system is also revealed to be higher than that of a direct gas burning system of MEAC, because the wasted heat is effectively utilized in the IWHU system.

  16. The utility of fractal analysis in clinical neuroscience.

    Science.gov (United States)

    John, Ann M; Elfanagely, Omar; Ayala, Carlos A; Cohen, Michael; Prestigiacomo, Charles J

    2015-01-01

    Physicians and scientists can use fractal analysis as a tool to objectively quantify complex patterns found in neuroscience and neurology. Fractal analysis has the potential to allow physicians to make predictions about clinical outcomes, categorize pathological states, and eventually generate diagnoses. In this review, we categorize and analyze the applications of fractal theory in neuroscience found in the literature. We discuss how fractals are applied and what evidence exists for fractal analysis in neurodegeneration, neoplasm, neurodevelopment, neurophysiology, epilepsy, neuropharmacology, and cell morphology. The goal of this review is to introduce the medical community to the utility of applying fractal theory in clinical neuroscience.

  17. 75 FR 37883 - Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities

    Science.gov (United States)

    2010-06-30

    ... planning processes provide an incumbent transmission owner with an unfair advantage over merchant and... provider with an undue advantage over a nonincumbent transmission developer. Neither incumbent nor... that provides an incumbent utility with an undue advantage over nonincumbent transmission project...

  18. The cost-utility of Viagra® in The Netherlands

    NARCIS (Netherlands)

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

    1999-01-01

    textabstractOBJECTIVE: Clinical trials suggest that sildenafil is an effective treatment for erectile dysfunction. Nevertheless, reimbursement is controversial: sildenafil is expected to be more effective than conservative therapy (papaverine/ phentolamine injections), but also more costly to societ

  19. Verify by Genability - Providing Solar Customers with Accurate Reports of Utility Bill Cost Savings

    Energy Technology Data Exchange (ETDEWEB)

    2015-12-01

    The National Renewable Energy Laboratory (NREL), partnering with Genability and supported by the U.S. Department of Energy's SunShot Incubator program, independently verified the accuracy of Genability's monthly cost savings.

  20. The sensitivity of wind technology utilization to cost and market parameters

    Energy Technology Data Exchange (ETDEWEB)

    Dodd, H.M. (Sandia National Labs., Albuquerque, NM (USA)); Hock, S.M.; Thresher, R.W. (Solar Energy Research Inst., Golden, CO (USA))

    1990-11-01

    This study explores the sensitivity of future wind energy market penetration to available wind resources, wind system costs, and competing energy system fuel costs for several possible energy market evolution scenarios. The methodology for the modeling is described in general terms. Cost curves for wind technology evolution are presented and used in conjunction with wind resource estimates and energy market projections to estimate wind penetration into the market. Results are presented that show the sensitivity of the growth of wind energy use to key cost parameters and to some of the underlying modeling assumptions. In interpreting the results, the authors place particular emphasis on the relative influence of the parameters studied. 4 refs., 8 figs., 1 tab.

  1. Cost-Effectiveness Analysis of Second-Line Chemotherapy Agents for Advanced Gastric Cancer.

    Science.gov (United States)

    Lam, Simon W; Wai, Maya; Lau, Jessica E; McNamara, Michael; Earl, Marc; Udeh, Belinda

    2017-01-01

    Gastric cancer is the fifth most common malignancy and second leading cause of cancer-related mortality. Chemotherapy options for patients who fail first-line treatment are limited. Thus the objective of this study was to assess the cost-effectiveness of second-line treatment options for patients with advanced or metastatic gastric cancer. Cost-effectiveness analysis using a Markov model to compare the cost-effectiveness of six possible second-line treatment options for patients with advanced gastric cancer who have failed previous chemotherapy: irinotecan, docetaxel, paclitaxel, ramucirumab, paclitaxel plus ramucirumab, and palliative care. The model was performed from a third-party payer's perspective to compare lifetime costs and health benefits associated with studied second-line therapies. Costs included only relevant direct medical costs. The model assumed chemotherapy cycle lengths of 30 days and a maximum number of 24 cycles. Systematic review of literature was performed to identify clinical data sources and utility and cost data. Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. The primary outcome measure for this analysis was the ICER between different therapies, where the incremental cost was divided by the number of QALYs saved. The ICER was compared with a willingness-to-pay (WTP) threshold that was set at $50,000/QALY gained, and an exploratory analysis using $160,000/QALY gained was also used. The model's robustness was tested by using 1-way sensitivity analyses and a 10,000 Monte Carlo simulation probabilistic sensitivity analysis (PSA). Irinotecan had the lowest lifetime cost and was associated with a QALY gain of 0.35 year. Docetaxel, ramucirumab alone, and palliative care were dominated strategies. Paclitaxel and the combination of paclitaxel plus ramucirumab led to higher QALYs gained, at an incremental cost of $86,815 and $1,056,125 per QALY gained, respectively. Based on our prespecified

  2. 中国不同抗-HAV流行区儿童接种甲型肝炎疫苗的成本效用分析%Cost-utility analysis on universal childhood hepatitis A vaccination in regions with different anti-HAV prevalence rates of China

    Institute of Scientific and Technical Information of China (English)

    潘新娟; 冯艳铭; 庄贵华

    2012-01-01

    Objective To explore the inputs and outputs of areas with different anti-HAY prevalence rates on universal childhood vaccination,and to provide a scientific basis for the formulation of the immunization strategy.Methods Since hepatitis A vaccination was scheduled at 12 and 18 months of age for all the healthy children,a single cohort including 1 000 000 individuals was formed in 2009,using the Chinese inactivated vaccine.Decision analysis was used to build Markov-decision tree model.The universal childhood hepatitis A vaccination was compared with nonvaccination group to evaluate the number of symptomatic infection,hospitalization,death,qualityadjusted life years (QALYs) lost,and the incremental cost-utility from the health system and the societal perspectives.Outcomes of the vaccination for the next 70 years were also predicted.The process of analysis was run separately in five regions defined by the anti-HAV prevalence rates (around 50%,50%-69%,70%-79%,80%-89% and >90% ).Sensitivity analysis was performed to test the stability or reliability of the results,and to identify sensitive variables.Results The study projected that,in the lowest,lower,and intermediate infection regions,the cost and output indicators of universal childhood hepatitis A vaccination were all lower than non-vaccinated group.Universal vaccination could gain QALYs and save both costs from the health systen or the society.In the regions with higher infection rate,the output indicators of universal childhood hepatitis A vaccination were lower than in those non-vaccinated groups,except for the number of death due to hepatitis A,which had a 20 cases of increase.The model also predicted that in the highest infected region,universal vaccination would increase 4 560 814 and 5 840 430 RMB Yuan in the total costs from both the health system and the societies,respectively,when compared to the non-vaccination groups.Universal vaccination would also decrease the numbers of symptomatic

  3. Environmental standards need cost/benefit analysis

    Energy Technology Data Exchange (ETDEWEB)

    Zeltman, E.W.

    1978-02-01

    To illustrate the basic advantages of employing cost/benefit analyses in the determination of emission limits for various sources of pollution, General Electric Co. discusses the activities of the US Environmental Protection Agency in the development of new source performance standards for combustion turbines. A review of specific decisions and their consequences regarding the emission of SO/sub 2/, CO, and NO/sub x/ from gas and oil turbines shows that to ensure good regulation, regulators must consider all sides of the issue; industry, in turn, must present its case in the most technically accurate manner possible to avoid the decrease in reliability, safety, and availability of equipment that can result from too restrictive emission limits.

  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. A MANAGERIAL AND COST ACCOUNTING APPROACH OF CUSTOMER PROFITABILITY ANALYSIS

    Directory of Open Access Journals (Sweden)

    CARDOS Ildiko Reka

    2010-07-01

    Full Text Available In the last years many organizations realized that market orientation is essential to their success. Satisfying the needs of customers, offering them products and services which meet their desires and demands, customer loyalty can increase profitability for long term. After analyzing the existing journal literature in this field we would like to emphasize that managerial accounting, cost calculation methods and techniques, the analysis of costs provides relevant information when analyzing the customer’s profitability. We pay special attention on cost systems. An activity based costing approach takes customer profitability to new levels of accuracy and usefulness, provides the basis for creating, communicating and delivering value to the customers.

  6. The Real Cost of "Cosmetic Tourism" Cost Analysis Study of "Cosmetic Tourism" Complications Presenting to a Public Hospital.

    Science.gov (United States)

    Livingston, Ryan; Berlund, Paul; Eccles-Smith, Jade; Sawhney, Raja

    2015-01-01

    "Cosmetic Tourism," the process of traveling overseas for cosmetic procedures, is an expanding global phenomenon. The model of care by which these services are delivered can limit perioperative assessment and postoperative follow-up. Our aim was to establish the number and type of complications being treated by a secondary referral hospital resulting from "cosmetic tourism" and the cost that has been incurred by the hospital in a 1-year period. Retrospective cost analysis and chart review of patients admitted to the hospital between the financial year of 2012 and 2013 were performed. Twelve "cosmetic tourism" patients presented to the hospital, requiring admission during the study period. Breast augmentation was the most common procedure and infected prosthesis was the most common complication (n = 4). Complications ranged from infection, pulmonary embolism to penile necrosis. The average cost of treating these patients was $AUD 12 597.71. The overall financial burden of the complication to the hospital was AUD$151 172.52. The "cosmetic tourism" model of care appears to be, in some cases, suboptimal for patients and their regional hospitals. In the cases presented in this study, it appears that care falls on the patient local hospital and home country to deal with the complications from their surgery abroad. This incurs a financial cost to that hospital in addition to redirecting medical resources that would otherwise be utilized for treating noncosmetic complications, without any remuneration to the local provider.

  7. Health services utilization, work absenteeism and costs of pandemic influenza A (H1N1 2009 in Spain: a multicenter-longitudinal study.

    Directory of Open Access Journals (Sweden)

    Mariana Galante

    Full Text Available BACKGROUND: The aim of this study was to estimate healthcare resource utilization, work absenteeism and cost per patient with pandemic influenza (H1N12009, from its beginning to March 2010, in Spain. We also estimated the economic impact on healthcare services. METHODS AND FINDINGS: Longitudinal, descriptive, multicenter study of in- and outpatients with confirmed diagnosis of influenza A (H1N1 in Spain. Temporal distribution of cases was comparable to that in Spain. Information of healthcare and social resources used from one week before admission (inpatient or index-medical visit (outpatient until recovery was gathered. Unit cost was imputed to utilization frequency for the monetary valuation of use. Mean cost per patient was calculated. A sensitivity analysis was conducted, and variables correlated with cost per patient were identified. Economic impact on the healthcare system was estimated using healthcare costs per patient and both, the reported number of confirmed and clinical cases in Spain. 172 inpatients and 224 outpatients were included. Less than 10% were over 65 years old and more than 50% had previous comorbidities. 12.8% of inpatients were admitted to the Intensive Care Unit. Mean length of hospital stay of patients not requiring critical care was 5 days (SD = 4.4. All working-inpatients and 91.7% working-outpatients went on sick leave. On average, work absenteeism was 30.5 days (SD = 20.7 for the first ones and 9 days (SD = 6.3 for the latest. Caregivers of 21.7% of inpatients and 8.5% of outpatients also had work absenteeism during 10.7 and 4.1 days on average respectively. Mean cost was €6,236/inpatient (CI95% = 1,384-14,623 and €940/outpatient (CI95% = 66-3,064. The healthcare economic burden of patients with confirmed influenza was €144,773,577 (IC95% 13,753,043-383,467,535. More than 86% of expenditures were a result of outpatients' utilization. CONCLUSION: Cost per H1N1-patient did not defer much from seasonal

  8. U.S. Photovoltaic Prices and Cost Breakdowns. Q1 2015 Benchmarks for Residential, Commercial, and Utility-Scale Systems

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Donald [National Renewable Energy Lab. (NREL), Golden, CO (United States); Davidson, Carolyn [National Renewable Energy Lab. (NREL), Golden, CO (United States); Fu, Ran [National Renewable Energy Lab. (NREL), Golden, CO (United States); Ardani, Kristen [National Renewable Energy Lab. (NREL), Golden, CO (United States); Margolis, Robert [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2015-09-01

    The price of photovoltaic (PV) systems in the United States (i.e., the cost to the system owner) has continued to decline across all major market sectors. This report provides a Q1 2015 update regarding the prices of residential, commercial, and utility scale PV systems, based on an objective methodology that closely approximates the book value of a PV system. Several cases are benchmarked to represent common variations in business models, labor rates, and system architecture choice. We estimate a weighted-average cash purchase price of $3.09/W for residential scale rooftop systems, $2.15/W for commercial scale rooftop systems, $1.77/W for utility scale systems with fixed mounting structures, and $1.91/W for utility scale systems using single-axis trackers. All systems are modeled assuming standard-efficiency, polycrystalline-silicon PV mo