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Sample records for cost-effective adverse-weather precision

  1. A cost-effective adverse-weather precision guidance system

    Energy Technology Data Exchange (ETDEWEB)

    Fellerhoff, R.; Burgett, S.

    1995-08-01

    This SAND report documents the results of an LDRD project undertaken to study the accuracy of terrain-aided navigation coupled with highly accurate topographic maps. A revolutionary new mapping technology, interferometric synthetic aperture radar (IFSAR), has the ability to make terrain maps of extremely high accuracy and spatial resolution, more than an order of magnitude better than currently available DMA map products. Using a laser altimeter and the Sandia Labs Twin Otter Radar Testbed, fix accuracies of less than 3 meters CEP were obtained over urban and natural terrain regions.

  2. A cost-effective adverse-weather precision guidance system

    Energy Technology Data Exchange (ETDEWEB)

    Fellerhoff, R.; Burgett, S.

    1995-08-01

    This SAND report documents the results of an LDRD project undertaken to study the accuracy of terrain-aided navigation coupled with highly accurate topographic maps. A revolutionary new mapping technology, interferometric synthetic aperture radar (IFSAR), has the ability to make terrain maps of extremely high accuracy and spatial resolution, more than an order of magnitude better than currently available DMA map products. Using a laser altimeter and the Sandia Labs Twin Otter Radar Testbed, fix accuracies of less than 3 meters CEP were obtained over urban and natural terrain regions.

  3. MEASURING SYSTEM OF ADVERSE WEATHER PHENOMENA

    Directory of Open Access Journals (Sweden)

    M. Ćurić

    2012-03-01

    Full Text Available Measuring system of adverse weather phenomena. The adverse weather phenomena in nowadays are becoming an extraordinary problem in human life and human activity. Therefore, it seems very important to know the thresholds of adverse weather phenomena. These thresholds can be calculated in different ways, but some experience has shown that for weather elements which departures from normal follow the normal distribution suits to use the Gaussian curve of frequency distribution (temperature and pressure. For such weather elements the normal curve of frequency distribution may be used for classification of thresholds. For weather elements which departures do not depend on such a frequency distribution configuration (precipitation amounts may be used a decile method. For wind speed thresholds, the Beaufort scale units can be used for calculation. In this paper the threshold scales for four basic weather elemnts are presented. All these scales contain four steps each. They are defined: normal, above normal, much above normal and extraordinary above normal or normal, below normal, much below normal and extraordinary below normal. The examples by observations of Meteorological Observatory in Belgrade are presented.

  4. Aircraft Path Planning under Adverse Weather Conditions

    Directory of Open Access Journals (Sweden)

    Xie Z.

    2016-01-01

    Full Text Available In recent years, flight safety is still one of the main issues for all airlines. En route civil airplanes may encounter adverse weather conditions. Some fatal airplane accidents happened because of the weather disturbance. Moreover, we should also design path to avoid the prohibited area. Therefore a good path planning algorithm plays an increasingly important role in air traffic management. An efficient path planning algorithm can help the plane to avoid severe weather conditions, restricted areas and moving obstacles to ensure the safety of the cabin crews and passengers. Here, we build our algorithm based on the A* search algorithm. Moreover, our algorithm can also find the path with least energy costs. As a result, our algorithm can improve the safety operation of the airplanes and reduce the workload of pilots and air traffic controllers.

  5. Uncertainty Comparison of Visual Sensing in Adverse Weather Conditions

    Directory of Open Access Journals (Sweden)

    Shi-Wei Lo

    2016-07-01

    Full Text Available This paper focuses on flood-region detection using monitoring images. However, adverse weather affects the outcome of image segmentation methods. In this paper, we present an experimental comparison of an outdoor visual sensing system using region-growing methods with two different growing rules—namely, GrowCut and RegGro. For each growing rule, several tests on adverse weather and lens-stained scenes were performed, taking into account and analyzing different weather conditions with the outdoor visual sensing system. The influence of several weather conditions was analyzed, highlighting their effect on the outdoor visual sensing system with different growing rules. Furthermore, experimental errors and uncertainties obtained with the growing rules were compared. The segmentation accuracy of flood regions yielded by the GrowCut, RegGro, and hybrid methods was 75%, 85%, and 87.7%, respectively.

  6. Quantifying the impact of adverse weather conditions on road network performance

    NARCIS (Netherlands)

    Snelder, M.; Calvert, S.C.

    2016-01-01

    Adverse weather conditions regularly lead to severe congestion and large travel time delays on road networks all over the world. Different climate scenarios indicate that in the future adverse weather conditions are likely to become more frequent, last longer and will be more extreme. Although

  7. Quantifying the impact of adverse weather conditions on road network performance

    NARCIS (Netherlands)

    Snelder, M.; Calvert, S.C.

    2016-01-01

    Adverse weather conditions regularly lead to severe congestion and large travel time delays on road networks all over the world. Different climate scenarios indicate that in the future adverse weather conditions are likely to become more frequent, last longer and will be more extreme. Although clima

  8. Quantifying the impact of adverse weather conditions on road network performance

    NARCIS (Netherlands)

    Snelder, M.; Calvert, S.

    2016-01-01

    Adverse weather conditions regularly lead to severe congestion and large travel time delays on road networks all over the world. Different climate scenarios indicate that in the future adverse weather conditions are likely to become more frequent, last longer and will be more extreme. Although clima

  9. COST EFFECTIVE PRE-FABRICATED SEMI-PRECISION ATTACH ED OVERDENTURE - A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Dole

    2012-12-01

    Full Text Available ABSTRACT: Considering the newer advances in the field of pros thodontics the use of implant has become popular. However not every patient can go for such procedures considering the economic norms and lack of awareness as well. A con ventional concept of preventive prosthodontics has been emphasizing on the importance of any procedures that can delay or eliminate future prosthodontic problems. In a recent study, post insertion of denture, most patients with removable partial or complete dentures w ere dissatisfied with their retention and stability. Considering this overall scenario when a patient with completely edentulous maxillary arch and partially edentulous mandibular arch report ed to the mentioned institution, a semi- precision attached overdenture were thought of, whic h in turn could show considerable advantages like increased retention, proprioception, a nd masticatory efficacy. A Prosthodontist who is well acquainted with semi-precision attachmen t will be in position to suggest a better treatment options in retaining teeth which might oth erwise be considered for extraction or immediate implant placement.

  10. Fluorescence parameters of leaves of trees and shrubs during period of adverse weather conditions in Krasnoyarsk

    Science.gov (United States)

    Zavorueva, E. N.; Zavoruev, V. V.

    2015-11-01

    The effect of adverse weather conditions (AWC) on the fluorescence parameters of leaves Prinsepia sinensis, Amelanchier florida, Crataegus chlorocarca is obtained. However, significant changes in the fluorescence of the leaves of Acer negundo, Betula pendula under AWC were not observed.

  11. Effect of adverse weather on neonatal caribou survival — a review

    Directory of Open Access Journals (Sweden)

    Frank L. Miller

    1986-06-01

    Full Text Available This paper reviews the relationship between adverse weather and neonatal caribou (Rangifer tarandus spp. survival in North America by examining the available literature and our own findings. The viewpoint that adverse weather on the calving ground can result in major losses of newborn barren-ground caribou (R. t. groenlandicus calves is largely unsupported. Published reports of calf mortality caused by adverse weather are questionable because causes of death were rarely determined by postmortem examinations. Circumstantial evidence associated with the small samples of dead calves does not support published assumptions that the mortality was weather related, or that high losses due to adverse weather are common events. The applicability of results from physiological testing are questionable, because the calves were restrained and the behaviour of unrestrained animals was ignored in the conclusions drawn from the tests. The relationship between adverse weather and calf mortality is more speculation than documentation yet often has been uncritically cited. In our view, healthy newborn barren-ground caribou are well adapted physiologically and behaviourally to cope with all but the most severe adverse weather.

  12. 7 CFR 760.203 - Eligible losses, adverse weather, and other loss conditions.

    Science.gov (United States)

    2010-01-01

    ... to, flood, freeze, hurricane, hail, tidal surge, volcanic eruption, and wildfire on non-Federal land... 7 Agriculture 7 2010-01-01 2010-01-01 false Eligible losses, adverse weather, and other loss conditions. 760.203 Section 760.203 Agriculture Regulations of the Department of Agriculture (Continued)...

  13. Adverse weather conditions for European wheat production will become more frequent with climate change

    DEFF Research Database (Denmark)

    Trnka, Miroslav; Rötter, Reimund P.; Ruiz-Ramos, Margarita

    2014-01-01

    Europe is the largest producer of wheat, the second most widely grown cereal crop after rice. The increased occurrence and magnitude of adverse and extreme agroclimatic events are considered a major threat for wheat production. We present an analysis that accounts for a range of adverse weather...... the probability of single and multiple adverse events occurring within one season. We showed that the occurrence of adverse conditions for 14 sites representing the main European wheat-growing areas might substantially increase by 2060 compared to the present (1981–2010). This is likely to result in more frequent...... crop failure across Europe. This study provides essential information for developing adaptation strategies....

  14. Building, testing and validating a set of home-made von Frey filaments: a precise, accurate and cost effective alternative for nociception assessment.

    Science.gov (United States)

    de Sousa, Marcelo Victor Pires; Ferraresi, Cleber; de Magalhães, Ana Carolina; Yoshimura, Elisabeth Mateus; Hamblin, Michael R

    2014-07-30

    A von Frey filament (vFF) is a type of aesthesiometer usually made of nylon perpendicularly held in a base. It can be used in paw withdrawal pain threshold assessment, one of the most popular tests for pain evaluation using animal models. For this test, a set of filaments, each able to exert a different force, is applied to the animal paw, from the weakest to the strongest, until the paw is withdrawn. We made 20 low cost vFF using nylon filaments of different lengths and constant diameter glued perpendicularly to the ends of popsicle sticks. They were calibrated using a laboratory balance scale. Building and calibrating took around 4h and confirmed the theoretical prediction that the force exerted is inversely proportional to the length and directly proportional to the width of the filament. The calibration showed that they were precise and accurate. We analyzed the paw withdrawal threshold assessed with the set of home-made vFF and with a high quality commercial set of 5 monofilaments vFF (Stoelting, Wood Dale, USA) in two groups (n=5) of healthy mice. The home-made vFF precisely and accurately measured the hind paw withdrawal threshold (20.3±0.9 g). The commercial vFF have different diameters while our set has the same diameter avoiding the problem of lower sensitivity to larger diameter filaments. Building a set of vFF is easy, cost effective, and depending on the kind of tests, can increase precision and accuracy of animal nociception evaluation. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. THE APPLICABILITY OF EXISTING COMPUTER TECHNOLOGY TO AUTOMATE FUZZY SYNTHESIS OF TRAFFIC LIGHT UAV IN ADVERSE WEATHER CONDITIONS

    Directory of Open Access Journals (Sweden)

    L. N. Lysenko

    2014-01-01

    Full Text Available The results of the analysis of the applicability of known application software systems for automated synthesis of fuzzy control traffic light UAV during its flight in adverse weather conditions. The solution is based on a previously formulated and put into consideration the principle of permissible limited a priori estimation of the uncertainty of aerodynamic characteristics of UAVs.

  16. Can Agrometeorological Indices of Adverse Weather Conditions Help to Improve Yield Prediction by Crop Models?

    Directory of Open Access Journals (Sweden)

    Branislava Lalić

    2014-12-01

    Full Text Available The impact of adverse weather conditions (AWCs on crop production is random in both time and space and depends on factors such as severity, previous agrometeorological conditions, and plant vulnerability at a specific crop development stage. Any exclusion or improper treatment of any of these factors can cause crop models to produce significant under- or overestimates of yield. The analysis presented in this paper focuses on a range of agrometeorological indices (AMI related to AWCs that might affect real yield as well as simulated yield. For this purpose, the analysis addressed four indicators of extreme temperatures and three indicators of dry conditions during the growth period of maize and winter wheat in Austria, Croatia, Serbia, Slovakia, and Sweden. It is shown that increases in the number and intensity of AWCs cannot be unambiguously associated with increased deviations in simulated yields. The identified correlations indicate an increase in modeling uncertainty. This finding represents important information for the crop modeling community. Additionally, it opens a window of opportunity for a statistical (“event scenario” approach based on correlations between agrometeorological indices of AWCs and crop yield data series. This approach can provide scenarios for certain locations, crop types, and AWC patterns and, therefore, improve yield forecasting in the presence of AWCs.

  17. Chosen risk level during car-following in adverse weather conditions.

    Science.gov (United States)

    Hjelkrem, Odd André; Ryeng, Eirin Olaussen

    2016-10-01

    This study examines how precipitation, light conditions and surface conditions affect the drivers' risk perception. An indicator CRI (Chosen Risk Index) is defined, which describes the chosen risk level for drivers in a car-following situation. The dataset contains about 70 000 observations of driver behaviour and weather status on a rural road. Based on the theory of risk homeostasis and an assumption that driving behaviour in situations with daylight, dry road and no precipitation reflects drivers' target level of risk, generalised linear models (GLM) were estimated for cars and trucks separately to reveal the effect of adverse weather conditions on risk perception. The analyses show that both car and truck drivers perceive the highest risk when driving on snow covered roads. For car drivers, a snow covered road in combination with moderate rain or light snow are the factors which lowers the CRI the most. For trucks, snow cover and partially covered roads significantly lowers the CRI, while precipitation did not seem to impose any higher risk. Interaction effects were found for car drivers only.

  18. Adaptation options for wheat in Europe will be limited by increased adverse weather events under climate change.

    Science.gov (United States)

    Trnka, Miroslav; Hlavinka, Petr; Semenov, Mikhail A

    2015-11-06

    Ways of increasing the production of wheat, the most widely grown cereal crop, will need to be found to meet the increasing demand caused by human population growth in the coming decades. This increase must occur despite the decrease in yield gains now being reported in some regions, increased price volatility and the expected increase in the frequency of adverse weather events that can reduce yields. However, if and how the frequency of adverse weather events will change over Europe, the most important wheat-growing area, has not yet been analysed. Here, we show that the accumulated probability of 11 adverse weather events with the potential to significantly reduce yield will increase markedly across all of Europe. We found that by the end of the century, the exposure of the key European wheat-growing areas, where most wheat production is currently concentrated, may increase more than twofold. However, if we consider the entire arable land area of Europe, a greater than threefold increase in risk was predicted. Therefore, shifting wheat production to new producing regions to reduce the risk might not be possible as the risk of adverse events beyond the key wheat-growing areas increases even more. Furthermore, we found a marked increase in wheat exposure to high temperatures, severe droughts and field inaccessibility compared with other types of adverse events. Our results also showed the limitations of some of the presently debated adaptation options and demonstrated the need for development of region-specific strategies. Other regions of the world could be affected by adverse weather events in the future in a way different from that considered here for Europe. This observation emphasizes the importance of conducting similar analyses for other major wheat regions.

  19. The role of situation assessment and flight experience in pilots' decisions to continue visual flight rules flight into adverse weather.

    Science.gov (United States)

    Wiegmann, Douglas A; Goh, Juliana; O'Hare, David

    2002-01-01

    Visual flight rules (VFR) flight into instrument meteorological conditions (IMC) is a major safety hazard in general aviation. In this study we examined pilots' decisions to continue or divert from a VFR flight into IMC during a dynamic simulation of a cross-country flight. Pilots encountered IMC either early or later into the flight, and the amount of time and distance pilots flew into the adverse weather prior to diverting was recorded. Results revealed that pilots who encountered the deteriorating weather earlier in the flight flew longer into the weather prior to diverting and had more optimistic estimates of weather conditions than did pilots who encountered the deteriorating weather later in the flight. Both the time and distance traveled into the weather prior to diverting were negatively correlated with pilots' previous flight experience. These findings suggest that VFR flight into IMC may be attributable, at least in part, to poor situation assessment and experience rather than to motivational judgment that induces risk-taking behavior as more time and effort are invested in a flight. Actual or potential applications of this research include the design of interventions that focus on improving weather evaluation skills in addition to addressing risk-taking attitudes.

  20. Developing a Traffic Management Framework for Coastal Expressway Bridges under Adverse Weather Conditions: Case Study of Rain Day in Shenzhen, China

    Directory of Open Access Journals (Sweden)

    Chenming Jiang

    2015-01-01

    Full Text Available Adverse weather can reduce visibility and road surface friction, lower vehicle maneuverability, and increase crash frequency and injury severity. The impacts of adverse weather and its interactions with drivers and roadway on the operation and management of expressway or expressway bridges have drawn the researchers’ and managers’ attention to develop traffic management frameworks to mitigate the negative influence. Considering the peculiar geographical location and meteorological conditions, the Guangshen Coast Expressway-Shenzhen Segment (GSCE-SS was selected as a case in this study to illustrate the proposed traffic management framework on rain days. Conditions categorized by rainfall intensity and traffic flow were the main precondition to make the management decisions. CORSIM simulator was used to develop the alternate routes choice schemes, providing reference for other systems in the proposed traffic management framework. Maps of (a entrance ramp control (ERC strategies; (b mainline control strategies; (c alternate routes choice; (d information release schemes, under scenarios of different volume and rainstorm warning grades (BLUE to RED, were drawn to present a reference or demonstration for managers of long-span expressway bridges not only in China, but even in the world.

  1. Cost effective solar Inverter

    Directory of Open Access Journals (Sweden)

    Nagarathna M

    2015-06-01

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

  2. Cost-effectiveness thresholds: pros and cons.

    Science.gov (United States)

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

    2016-12-01

    Cost-effectiveness analysis is used to compare the costs and outcomes of alternative policy options. Each resulting cost-effectiveness ratio represents the magnitude of additional health gained per additional unit of resources spent. Cost-effectiveness thresholds allow cost-effectiveness ratios that represent good or very good value for money to be identified. In 2001, the World Health Organization's Commission on Macroeconomics in Health suggested cost-effectiveness thresholds based on multiples of a country's per-capita gross domestic product (GDP). In some contexts, in choosing which health interventions to fund and which not to fund, these thresholds have been used as decision rules. However, experience with the use of such GDP-based thresholds in decision-making processes at country level shows them to lack country specificity and this - in addition to uncertainty in the modelled cost-effectiveness ratios - can lead to the wrong decision on how to spend health-care resources. Cost-effectiveness information should be used alongside other considerations - e.g. budget impact and feasibility considerations - in a transparent decision-making process, rather than in isolation based on a single threshold value. Although cost-effectiveness ratios are undoubtedly informative in assessing value for money, countries should be encouraged to develop a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in, for example the involvement of civil society organizations and patient groups, and is transparent, consistent and fair.

  3. A Departmental Cost-Effectiveness Model.

    Science.gov (United States)

    Holleman, Thomas, Jr.

    In establishing a departmental cost-effectiveness model, the traditional cost-effectiveness model was discussed and equipped with a distant and deflation equation for both benefits and costs. Next, the economics of costing was examined and program costing procedures developed. Then, the model construct was described as it was structured around the…

  4. Complex Grid Failure Propagating Chain Model in Consideration of Adverse Weather%计及恶劣天气因素的复杂电网连锁故障事故链模型

    Institute of Scientific and Technical Information of China (English)

    刘文颖; 杨楠; 张建立; 孙建华; 姚峰; 王佳明

    2012-01-01

    In condition of adverse weather, the probability of components failure in the power grid was increasing significantly and amplifying the probability of serious grid accidents. In comparison with the evolution of grid self-organized criticality and the section development of failure propagation chain, this paper first proposed that the failure propagation chain could be characterized as an effective tool for expressing the grid self-organized status. Then, after the analysis of traditional cascading failure chain, the complex grid failure propagating chain model, using grid self-organized criticality, in consideration of adverse weather, was established, simulating the potential cascading failure trail during the process of evolution of grid self-organized status in form of failure propagating chain. The introduction of this model can provide a key reference for grid operator in screening the weakness of power grid. The simulation of Henan power grid proves the availability and feasibility of the model.%恶劣天气条件下电网各元件发生故障的机率明显增加,加大了电网恶性事故发生的概率。通过电网自组织临界态的演化与事故链各环节发展的对比,指出事故链可以作为表征电网自组织临界态进程的有效工具。在传统电网事故链模型基础之上,基于白组织临界理论,建立计及恶劣天气因素的复杂电网连锁故障事故链模型及其仿真算法,以事故链的形式仿真电网自临界状态演化进程中潜在的连锁故障传播途径,为运行方式制订人员甄别恶劣天气下电网危险环节提供重要依据。对河南电网的实例分析,证明了所提出模型的有效性和可行性。

  5. CT colonography and cost-effectiveness

    Energy Technology Data Exchange (ETDEWEB)

    Mavranezouli, Ifigeneia [University College London, National Collaborating Centre for Mental Health, Centre for Outcomes Research and Effectiveness, Sub-department of Clinical Health Psychology, London (United Kingdom); East, James E. [St Marks Hospital, Imperial College London, Wolfson Unit for Endoscopy, London (United Kingdom); Taylor, Stuart A. [University College Hospital, Specialist X-Ray, London (United Kingdom); University College Hospital, Department of Imaging, London (United Kingdom)

    2008-11-15

    CT colonography (CTC) is increasingly advocated as an effective initial screening tool for colorectal cancer. Nowadays, policy-makers are increasingly interested in cost-effectiveness issues. A number of studies assessing the cost-effectiveness of CTC have been published to date. The majority of findings indicate that CTC is probably not cost-effective when colonoscopy is available, but this conclusion is sensitive to a number of key parameters. This review discusses the findings of these studies, and considers those factors which most influence final conclusions, notably intervention costs, compliance rates, effectiveness of colonoscopy, and the assumed prevalence and natural history of diminutive advanced polyps. (orig.)

  6. 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.

  7. Cost-Effective Stress Management Training.

    Science.gov (United States)

    Shea, Gordon F.

    1980-01-01

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

  8. Biosimilar medicines and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Steven Simoens

    2011-02-01

    Full Text Available Steven SimoensResearch Centre for Pharmaceutical Care and Pharmaco-economics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, Leuven, BelgiumAbstract: Given that biosimilars are agents that are similar but not identical to the reference biopharmaceutical, this study aims to introduce and describe specific issues related to the economic evaluation of biosimilars by focusing on the relative costs, relative effectiveness, and cost-effectiveness of biosimilars. Economic evaluation assesses the cost-effectiveness of a medicine by comparing the costs and outcomes of a medicine with those of a relevant comparator. The assessment of cost-effectiveness of a biosimilar is complicated by the fact that evidence needed to obtain marketing authorization from a registration authority does not always correspond to the data requirements of a reimbursement authority. In particular, this relates to the availability of adequately powered equivalence or noninferiority studies, the need for comparative data about the effectiveness in a real-world setting rather than the efficacy in a structured setting, and the use of health outcome measures instead of surrogate endpoints. As a biosimilar is likely to be less expensive than the comparator (eg, the reference biopharmaceutical, the assessment of the cost-effectiveness of a biosimilar depends on the relative effectiveness. If appropriately designed and powered clinical studies demonstrate equivalent effectiveness between a biosimilar and the comparator, then a cost-minimization analysis identifies the least expensive medicine. If there are differences in the effectiveness of a biosimilar and the comparator, other techniques of economic evaluation need to be employed, such as cost-effectiveness analysis or cost-utility analysis. Given that there may be uncertainty surrounding the long-term safety (ie, risk of immunogenicity and rare adverse events and effectiveness of a biosimilar, the cost-effectiveness

  9. 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...

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

    OpenAIRE

    Roth, Dana L

    2004-01-01

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

  11. Cost-effectiveness in reproductive medicine

    NARCIS (Netherlands)

    L.M. Moolenaar

    2013-01-01

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

  12. 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.

  13. Cost effectiveness of a medical digital library.

    Science.gov (United States)

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

    2001-01-01

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

  14. Sampling: Making Electronic Discovery More Cost Effective

    Directory of Open Access Journals (Sweden)

    Milton Luoma

    2011-06-01

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

  15. Hip Fracture Prevention: Cost-Effective Strategies

    OpenAIRE

    Peter Vestergaard; Lars Rejnmark; Leif Mosekilde

    2001-01-01

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

  16. Cost effectiveness of surveillance for GI cancers.

    Science.gov (United States)

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

    2016-12-01

    Gastrointestinal (GI) diseases are among the leading causes of death in the world. To reduce the burden of GI diseases, surveillance is recommended for some diseases, including for patients with inflammatory bowel diseases, Barrett's oesophagus, precancerous gastric lesions, colorectal adenoma, and pancreatic neoplasms. This review aims to provide an overview of the evidence on cost-effectiveness of surveillance of individuals with GI conditions predisposing them to cancer, specifically focussing on the aforementioned conditions. We searched the literature and reviewed 21 studies. Despite heterogeneity of studies in terms of settings, study populations, surveillance strategies and outcomes, most reviewed studies suggested at least some surveillance of patients with these GI conditions to be cost-effective. For some high-risk conditions frequent surveillance with 3-month intervals was warranted, while for other conditions, surveillance may only be cost-effective every 10 years. Further studies based on more robust effectiveness evidence are needed to inform and optimise surveillance programmes for GI cancers. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. [Cost effectiveness and health sector reform].

    Science.gov (United States)

    Musgrove, P

    1995-01-01

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

  18. Cost effectiveness of new roadway lighting systems

    Directory of Open Access Journals (Sweden)

    Yi Jiang

    2015-06-01

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

  19. Cost-effectiveness assessment in outpatient sinonasal surgery.

    Science.gov (United States)

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

    2017-09-15

    To assess the cost-effectiveness of outpatient sinonasal surgery in terms of clinical efficacy and control of expenses. A retrospective study was conducted from January 2014 to January 2016. Patients scheduled for outpatient sinonasal surgery were systematically included. Clinical data were extracted from surgical and anesthesiology computer files. The cost accounting methods applied in our institution were used to evaluate logistic and technical costs. The standardized hospital fees rating system based on hospital stay and severity in diagnosis-related groups (Groupes homogènes de séjours: GHS) was used to estimate institutional revenue. Over 2years, 927 outpatient surgical procedures were performed. The crossover rate to conventional hospital admission was 2.9%. In a day-1 telephone interview, 85% of patients were very satisfied with the procedure. All outpatient cases showed significantly lower costs than estimated for conventional management with overnight admission, while hospital revenue did not differ between the two. This study confirmed the efficacy of outpatient surgery in this indication. Lower costs could allow savings for the health system by readjusting the rating for the procedure. More precise assessment of cost-effectiveness will require more fine-grained studies based on micro costing at hospital level and assessment of impact on conventional surgical activity and post-discharge community care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  20. A cost effective CO2 strategy

    DEFF Research Database (Denmark)

    by the Ministry of Transport, with the Technical University of Denmark as one of the main contributors. The CO2-strategy was to be based on the principle of cost-effectiveness. A model was set up to assist in the assessment. The model consists of a projection of CO2-emissions from road and rail modes from 2020...... are evaluated according to CO2 reduction potential and according to the ‘shadow price’ on a reduction of one ton CO2. The shadow price reflects the costs (and benefits) of the different measures. Comparing the measures it is possible to identify cost effective measures, but these measures are not necessarily......, a scenario-part and a cost-benefit part. Air and sea modes are not analyzed. The model adopts a bottom-up approach to allow a detailed assessment of transport policy measures. Four generic areas of intervention were identified and the likely effect on CO2 emissions, socioeconomic efficiency and other...

  1. OPCAB Surgery is cost-effective for elderly patients

    DEFF Research Database (Denmark)

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

    2013-01-01

    To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years.......To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years....

  2. Cost-Effective Fuel Treatment Planning

    Science.gov (United States)

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

    2014-12-01

    The cost of fighting large wildland fires in the western United States has grown dramatically over the past decade. This trend will likely continue with growth of the WUI into fire prone ecosystems, dangerous fuel conditions from decades of fire suppression, and a potentially increasing effect from prolonged drought and climate change. Fuel treatments are often considered the primary pre-fire mechanism to reduce the exposure of values at risk to wildland fire, and a growing suite of fire models and tools are employed to prioritize where treatments could mitigate wildland fire damages. Assessments using the likelihood and consequence of fire are critical because funds are insufficient to reduce risk on all lands needing treatment, therefore prioritization is required to maximize the effectiveness of fuel treatment budgets. Cost-effectiveness, doing the most good per dollar, would seem to be an important fuel treatment metric, yet studies or plans that prioritize fuel treatments using costs or cost-effectiveness measures are absent from the literature. Therefore, to explore the effect of using costs in fuel treatment planning we test four prioritization algorithms designed to reduce risk in a case study examining fuel treatments on the Sisters Ranger District of central Oregon. For benefits we model sediment retention and standing biomass, and measure the effectiveness of each algorithm by comparing the differences among treatment and no treat alternative scenarios. Our objective is to maximize the averted loss of net benefits subject to a representative fuel treatment budget. We model costs across the study landscape using the My Fuel Treatment Planner software, tree list data, local mill prices, and GIS-measured site characteristics. We use fire simulations to generate burn probabilities, and estimate fire intensity as conditional flame length at each pixel. Two prioritization algorithms target treatments based on cost-effectiveness and show improvements over those

  3. Precision manufacturing

    CERN Document Server

    Dornfeld, David

    2008-01-01

    Today there is a high demand for high-precision products. The manufacturing processes are now highly sophisticated and derive from a specialized genre called precision engineering. Precision Manufacturing provides an introduction to precision engineering and manufacturing with an emphasis on the design and performance of precision machines and machine tools, metrology, tooling elements, machine structures, sources of error, precision machining processes and precision process planning. As well as discussing the critical role precision machine design for manufacturing has had in technological developments over the last few hundred years. In addition, the influence of sustainable manufacturing requirements in precision processes is introduced. Drawing upon years of practical experience and using numerous examples and illustrative applications, David Dornfeld and Dae-Eun Lee cover precision manufacturing as it applies to: The importance of measurement and metrology in the context of Precision Manufacturing. Th...

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

    Science.gov (United States)

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

    1999-01-20

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

  5. Custom LSI plus hybrid equals cost effectiveness

    Science.gov (United States)

    Friedman, S. N.

    The possibility to combine various technologies, such as Bi-Polar linear and CMOS/Digital makes it feasible to create systems with a tailored performance not available on a single monolithic circuit. The custom LSI 'BLOCK', especially if it is universal in nature, is proving to be a cost effective way for the developer to improve his product. The custom LSI represents a low price part in contrast to the discrete components it will replace. In addition, the hybrid assembly can realize a savings in labor as a result of the reduced parts handling and associated wire bonds. The possibility of the use of automated system manufacturing techniques leads to greater reliability as the human factor is partly eliminated. Attention is given to reliability predictions, cost considerations, and a product comparison study.

  6. Cost-effective ultrasound PACS solution

    Science.gov (United States)

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

    1995-05-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-11-01

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

  8. 2005-2014年我国不利天气条件下交通事故特征分析%Analysis of Characteristics of Traffic Accidents Under Adverse Weather Conditions in China During 2005 -20 1 4

    Institute of Scientific and Technical Information of China (English)

    宁贵财; 康彩燕; 陈东辉; 孙广林; 刘君; 王式功; 尚可政; 马敏劲

    2016-01-01

    Through analysis of the number of traffic accidents,the economic losses of traffic accident,the injured number,the deaths number due to traffic accidents under adverse weather conditions and the meteorological observations from 2005 to 2014,the results are as follows:(1 )The number of traffic accidents and the injured occurring on rainy days was most,second for snowy days and third for foggy days.The economic losses and the deaths due to traffic accidents happened on rainy day were largest,second for foggy days and third for snowy days.The average economic losses for each accident were largest on foggy days,then for snowy days and rainy days, the average injured due to traffic accidents was most on hail days,then for foggy days and snowy days,the average deaths number due to traffic accidents was most on foggy days,then for sand days and hail days.(2)Considering the related cooperation policy between the traffic administration and the meteorological department,the number of traffic accidents and their economic losses,the injured and the deaths number were reduced effectively on rainy days,snowy days and windy days.(3)Due to the unprecedented disasters of low temperature,persistent rain,snow and ice storms in 2008,the number of traffic accidents and their economic losses,the injured and the deaths number increased obviously on snowy days in this year.(4)Through analysis of the traffic death toll on eight types of road under rainy days,snowy days and foggy days from 2005 to 2014,the largest traffic death toll in recent ten years happened on the sec-ondary roads under rainy days or snowy days,but under foggy days,the traffic death toll was most on the highway.%根据2005—2014年全国不利天气条件发生的交通事故起数、其经济损失和伤亡人数及气象观测资料研究近10 a我国不利天气条件下的交通事故特征,结果表明:(1)不利天气条件造成的交通事故起数及受伤人数雨天>雪天>雾天,造成经济

  9. Cost effectiveness of robotic mitral valve surgery

    Science.gov (United States)

    2017-01-01

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

  10. The challenge of paying for cost-effective cures.

    Science.gov (United States)

    Zettler, Patricia J; Fuse Brown, Erin C

    2017-01-01

    In this article, we consider the problem of financing highly effective and cost-effective prescription drugs within a value-based pricing system. Precisely because these drugs are highly effective, their value-based prices may be quite expensive; and moreover, the value-based price of a cure ought to be set high enough to create incentives for innovation, otherwise these beneficial therapies may be underdeveloped. However, in our fragmented health insurance system, where patients move frequently between payers, these payers generally lack the incentives to pay value-based prices for cures because they cannot ensure that they will reap the long-term economic benefits. Therefore, we argue that there is a need for mechanisms to spread the burden of financing of cures across payers to maximize patient access and the public good. We suggest that risk adjustment, reinsurance, and risk corridors are familiar policy options that merit consideration to address the problem and create incentives for value-based pricing.

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

    Science.gov (United States)

    Fisher, P

    1993-12-01

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

  12. Cost Effective Machining Of Ceramics (CEMOC)

    Energy Technology Data Exchange (ETDEWEB)

    Barkman, W.E.

    1997-04-18

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

  13. Cost-effectiveness of an injury and drowning prevention program in Bangladesh.

    Science.gov (United States)

    Rahman, Fazlur; Bose, Saideep; Linnan, Michael; Rahman, Aminur; Mashreky, Saidur; Haaland, Benjamin; Finkelstein, Eric

    2012-12-01

    Interventions that mitigate drowning risk in developing countries are needed. This study presents the cost-effectiveness of a low-cost, scalable injury and drowning prevention program called Prevention of Child Injuries through Social-Intervention and Education (PRECISE) in Bangladesh. Between 2006 and 2010, the 2 components of PRECISE (Anchal, which sequestered children in crèches [n = 18 596 participants], and SwimSafe, which taught children how to swim [n = 79421 participants]) were implemented in rural Bangladesh. Mortality rates for participants were compared against a matched sample of nonparticipants in a retrospective cohort analysis. Effectiveness was calculated via Cox proportional hazard analysis. Cost-effectiveness was estimated according to World Health Organization-CHOosing Interventions that are Cost Effective guidelines. Anchal costs between $50.74 and $60.50 per child per year. SwimSafe costs $13.46 per child. For Anchal participants, the relative risk of a drowning death was 0.181 (P = .004). The relative risk of all-cause mortality was 0.56 (P = .001). For SwimSafe, the relative risk of a drowning death was 0.072 (P mortality was 0.750 (P = .024). For Anchal, the cost per disability-adjusted life-year (DALY) averted is $812 (95% confidence interval: $589\\x{2013}$1777). For SwimSafe, the cost per DALY averted is $85 ($51\\x{2013}$561). Combined, the cost per DALY averted is $362 ($232\\x{2013}$1364). Based on World Health Organization criteria, PRECISE is very cost-effective and should be considered for implementation in other areas where drowning is a significant problem.

  14. The Cost-Effectiveness of NBPTS Teacher Certification

    Science.gov (United States)

    Yeh, Stuart S.

    2010-01-01

    A cost-effectiveness analysis of the National Board for Professional Teaching Standards (NBPTS) program suggests that Board certification is less cost-effective than a range of alternative approaches for raising student achievement, including comprehensive school reform, class size reduction, a 10% increase in per pupil expenditure, the use of…

  15. Cost-effectiveness of vaccination against herpes zoster.

    Science.gov (United States)

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

    2014-01-01

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

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  17. Why precision?

    Energy Technology Data Exchange (ETDEWEB)

    Bluemlein, Johannes

    2012-05-15

    Precision measurements together with exact theoretical calculations have led to steady progress in fundamental physics. A brief survey is given on recent developments and current achievements in the field of perturbative precision calculations in the Standard Model of the Elementary Particles and their application in current high energy collider data analyses.

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

    Science.gov (United States)

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

    2015-09-01

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

  19. Precision mechanics

    CERN Document Server

    Kittell, David

    1989-01-01

    David Kittell, the father of the discipline, Precision Mechanics, shares the foundation of this science with you in his highly practical and fun to read book, Precision Mechanics. Based on his highly acclaimed course by the same name, first taught at the Perkin-Elmer Technical institute in Norwalk, Connecticut, and later as a short course offered in such places as Bell Labs, SPIE, IEEE, NASA, and several national labs, you will find this book relevant and immediately useful.

  20. Cost-effectiveness of external cephalic version for term breech presentation

    Directory of Open Access Journals (Sweden)

    Carvalho Brendan

    2010-01-01

    to breech, successful second ECV trial, or adverse outcome from emergency cesarean. Conclusions From society's perspective, ECV trial is cost-effective when compared to a scheduled cesarean for breech presentation provided the probability of successful ECV is > 32%. Improved algorithms are needed to more precisely estimate the likelihood that a patient will have a successful ECV.

  1. 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,.

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

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

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

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

    Science.gov (United States)

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

    2016-04-01

    How should managers choose among conservation options when resources are scarce and there is uncertainty regarding the effectiveness of actions? Well-developed tools exist for prioritizing areas for one-time and binary actions (e.g., protect vs. not protect), but methods for prioritizing incremental or ongoing actions (such as habitat creation and maintenance) remain uncommon. We devised an approach that combines metapopulation viability and cost-effectiveness analyses to select among alternative conservation actions while accounting for uncertainty. In our study, cost-effectiveness is the ratio between the benefit of an action and its economic cost, where benefit is the change in metapopulation viability. We applied the approach to the case of the endangered growling grass frog (Litoria raniformis), which is threatened by urban development. We extended a Bayesian model to predict metapopulation viability under 9 urbanization and management scenarios and incorporated the full probability distribution of possible outcomes for each scenario into the cost-effectiveness analysis. This allowed us to discern between cost-effective alternatives that were robust to uncertainty and those with a relatively high risk of failure. We found a relatively high risk of extinction following urbanization if the only action was reservation of core habitat; habitat creation actions performed better than enhancement actions; and cost-effectiveness ranking changed depending on the consideration of uncertainty. Our results suggest that creation and maintenance of wetlands dedicated to L. raniformis is the only cost-effective action likely to result in a sufficiently low risk of extinction. To our knowledge we are the first study to use Bayesian metapopulation viability analysis to explicitly incorporate parametric and demographic uncertainty into a cost-effective evaluation of conservation actions. The approach offers guidance to decision makers aiming to achieve cost-effective

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

    Science.gov (United States)

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

    2017-08-01

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

  8. Precision metrology.

    Science.gov (United States)

    Jiang, X; Whitehouse, D J

    2012-08-28

    This article is a summary of the Satellite Meeting, which followed on from the Discussion Meeting at the Royal Society on 'Ultra-precision engineering: from physics to manufacture', held at the Kavli Royal Society International Centre, Chicheley Hall, Buckinghamshire, UK. The meeting was restricted to 18 invited experts in various aspects of precision metrology from academics from the UK and Sweden, Government Institutes from the UK and Germany and global aerospace industries. It examined and identified metrology problem areas that are, or may be, limiting future developments in precision engineering and, in particular, metrology. The Satellite Meeting was intended to produce a vision that will inspire academia and industry to address the solutions of those open-ended problems identified. The discussion covered three areas, namely the function of engineering parts, their measurement and their manufacture, as well as their interactions.

  9. A Versatile Mixed-Signal Pin Approach for Cost-Effective Test of Automotive ICs

    Institute of Scientific and Technical Information of China (English)

    Credence Systems Corporation

    2004-01-01

    @@ Integrated circuits (ICs) intended for increasingly sophisticated automotive applications bring unique test demands. Advanced ICs for applications such as highly integrated automatic braking system (ABS) and airbag controllers combine high voltage digital channels, significant VI demands and precise timing capability. Along with continued missioncritical reliability concerns, the trend toward higher voltage operation and increased device integration requires specialized test capabilities able to extend across the wide operating ranges found in automotive applications. Among these capabilities, automotive test requirements increasingly dictate a need for a cost-effective versatile mixed-signal pin electronics with very high data rates reaching up to 50MHz with a voltage swing of-2 V to +28 V.

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

    Science.gov (United States)

    Lam, Hwai-Tai Chen

    In view of the increasing costs of hospital care, it is essential to investigate methods to improve the labor efficiency and the cost-effectiveness of the hospital technical core in order to control costs while maintaining the quality of care. This study was conducted to develop indices to measure efficiency, cost-effectiveness, and the quality of blood banks; to identify factors associated with efficiency, cost-effectiveness, and quality; and to generate strategies to improve blood bank labor efficiency and cost-effectiveness. Indices developed in this study for labor efficiency and cost-effectiveness were not affected by patient case mix and illness severity. Factors that were associated with labor efficiency were identified as managerial styles, and organizational designs that balance workload and labor resources. Medical directors' managerial involvement was not associated with labor efficiency, but their continuing education and specialty in blood bank were found to reduce the performance of unnecessary tests. Surprisingly, performing unnecessary tests had no association with labor efficiency. This suggested the existence of labor slack in blood banks. Cost -effectiveness was associated with workers' benefits, wages, and the production of high-end transfusion products by hospital-based donor rooms. Quality indices used in this study included autologous transfusion rates, platelet transfusion rates, and the check points available in an error-control system. Because the autologous transfusion rate was related to patient case mix, severity of illness, and possible inappropriate transfusion, it was not recommended to be used for quality index. Platelet-pheresis transfusion rates were associated with the transfusion preferences of the blood bank medical directors. The total number of check points in an error -control system was negatively associated with government ownership and workers' experience. Recommendations for improving labor efficiency and cost-effectiveness

  11. 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.

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

    Science.gov (United States)

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

    2013-08-20

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

  13. Groundwater remediation and the cost effectiveness of phytoremediation.

    Science.gov (United States)

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

    2012-10-01

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

  14. Cost-effectiveness and pricing of antibacterial drugs.

    Science.gov (United States)

    Verhoef, Talitha I; Morris, Stephen

    2015-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  16. Precision Cosmology

    Science.gov (United States)

    Jones, Bernard J. T.

    2017-04-01

    Preface; Notation and conventions; Part I. 100 Years of Cosmology: 1. Emerging cosmology; 2. The cosmic expansion; 3. The cosmic microwave background; 4. Recent cosmology; Part II. Newtonian Cosmology: 5. Newtonian cosmology; 6. Dark energy cosmological models; 7. The early universe; 8. The inhomogeneous universe; 9. The inflationary universe; Part III. Relativistic Cosmology: 10. Minkowski space; 11. The energy momentum tensor; 12. General relativity; 13. Space-time geometry and calculus; 14. The Einstein field equations; 15. Solutions of the Einstein equations; 16. The Robertson–Walker solution; 17. Congruences, curvature and Raychaudhuri; 18. Observing and measuring the universe; Part IV. The Physics of Matter and Radiation: 19. Physics of the CMB radiation; 20. Recombination of the primeval plasma; 21. CMB polarisation; 22. CMB anisotropy; Part V. Precision Tools for Precision Cosmology: 23. Likelihood; 24. Frequentist hypothesis testing; 25. Statistical inference: Bayesian; 26. CMB data processing; 27. Parametrising the universe; 28. Precision cosmology; 29. Epilogue; Appendix A. SI, CGS and Planck units; Appendix B. Magnitudes and distances; Appendix C. Representing vectors and tensors; Appendix D. The electromagnetic field; Appendix E. Statistical distributions; Appendix F. Functions on a sphere; Appendix G. Acknowledgements; References; Index.

  17. Cost-effectiveness of Intensive Blood Pressure Management

    DEFF Research Database (Denmark)

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

    2016-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-10-01

    System security involves decisions in at least three areas: identification of well-defined security policies, selection of cost-effective defence strategies, and implementation of real-time defence tactics. Although choices made in each of these areas affect the others, existing decision models typically handle these three decision areas in isolation. There is no comprehensive tool that can integrate them to provide a single efficient model for safeguarding a network. In addition, there is no clear way to determine which particular combinations of defence decisions result in cost-effective solutions. To address these problems, this paper introduces a Layered Decision Model (LDM) for use in deciding how to address defence decisions based on their cost-effectiveness. To validate the LDM and illustrate how it is used, we used simulation to test model rationality and applied the LDM to the design of system security for an e-commercial business case.

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

    CERN Document Server

    Baio, Gianluca; Heath, Anna

    2017-01-01

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

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

    Science.gov (United States)

    Warren, C G

    1993-01-01

    In order to develop and maintain a viable service delivery program, the realities of cost effectiveness and cost efficiency in providing assistive technology must be addressed. Cost effectiveness relates to value of the outcome compared to the expenditures. Cost efficiency analyzes how a provider uses available resources to supply goods and services. This paper describes how basic business principles of benefit/cost analysis can be used to determine cost effectiveness. In addition, basic accounting principles are used to illustrate methods of evaluating a program's cost efficiency. Service providers are encouraged to measure their own program's effectiveness and efficiency (and potential viability) in light of current trends. This paper is meant to serve as a catalyst for continued dialogue on this topic.

  1. Cost-effectiveness analysis of computer-based assessment

    Directory of Open Access Journals (Sweden)

    Pauline Loewenberger

    2003-12-01

    Full Text Available The need for more cost-effective and pedagogically acceptable combinations of teaching and learning methods to sustain increasing student numbers means that the use of innovative methods, using technology, is accelerating. There is an expectation that economies of scale might provide greater cost-effectiveness whilst also enhancing student learning. The difficulties and complexities of these expectations are considered in this paper, which explores the challenges faced by those wishing to evaluate the costeffectiveness of computer-based assessment (CBA. The paper outlines the outcomes of a survey which attempted to gather information about the costs and benefits of CBA.

  2. 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

  3. Privacy Enforcement in a Cost-Effective Smart Grid

    DEFF Research Database (Denmark)

    Mikkelsen, Søren Aagaard

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

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

    African Journals Online (AJOL)

    USER

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

  5. Cost-effectiveness of hepatitis a vaccination in indonesia

    NARCIS (Netherlands)

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

    2014-01-01

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

  6. Cost-effectiveness of hepatitis A vaccination in Indonesia

    NARCIS (Netherlands)

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

    2014-01-01

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

  7. Cost-effectiveness of varenicline for smoking cessation

    DEFF Research Database (Denmark)

    Keiding, Hans

    2009-01-01

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

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

    Science.gov (United States)

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

    2003-01-01

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

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

    Science.gov (United States)

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

    2009-10-01

    To investigate the cost-effectiveness of private umbilical cord blood banking. A decision-analytic model was designed comparing private umbilical cord blood banking with no umbilical cord blood banking. Baseline assumptions included a cost of $3,620 for umbilical cord blood banking and storage for 20 years, a 0.04% chance of requiring an autologous stem cell transplant, a 0.07% chance of a sibling requiring an allogenic stem cell transplant, and a 50% reduction in risk of graft-versus-host disease if a sibling uses banked umbilical cord blood. Private cord blood banking is not cost-effective because it cost an additional $1,374,246 per life-year gained. In sensitivity analysis, if the cost of umbilical cord blood banking is less than $262 or the likelihood of a child needing a stem cell transplant is greater than 1 in 110, private umbilical cord blood banking becomes cost-effective. Currently, private umbilical cord blood banking is cost-effective only for children with a very high likelihood of needing a stem cell transplant. Patients considering private blood banking should be informed of the remote likelihood that a unit will be used for a child or another family member. III.

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

    Directory of Open Access Journals (Sweden)

    Clark Allan

    2007-09-01

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

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

    Science.gov (United States)

    Young, Andrea

    2015-01-01

    This article discusses a cost-effective approach to flipping the calculus classroom. In particular, the emphasis is on low-cost choices, both monetarily and with regards to faculty time, that make the daunting task of flipping a course manageable for a single instructor. Student feedback and overall impressions are also presented.

  12. The Cost-Effectiveness of Atypicals in the UK

    NARCIS (Netherlands)

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

    2008-01-01

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

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

    Science.gov (United States)

    Young, Andrea

    2015-01-01

    This article discusses a cost-effective approach to flipping the calculus classroom. In particular, the emphasis is on low-cost choices, both monetarily and with regards to faculty time, that make the daunting task of flipping a course manageable for a single instructor. Student feedback and overall impressions are also presented.

  14. Systemic cost-effectiveness analysis of food hazard reduction

    DEFF Research Database (Denmark)

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

    2015-01-01

    stage are considered. Cost analyses are conducted for different risk reduction targets and for three alternative scenarios concerning the acceptable range of interventions. Results demonstrate that using a system-wide policy approach to risk reduction can be more cost-effective than a policy focusing...

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jensen Lotte

    2008-11-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

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

    Science.gov (United States)

    Kaufer, Steve

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

  19. Cost-effectiveness of periconceptional supplementation of folic acid

    NARCIS (Netherlands)

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

    2002-01-01

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

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

    African Journals Online (AJOL)

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

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

    Science.gov (United States)

    Gallagher, Michael P.

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

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

    Science.gov (United States)

    Persad, Govind

    2015-01-01

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

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

    Science.gov (United States)

    Ashmole, R. F.; And Others

    1973-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-12-21

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    DEFF Research Database (Denmark)

    Gerke, Oke; Hermansson, Ronnie; Hess, Søren

    2015-01-01

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

  7. Cost Effectiveness of Infant Vaccination for Rotavirus in Canada

    Directory of Open Access Journals (Sweden)

    Doug Coyle

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ruggeri M

    2012-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Vos Theo

    2011-05-01

    Full Text Available Abstract Background Information on cost-effectiveness of interventions to treat schizophrenia can assist health policy decision making, particularly given the lack of health resources in developing countries like Thailand. This study aims to determine the optimal treatment package, including drug and non-drug interventions, for schizophrenia in Thailand. Methods A Markov model was used to evaluate the cost-effectiveness of typical antipsychotics, generic risperidone, olanzapine, clozapine and family interventions. Health outcomes were measured in disability adjusted life years. We evaluated intervention benefit by estimating a change in disease severity, taking into account potential side effects. Intervention costs included outpatient treatment costs, hospitalization costs as well as time and travel costs of patients and families. Uncertainty was evaluated using Monte Carlo simulation. A sensitivity analysis of the expected range cost of generic risperidone was undertaken. Results Generic risperidone is more cost-effective than typicals if it can be produced for less than 10 baht per 2 mg tablet. Risperidone was the cheapest treatment with higher drug costs offset by lower hospital costs in comparison to typicals. The most cost-effective combination of treatments was a combination of risperidone (dominant intervention. Adding family intervention has an incremental cost-effectiveness ratio of 1,900 baht/DALY with a 100% probability of a result less than a threshold for very cost-effective interventions of one times GDP or 110,000 baht per DALY. Treating the most severe one third of patients with clozapine instead of risperidone had an incremental cost-effectiveness ratio of 320,000 baht/DALY with just over 50% probability of a result below three times GDP per capita. Conclusions There are good economic arguments to recommend generic risperidone as first line treatment in combination with family intervention. As the uncertainty interval indicates

  10. Common Mistakes of a Lancair Pilot facing Adverse Weather Conditions

    Directory of Open Access Journals (Sweden)

    Martín Zorrilla

    2015-10-01

    Full Text Available This article discusses the origin of the main causes of accidents that occur in experimental Lancair aircrafts. By its nature, the experimental aircrafts exhibit unique flight conditions that could become difficult during inclement weather. For this study, we used the database of the National Transportation Safety Board (NTSB in the United States, from January 2005 to December 2014, taking into account ten cases of fatal accidents involving planes from this brand. It was concluded that the disorientation and decision-making related to errors were the main reasons, which are directly associated with pilots skills at the time of the accident. Also, a thorough analysis of this research is recommended for a subsequent application to actual cases in the Colombian Air Force.

  11. Army Helicopter Night/Adverse Weather System (N/AWS)

    Science.gov (United States)

    1976-06-11

    KOUM JAN 66 69 71 73 66 60 bO ö5 67 FEB 59 66 70 73 -n 50 51 60 MAR 1)2 53 61» 60 )6 g-t-fr 29 l»2 APR 29 "•5...s Al i X 8 TEMPERATURE (’F ■ w - II 0 el Al Al g MAXIMUM MINIMUM r 1 \\ 1 *. > > < < suss wS K - ia;w> 1 i 1 JAN 56 28 1-13 i...DAY, 0.5 OR 0.05 INCH, OR 0.5 PERCENT (V) AS APPUCAELE. FLYING WEATHER (%FREO) HOURS (LST) JAN FEB MAR APR MAY JUN JUL AU6 SEP XT NOV DEC’ANN

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

    Science.gov (United States)

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

    2001-09-26

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

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

    Science.gov (United States)

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

    2017-02-01

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

  14. Evaluation of a cost effective in-house method for HIV-1 drug resistance genotyping using plasma samples.

    Directory of Open Access Journals (Sweden)

    Devidas N Chaturbhuj

    Full Text Available OBJECTIVES: Validation of a cost effective in-house method for HIV-1 drug resistance genotyping using plasma samples. DESIGN: The validation includes the establishment of analytical performance characteristics such as accuracy, reproducibility, precision and sensitivity. METHODS: The accuracy was assessed by comparing 26 paired Virological Quality Assessment (VQA proficiency testing panel sequences generated by in-house and ViroSeq Genotyping System 2.0 (Celera Diagnostics, US as a gold standard. The reproducibility and precision were carried out on five samples with five replicates representing multiple HIV-1 subtypes (A, B, C and resistance patterns. The amplification sensitivity was evaluated on HIV-1 positive plasma samples (n = 88 with known viral loads ranges from 1000-1.8 million RNA copies/ml. RESULTS: Comparison of the nucleotide sequences generated by ViroSeq and in-house method showed 99.41±0.46 and 99.68±0.35% mean nucleotide and amino acid identity respectively. Out of 135 Stanford HIVdb listed HIV-1 drug resistance mutations, partial discordance was observed at 15 positions and complete discordance was absent. The reproducibility and precision study showed high nucleotide sequence identities i.e. 99.88±0.10 and 99.82±0.20 respectively. The in-house method showed 100% analytical sensitivity on the samples with HIV-1 viral load >1000 RNA copies/ml. The cost of running the in-house method is only 50% of that for ViroSeq method (112$ vs 300$, thus making it cost effective. CONCLUSIONS: The validated cost effective in-house method may be used to collect surveillance data on the emergence and transmission of HIV-1 drug resistance in resource limited countries. Moreover, the wide applications of a cost effective and validated in-house method for HIV-1 drug resistance testing will facilitate the decision making for the appropriate management of HIV infected patients.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2016-09-16

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

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

    Science.gov (United States)

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

    2009-01-01

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

  18. An fMRI study on sunk cost effect.

    Science.gov (United States)

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

    2013-06-26

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

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

    Directory of Open Access Journals (Sweden)

    A. M. Oliveira Filho

    1989-01-01

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

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

    Science.gov (United States)

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

    1999-01-01

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

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

    Directory of Open Access Journals (Sweden)

    N. N. Climko

    2009-01-01

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

  2. Above Bonneville Passage and Propagation Cost Effectiveness Analysis.

    Energy Technology Data Exchange (ETDEWEB)

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

    1993-05-01

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

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

    Science.gov (United States)

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

    1989-01-01

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

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

    Science.gov (United States)

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

    2015-04-01

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

  5. Evaluating the cost-effectiveness of preventive zinc supplementation

    OpenAIRE

    Fink, Günther; Heitner, Jesse

    2014-01-01

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

  6. Evaluating the cost-effectiveness of preventive zinc supplementation

    OpenAIRE

    Fink, Günther; Heitner, Jesse

    2014-01-01

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

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

    Science.gov (United States)

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

    2009-01-01

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

  8. Modified Transverse Thoracosternotomy and Cost-Effective Reinforced Sternal Closure.

    Science.gov (United States)

    Costa, Joseph; Sonett, Joshua R; D'Ovidio, Frank

    2015-12-01

    The bilateral transverse thoracosternotomy clamshell incision provides excellent exposure to the mediastinal structures in double lung transplantation. The use of a modified transverse sternotomy and a figure of 8 configuration with one monofilament metal wire, along with two longitudinal wires across the sternal division, results in greater stability and equally distributed oblique tension. Our described technique was more cost effective and resulted in no incidence of dehiscence. We present our experience using a modified transverse sternotomy and reinforced sternal closure method.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2017-02-15

    The Norwegian Breast Cancer Screening Programme (NBCSP) has a nation-wide coverage since 2005. All women aged 50-69 years are invited biennially for mammography screening. We evaluated breast cancer mortality reduction and performed a cost-effectiveness analysis, using our microsimulation model, calibrated to most recent data. The microsimulation model allows for the comparison of mortality and costs between a (hypothetical) situation without screening and a situation with screening. Breast cancer incidence in Norway had a steep increase in the early 1990s. We calibrated the model to simulate this increase and included recent costs for screening, diagnosis and treatment of breast cancer and travel and productivity loss. We estimate a 16% breast cancer mortality reduction for a cohort of women, invited to screening, followed over their complete lifetime. Cost-effectiveness is estimated at NOK 112,162 per QALY gained, when taking only direct medical costs into account (the cost of the buses, examinations, and invitations). We used a 3.5% annual discount rate. Cost-effectiveness estimates are substantially below the threshold of NOK 1,926,366 as recommended by the WHO guidelines. For the Norwegian population, which has been gradually exposed to screening, breast cancer mortality reduction for women exposed to screening is increasing and is estimated to rise to ∼30% in 2020 for women aged 55-80 years. The NBCSP is a highly cost-effective measure to reduce breast cancer specific mortality. We estimate a breast cancer specific mortality reduction of 16-30%, at the cost of 112,162 NOK per QALY gained. © 2016 UICC.

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

    Directory of Open Access Journals (Sweden)

    Ceri J Phillips

    2009-11-01

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

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

    OpenAIRE

    Clemmensen, Torkil; Vendelø, Morten

    2004-01-01

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

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

    OpenAIRE

    Clemmensen, Torkil; Vendelø, Morten

    2004-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  15. Cost-effective wearable sensor to detect EMF

    OpenAIRE

    Paradiso, Joseph A.; Vaucelle, Catherine Nicole; Ishii, Hiroshi

    2009-01-01

    In this paper we present the design of a cost-effective wearable sensor to detect and indicate the strength and other characteristics of the electric field emanating from a laptop display. Our Electromagnetic Field Detector Bracelet can provide an immediate awareness of electric fields radiated from an object used frequently. Our technology thus supports awareness of ambient background emanation beyond human perception. We discuss how detection of such radiation mig...

  16. Data Center Storage Cost-Effective Strategies, Implementation, and Management

    CERN Document Server

    Smith, Hubbert

    2011-01-01

    We overspend on data center storage ! yet, we fall short of business requirements. It's not about the technologies. It's about the proper application of technologies to deliver storage services efficiently and affordably. It's about meeting business requirements dependent on data center storage. Spend less, deliver more. Data Center Storage: Cost-Effective Strategies, Implementation, and Management provides an industry insider's insight on how to properly scope, plan, evaluate, and implement storage technologies to maximize performance, capacity, reliability, and power savings. It provides bus

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

    Science.gov (United States)

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

    2017-09-01

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

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

    Science.gov (United States)

    Hale, Rachel; Giese, Jeannie

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

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

    Science.gov (United States)

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

    2015-05-07

    Rotavirus is a leading cause of severe diarrhea in children under 5. In Argentina, the most affected regions are the Northeast and Northwest, where hospitalizations and deaths are more frequent. This study estimated the cost-effectiveness of adding either of the two licensed rotavirus vaccines to the routine immunization schedule. The integrated TRIVAC vaccine cost-effectiveness model from the Pan American Health Organization's ProVac Initiative (Version 2.0) was used to assess health benefits, costs savings, life-years gained (LYGs), DALYs averted, and cost/DALY averted of vaccinating 10 successive cohorts, from the health care system and societal perspectives. Two doses of monovalent (RV1) rotavirus vaccine and three doses of pentavalent (RV5) rotavirus vaccine were each compared to a scenario assuming no vaccination. The price/dose was US$ 7.50 and US$ 5.15 for RV1 and RV5, respectively. We ran both a national and sub-national analysis, discounting all costs and benefits 3% annually. Our base case results were compared to a range of alternative univariate and multivariate scenarios. The number of LYGs was 5962 and 6440 for RV1 and RV5, respectively. The cost/DALY averted when compared to no vaccination from the health care system and societal perspective was: US$ 3870 and US$ 1802 for RV1, and US$ 2414 and US$ 358 for RV5, respectively. Equivalent figures for the Northeast were US$ 1470 and US$ 636 for RV1, and US$ 913 and US$ 80 for RV5. Therefore, rotavirus vaccination was more cost-effective in the Northeast compared to the whole country; and, in the Northwest, health service's costs saved outweighed the cost of introducing the vaccine. Vaccination with either vaccine compared to no vaccination was highly cost-effective based on WHO guidelines and Argentina's 2011 per capita GDP of US$ 9090. Key variables influencing results were vaccine efficacy, annual loss of efficacy, relative coverage of deaths, vaccine price, and discount rate. Compared to no

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

    Science.gov (United States)

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

    2014-01-01

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

  1. Acceptance of health technology assessment submissions with incremental cost-effectiveness ratios above the cost-effectiveness threshold

    Directory of Open Access Journals (Sweden)

    Griffiths EA

    2015-08-01

    Full Text Available Elizabeth A Griffiths, Janek K Hendrich, Samuel DR Stoddart, Sean CM Walsh HERON™ Commercialization, PAREXEL International, London, UK Objectives: In health technology assessment (HTA agencies where cost-effectiveness plays a role in decision-making, an incremental cost-effectiveness ratio (ICER threshold is often used to inform reimbursement decisions. The acceptance of submissions with ICERs higher than the threshold was assessed across different agencies and across indications, in order to inform future reimbursement submissions. Methods: All HTA appraisals from May 2000 to May 2014 from National Institute for Health and Care Excellence (NICE, Scottish Medicines Consortium (SMC, Pharmaceutical Benefits Advisory Committee (PBAC, and Canadian Agency for Drugs and Technologies in Health (CADTH were assessed. Multiple technology appraisals, resubmissions, vaccination programs, and requests for advice were excluded. Submissions not reporting an ICER, or for which an ICER could not be determined were also excluded. The remaining appraisals were reviewed, and the submitted ICER, recommendation, and reasoning behind the recommendation were extracted. Results: NICE recommended the highest proportion of submissions with ICERs higher than the threshold (34% accepted without restrictions; 20% with restrictions, followed by PBAC (16% accepted without restrictions; 4% with restrictions, SMC (11% accepted without restrictions; 14% accepted with restrictions, and CADTH (0% accepted without restrictions; 26% with restrictions. Overall, the majority of higher-than-threshold ICER submissions were classified into the "malignant disease and immunosuppression" therapeutic category; however, there was no notable variation in acceptance rates by disease area. Reasons for accepting submissions reporting ICERs above the threshold included high clinical benefit over the standard of care, and addressing an unmet therapeutic need. Conclusion: Acceptance of submissions

  2. Precision medicine: what's all the fuss about?

    Science.gov (United States)

    Barker, Richard

    2016-01-01

    Precision medicine is now recognized globally as a major new era in medicine. It is being driven by advances in genomics and other 'omics' but also by the desire on the part of both health systems and governments to offer more targeted and cost-effective care. However, it faces a number of challenges, from the economics of developing more expensive companion diagnostics to the need to educate patients and the public on the advantages for them. New models of both R&D and care delivery are needed to capture the scientific, clinical and economic benefits of precision medicine.

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

    Science.gov (United States)

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

    2013-01-01

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

  4. Cost-effectiveness of pharmacotherapy to reduce obesity.

    Directory of Open Access Journals (Sweden)

    J Lennert Veerman

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

  5. Cost-effectiveness of HPV vaccination in Belize.

    Science.gov (United States)

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

    2015-05-07

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

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

    Directory of Open Access Journals (Sweden)

    Gialama F

    2013-10-01

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

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

    Science.gov (United States)

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

    2013-06-01

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

  8. 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.

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

    Science.gov (United States)

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

    2017-02-01

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

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

    Science.gov (United States)

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

    2011-11-01

    The cost-effectiveness of introducing infant rotavirus vaccination in Armenia in 2012 using Rotarix(R) was evaluated using a multiple birth cohort model. The model considered the cost and health implications of hospitalisations, primary health care consultations and episodes not leading to medical care in children under five years old. Rotavirus vaccination is expected to cost the Ministry of Health $220,000 in 2012, rising to $830,000 in 2016 following termination of GAVI co-financing, then declining to $260,000 in 2025 due to vaccine price maturity. It may reduce health care costs by $34,000 in the first year, rising to $180,000 by 2019. By 2025, vaccination may be close to cost saving to the Ministry of Health if the vaccine purchase price declines as expected. Once coverage has reached high levels, vaccination may prevent 25,000 cases, 3000 primary care consultations, 1000 hospitalisations and 8 deaths per birth cohort vaccinated. The cost per disability-adjusted life year (DALY) saved is estimated to be about $650 from the perspective of the Ministry of Health, $850 including costs accrued to both the Ministry and to GAVI, $820 from a societal perspective excluding indirect costs and $44 from a societal perspective including indirect costs. Since the gross domestic product per capita of Armenia in 2008 was $3800, rotavirus vaccination is likely to be regarded as "very cost-effective" from a WHO standpoint. Vaccination may still be "very cost-effective" if less favourable assumptions are used regarding vaccine price and disease incidence, as long as DALYs are not age-weighted.

  11. Cost-effectiveness of pharmacotherapy to reduce obesity.

    Science.gov (United States)

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

    2011-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2002-12-13

    The purpose of this paper is to determine the cost-effectiveness of vaccinating inmates against hepatitis B. From the prison perspective, vaccinating inmates at intake is not cost-saving. It could be economically beneficial when the cost of a vaccine dose is 1.6 and 50%, respectively. The health care system realizes net savings even when there is no incidence in prison, or there is no cost of chronic liver disease, or when only one dose of vaccine is administered. Thus, while prisons might not have economic incentives to implement hepatitis B vaccination programs, the health care system would benefit from allocating resources to them.

  14. Development and Manufacture of Cost Effective Composite Drill Pipe

    Energy Technology Data Exchange (ETDEWEB)

    James C. Leslie; James C. Leslie, II; Lee Truong; James T. Heard

    2006-09-29

    This technical report presents the engineering research, process development and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report presents progress made from October 1, 2005 through September 30, 2006 and contains the following discussions: Qualification Testing; Prototype Development and Testing of ''Smart Design'' Configuration; Field Test Demonstration; Development of Ultra-Short Radius Composite Drill Pipe (USR-CDP); and Development of Smart USR-CDP.

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

    Directory of Open Access Journals (Sweden)

    Yolanda Hernández-Gago

    2017-03-01

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

  16. Global cost-effectiveness of GDM screening and management

    DEFF Research Database (Denmark)

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

    2015-01-01

    and intervention approaches, and outcomes (e.g., inclusion or exclusion of long-term type 2 diabetes risk and associated costs). We concluded that incorporation of long-term benefits of GDM screening and treatment has huge impact on cost-effectiveness estimates. Based on the large methodological heterogeneity...... and varying results in the existing body of evidence, we find it unreasonable to outline any global recommendations. For future economic studies, we recommend inclusion of long-term outcomes and adaptation to local preferences, as well as examination of the impact of the diagnostic criteria recently proposed...

  17. Cost-effective wound management: a survey of 1717 nurses.

    Science.gov (United States)

    Newton, Heather

    2017-06-22

    Delivering high-quality wound care requires a mix of knowledge and skills, which nurses aim to update by attending educational events such as conferences and study days. This article describes the data obtained from 30 educational study days, which took place across England, Scotland and Wales. It will explore nurses' knowledge in relation to the cost-effectiveness and clinical efficacy of current wound care practices, based on the answers of 1717 delegates that attended the events. It will also outline the results in relation to reducing expenditure on wound dressings and the importance of performing an accurate wound assessment.

  18. Cost Effective Polymer Solar Cells Research and Education

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-10-13

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

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

    Science.gov (United States)

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

    2016-05-01

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

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

    Science.gov (United States)

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

    2014-06-01

    The advent of cloud computing centres such as Amazon's EC2 and Google's Computing Engine has elicited comparisons with dedicated computing clusters. Discussions on appropriate usage of cloud resources (both academic and commercial) and costs have ensued. This presentation discusses a detailed analysis of the costs of operating and maintaining the RACF (RHIC and ATLAS Computing Facility) compute cluster at Brookhaven National Lab and compares them with the cost of cloud computing resources under various usage scenarios. An extrapolation of likely future cost effectiveness of dedicated computing resources is also presented.

  1. Privacy Enforcement in a Cost-Effective Smart Grid

    DEFF Research Database (Denmark)

    Mikkelsen, Søren Aagaard

    In this technical report we present the current state of the research conducted during the first part of the PhD period. The PhD thesis “Privacy Enforcement in a Cost-Effective Smart Grid” focuses on ensuring privacy when generating market for energy service providers that develop web services...... for the residential domain in the envisaged smart grid. The PhD project is funded and associated to the EU project “Energy Demand Aware Open Services for Smart Grid Intelligent Automation” (Smart HG) and therefore introduces the project on a system-level. Based on this, we present some of the integration, security...

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

    Energy Technology Data Exchange (ETDEWEB)

    Baum, J.W.

    1986-01-01

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

  3. Cost-Effective Helicopter Options for Partner Nations

    Science.gov (United States)

    2015-01-01

    elevation feature MGTOW maximum gross takeoff weight MOB main operating base MoD Ministry of Defense MoI Ministry of Interior nm nautical miles NSRW...we provided a main operat- ing base ( MOB ) or forward operating base (FOB) from which operations would be conducted. In these instances, the...RAND RR141z1-2.2 MOB /FOB MOB /FOB X Y Z LZs Alternate LZs 23 nmPrimary LZ Bor der Bor der 120º 120º 10 Cost-Effective Helicopter Options for Partner

  4. Cost-effectiveness of minimally invasive sacroiliac joint fusion

    Directory of Open Access Journals (Sweden)

    Cher DJ

    2015-12-01

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

  5. DEVELOPMENT AND MANUFACTURE OF COST EFFECTIVE COMPOSITE DRILL PIPE

    Energy Technology Data Exchange (ETDEWEB)

    James C. Leslie; James C. Leslie II; Lee Truong; James T. Heard; Peter Manekas

    2005-03-18

    This technical report presents the engineering research, process development and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report presents progress made from October 1, 2003 through September 30, 2004 and contains the following discussions: (1) Direct Electrical Connection for Rotary Shoulder Tool Joints; (2) Conductors for inclusion in the pipe wall (ER/DW-CDP); (3) Qualify fibers from Zoltek; (4) Qualify resin from Bakelite; (5) First commercial order for SR-CDP from Integrated Directional Resources (SR-CDP); and (6) Preparation of papers for publication and conference presentations.

  6. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

    Directory of Open Access Journals (Sweden)

    V. V. Omel'yanovskiy

    2011-01-01

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

  7. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

    Directory of Open Access Journals (Sweden)

    V. V. Omel'yanovskiy

    2016-01-01

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

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

    Science.gov (United States)

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

    2004-05-01

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

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

    Science.gov (United States)

    Russell, Louise B; Sinha, Anushua

    2016-05-01

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

  10. 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.

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Erin M Graybill

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

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

    Science.gov (United States)

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

    2017-01-10

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

  14. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Wyoming

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Wyoming. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Wyoming.

  15. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for South Dakota

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in South Dakota. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in South Dakota.

  16. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for West Virginia

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in West Virginia. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in West Virginia.

  17. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Texas

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Texas. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Texas.

  18. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Wisconsin

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Wisconsin. Moving to the 2015 IECC from the 2006 IECC base code is cost-effective for residential buildings in all climate zones in Wisconsin.

  19. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Utah

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Utah. Moving to the 2015 IECC from the 2012 Utah State Code base code is cost-effective for residential buildings in all climate zones in Utah.

  20. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Tennessee

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Tennessee. Moving to the 2015 IECC from the 2006 IECC base code is cost-effective for residential buildings in all climate zones in Tennessee.

  1. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Rhode Island

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Rhode Island. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Rhode Island.

  2. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Oklahoma

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Oklahoma. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Oklahoma.

  3. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Vermont

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Vermont. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Vermont.

  4. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Pennsylvania

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Pennsylvania. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Pennsylvania.

  5. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for South Carolina

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in South Carolina. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in South Carolina.

  6. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Virginia

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Virginia. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Virginia.

  7. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Illinois

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Illinois. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Illinois.

  8. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Mississippi

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Mississippi. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Mississippi.

  9. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Colorado

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Colorado. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Colorado.

  10. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Missouri

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Missouri. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Missouri.

  11. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Nevada

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Nevada. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Nevada.

  12. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Idaho

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Idaho. Moving to the 2015 IECC from the 2015 Idaho State Code base code is cost-effective for residential buildings in all climate zones in Idaho.

  13. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Montana

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Montana. Moving to the 2015 IECC from the 2014 Montana State Code base code is cost-effective for residential buildings in all climate zones in Montana.

  14. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Delaware

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Delaware. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Delaware.

  15. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Louisiana

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Louisiana. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Louisiana.

  16. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Kansas

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Kansas. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Kansas.

  17. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Minnesota

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Minnesota. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Minnesota.

  18. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for New Mexico

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in New Mexico. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in New Mexico.

  19. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Indiana

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V.; Zhao, Mingjie; Taylor, Zachary T.; Poehlman, Eric A.

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Indiana. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Indiana.

  20. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Arkansas

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Arkansas. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Arkansas.

  1. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Michigan

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Michigan. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Michigan.

  2. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Kentucky

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Kentucky. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Kentucky.

  3. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Hawaii

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Hawaii. Moving to the 2015 IECC from the 2006 IECC base code is cost-effective for residential buildings in all climate zones in Hawaii.

  4. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Nebraska

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Nebraska. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Nebraska.

  5. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Massachusetts

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Massachusetts. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Massachusetts.

  6. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Florida

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Florida. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Florida.

  7. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Connecticut

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Connecticut. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Connecticut.

  8. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Alaska

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Alaska. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Alaska.

  9. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Georgia

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Georgia. Moving to the 2015 IECC from the 2011 Georgia State Code base code is cost-effective for residential buildings in all climate zones in Georgia.

  10. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Arizona

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Arizona. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Arizona.

  11. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for New York

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in New York. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in New York.

  12. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for North Dakota

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in North Dakota. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in North Dakota.

  13. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Maine

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Maine. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Maine.

  14. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Ohio

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Ohio. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Ohio.

  15. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Iowa

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Iowa. Moving to the 2015 IECC from the 2014 Iowa State Code base code is cost-effective for residential buildings in all climate zones in Iowa.

  16. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Maryland

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Maryland. Moving to the 2015 IECC from the 2012 IECC base code is cost-effective for residential buildings in all climate zones in Maryland.

  17. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for Alabama

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in Alabama. Moving to the 2015 IECC from the 2009 IECC base code is cost-effective for residential buildings in all climate zones in Alabama.

  18. REVASCULARIZATION FOR FEMOROPOPLITEAL DISEASE - A DECISION AND COST-EFFECTIVENESS ANALYSIS

    NARCIS (Netherlands)

    HUNINK, MGM; WONG, JB; DONALDSON, MC; MEYEROVITZ, MF; DEVRIES, J; HARRINGTON, DP

    1995-01-01

    Objective.-To evaluate the relative benefits and cost-effectiveness of revascularization for femoropopliteal disease using percutaneous transluminal angioplasty or bypass surgery. Design.-Decision analysis using a multistate transition simulation model (Markov process) and cost-effectiveness analysi

  19. Cost-effective multiplexing before capture allows screening of 25 000 clinically relevant SNPs in childhood acute lymphoblastic leukemia

    DEFF Research Database (Denmark)

    Wesolowska, Agata; Dalgaard, M. D.; Borst, L.;

    2011-01-01

    a model disease for exploring the impact of genetic variation due to well-characterized cytogenetics, drug response pathways and precise monitoring of minimal residual disease. Here, we have selected clinically relevant genes and SNPs through literature screening, and on the basis of associations with key...... designed a cost-effective, high-throughput capture assay of â¼25â000 clinically relevant SNPs, and demonstrated that multiple samples can be tagged and pooled before genome capture in targeted enrichment with a sufficient sequencing depth for genotyping. This multiplexed, targeted sequencing method allows...

  20. Cost-effective therapy in patients with idiopathic hirsutism.

    Science.gov (United States)

    Lumachi, Franco; Zulian, Elisa; Scaroni, Carla

    2004-06-01

    Hirsutism affects 10% of women. Hirsute women with normal circulating androgen levels and normal ovarian function (i.e., regular and ovulatory menstrual cycles) are defined as having idiopathic hirsutism, which may affect more than 20% of all hirsute women. In the treatment of idiopathic hirsutism, different medical therapies, alone or in combination, have been reported. The drugs currently available are oral contraceptives, cyproterone acetate androgen receptors blockers (i.e., spironolactone and flutamide), 5alpha-reductase inhibitors (e.g., finasteride [Proscar, Aventis]) and gonadotrophin-releasing hormone analogs. After 1 year of treatment, each drug may improve hirsutism and reduce the Ferriman-Gallwey score by 35-40%. This review analyses the causes of hirsutism and provides information on each therapy and the cost-effective results in patients with idiopathic hirsutism.

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

    DEFF Research Database (Denmark)

    Clemmensen, Torkil; Vendelø, Morten Thanning

    2004-01-01

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

  2. Cost-effective design of economic instruments in nutrition policy.

    Science.gov (United States)

    Jensen, Jørgen D; Smed, Sinne

    2007-04-04

    This paper addresses the potential for using economic regulation, e.g. taxes or subsidies, as instruments to combat the increasing problems of inappropriate diets, leading to health problems such as obesity, diabetes 2, cardiovascular diseases etc. in most countries. Such policy measures may be considered as alternatives or supplements to other regulation instruments, including information campaigns, bans or enhancement of technological solutions to the problems of obesity or related diseases. 7 different food tax and subsidy instruments or combinations of instruments are analysed quantitatively. The analyses demonstrate that the average cost-effectiveness with regard to changing the intake of selected nutritional variables can be improved by 10-30 per cent if taxes/subsidies are targeted against these nutrients, compared with targeting selected food categories. Finally, the paper raises a range of issues, which need to be investigated further, before firm conclusions about the suitability of economic instruments in nutrition policy can be drawn.

  3. Cost-effective design of economic instruments in nutrition policy

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Smed, Sinne

    2007-01-01

    This paper addresses the potential for using economic regulation, e.g. taxes or subsidies, as instruments to combat the increasing problems of inappropriate diets, leading to health problems such as obesity, diabetes 2, cardiovascular diseases etc. in most countries. Such policy measures may....... The analyses demonstrate that the average cost-effectiveness with regard to changing the intake of selected nutritional variables can be improved by 10–30 per cent if taxes/subsidies are targeted against these nutrients, compared with targeting selected food categories. Finally, the paper raises a range...... of issues, which need to be investigated further, before firm conclusions about the suitability of economic instruments in nutrition policy can be drawn....

  4. Development of a Cost Effective Power Generation System: An Overview

    Directory of Open Access Journals (Sweden)

    Shiv Prakash Bihari

    2016-03-01

    Full Text Available This paper presents an overview on development of cost effective power generation system and motivates for development of a model for hybrid system with wind to investigate the combined operation of wind with different sources to cater to wind’s stochastic nature for imbalance minimization and optimal operation. Development of model for trading power in competitive electricity market and development of strategies for trading in electricity markets (wind energy and reserves markets to investigate the effects of real time pricing tariffs on electricity market operation has been illustrated in this paper. Dynamic modelling related studies to investigate the wind generator’s kinetic energy for primary frequency support using simulink and simulation studies on doubly fed induction generator to study its capability during small disturbances / fluctuations on power system have been described.

  5. Cost-effective design of economic instruments in nutrition policy

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Smed, Sinne

    2007-01-01

    This paper addresses the potential for using economic regulation, e.g. taxes or subsidies, as instruments to combat the increasing problems of inappropriate diets, leading to health problems such as obesity, diabetes 2, cardiovascular diseases etc. in most countries. Such policy measures may...... be considered as alternatives or supplements to other regulation instruments, including information campaigns, bans or enhancement of technological solutions to the problems of obesity or related diseases. 7 different food tax and subsidy instruments or combinations of instruments are analysed quantitatively....... The analyses demonstrate that the average cost-effectiveness with regard to changing the intake of selected nutritional variables can be improved by 10–30 per cent if taxes/subsidies are targeted against these nutrients, compared with targeting selected food categories. Finally, the paper raises a range...

  6. A Cost- Effective Design of Reversible Programmable Logic Array

    CERN Document Server

    Singla, Pradeep; 10.5120/5619-7911

    2012-01-01

    In the recent era, Reversible computing is a growing field having applications in nanotechnology, optical information processing, quantum networks etc. In this paper, the authors show the design of a cost effective reversible programmable logic array using VHDL. It is simulated on xilinx ISE 8.2i and results are shown. The proposed reversible Programming logic array called RPLA is designed by MUX gate [10] & Feynman gate for 3- inputs, which is able to perform any reversible 3- input logic function or Boolean function. Furthermore the quantized analysis with camparitive finding is shown for the realized RPLA against the existing one. The result shows improvement in the quantum cost and total logical caculation in proposed RPLA.

  7. Cost effectiveness of rural development programme instruments in denmark

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Jacobsen, Lars Bo; Madsen, Bjarne

    2011-01-01

    support (e.g. 10 million €/year) for the respective instruments, and in turn assess the geographically distributed effects on farm income and employment, on production, value-added and employment in related upstream and downstream industries, on income and employment in the municipalities, and on a number......The objective of this study is to investigate the cost-effectiveness of selected instruments of the Danish Rural Development Programme 2007-2013, which constitutes the Danish implementation of the EU Rural Development Programme under Pillar Two of the Common Agricultural Policy. The Programme aims...... (micro-based “National Accounts” for municipalities, municipality economic model) and national level (national economic model), which enables analysis at a fairly detailed geographical level and hence to evaluate the spatially distributed effects of the considered policy instruments, while at the same...

  8. Cost effectiveness of rural development programme instruments in denmark

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Jacobsen, Lars Bo; Madsen, Bjarne

    2011-01-01

    The objective of this study is to investigate the cost-effectiveness of selected instruments of the Danish Rural Development Programme 2007-2013, which constitutes the Danish implementation of the EU Rural Development Programme under Pillar Two of the Common Agricultural Policy. The Programme aims...... (micro-based “National Accounts” for municipalities, municipality economic model) and national level (national economic model), which enables analysis at a fairly detailed geographical level and hence to evaluate the spatially distributed effects of the considered policy instruments, while at the same...... time incorporating economic interactions between different geographical areas, via inter-regional trade, commuting and influences via prices and wages. In order to make results for different policy instruments comparable, we use the simulation models to assess the effects of a given amount of public...

  9. Simple and cost-effective fluorescent labeling of 5-hydroxymethylcytosine

    Science.gov (United States)

    Shahal, Tamar; Green, Ori; Hananel, Uri; Michaeli, Yael; Shabat, Doron; Ebenstein, Yuval

    2016-12-01

    The nucleobase 5-hydroxymethylcytosine (5-hmC), a modified form of cytosine, is an important epigenetic mark related to regulation of gene expression. 5-hmC levels are highly dynamic during early development and are modulated during the progression of neurodegenerative disease and cancer. We describe a spectroscopic method for the global quantification of 5-hmC in genomic DNA. This method relies on the enzymatic glucosylation of 5-hmC, followed by a glucose oxidation step that results in the formation of aldehyde moieties that are covalently linked to a fluorescent reporter by oxime ligation. The fluorescence intensity of the labeled sample is directly proportional to its 5-hmC content. We show that this simple and cost-effective technique is suitable for quantification of 5-hmC content in different mouse tissues.

  10. Cost effectiveness of ergonomic redesign of electronic motherboard.

    Science.gov (United States)

    Sen, Rabindra Nath; Yeow, Paul H P

    2003-09-01

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

  11. DEVELOPMENT AND MANUFACTURE OF COST EFFECTIVE COMPOSITE DRILL PIPE

    Energy Technology Data Exchange (ETDEWEB)

    James C. Leslie; James C. Leslie II; Lee Truong; James T. Heard

    2003-03-30

    This technical report presents the engineering research and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report presents accomplishments made from October 1, 2002 through September 30, 2003. The following have been accomplished and are reported in detail herein: Metal-to-Composite Interface (MCI) redesign and testing; Successful demonstration of MCI connection for both SR and ER/DW CDP; Specifications for a 127mm (5 inch) ID by 152.4 mm (6 inch) OD composite drill pipe have been finalized for Extended Reach/Deep Water applications (ER/DW); Field testing of Short Radius CDP (SR); Sealing composite laminate to contain high pressure; Amendments; Amendment for ''Smart'' feature added to ER/DW development along with time and funding to complete battery of qualification tests with option for field demonstration; and Preparation of papers for publication and conference presentations.

  12. Development of a cost effective microscope heater stage

    Science.gov (United States)

    Dugre, Joshua; Prayaga, Chandra; Wade, Aaron

    Utilizing 3D printing technology, a heater stage has been developed and implemented for microscopic systems. Due to the flexibility of 3D printing,the heater stage can be easily modified to fit any sample size with only slight modifications to the heating element being required. The sample in contact with the heating element can also easily be secured in a thermal insulator, such as aluminum foil. The thermal gradient of the heater stage has been recorded to be less than 1°C and has been compared to more expensive designs, and the cost effectiveness of the system has been determined. The system has been tested with a sample of the liquid crystal 8CB in order to determine the exact temperatures of the phase transitions of the crystal to verify that the system is applicable to a wide range of experimental physics. UWF Quality Enhancement Plan Award.

  13. Cost-effective design of economic instruments in nutrition policy

    Directory of Open Access Journals (Sweden)

    Smed Sinne

    2007-04-01

    Full Text Available Abstract This paper addresses the potential for using economic regulation, e.g. taxes or subsidies, as instruments to combat the increasing problems of inappropriate diets, leading to health problems such as obesity, diabetes 2, cardiovascular diseases etc. in most countries. Such policy measures may be considered as alternatives or supplements to other regulation instruments, including information campaigns, bans or enhancement of technological solutions to the problems of obesity or related diseases. 7 different food tax and subsidy instruments or combinations of instruments are analysed quantitatively. The analyses demonstrate that the average cost-effectiveness with regard to changing the intake of selected nutritional variables can be improved by 10–30 per cent if taxes/subsidies are targeted against these nutrients, compared with targeting selected food categories. Finally, the paper raises a range of issues, which need to be investigated further, before firm conclusions about the suitability of economic instruments in nutrition policy can be drawn.

  14. Cost-effective unilateral climate policy design: Size Matters

    Energy Technology Data Exchange (ETDEWEB)

    Boehringer, Christoph; Fischer, Carolyn; Rosendahl, Knut Einar

    2011-07-01

    Given the bleak prospects for a global agreement on mitigating climate change, pressure for unilateral abatement is increasing. A major challenge is emissions leakage. Border carbon adjustments and output-based allocation of emissions allowances can increase effectiveness of unilateral action but introduce distortions of their own. We assess antileakage measures as a function of abatement coalition size. We first develop a partial equilibrium analytical framework to see how these instruments affect emissions within and outside the coalition. We then employ a computable general equilibrium model of international trade and energy use to assess the strategies as the coalition grows. We find that full border adjustments rank first in global cost-effectiveness, followed by import tariffs and output-based rebates. The differences across measures and their overall appeal decline as the abatement coalition grows. In terms of cost, the coalition countries prefer border carbon adjustments; countries outside the coalition prefer output-based rebates.(Author)

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

    Directory of Open Access Journals (Sweden)

    Dilawar Ali

    2013-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Ajai R. Singh

    2007-01-01

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

  17. RTM: Cost-effective processing of composite structures

    Science.gov (United States)

    Hasko, Greg; Dexter, H. Benson

    1991-01-01

    Resin transfer molding (RTM) is a promising method for cost effective fabrication of high strength, low weight composite structures from textile preforms. In this process, dry fibers are placed in a mold, resin is introduced either by vacuum infusion or pressure, and the part is cured. RTM has been used in many industries, including automotive, recreation, and aerospace. Each of the industries has different requirements of material strength, weight, reliability, environmental resistance, cost, and production rate. These requirements drive the selection of fibers and resins, fiber volume fractions, fiber orientations, mold design, and processing equipment. Research is made into applying RTM to primary aircraft structures which require high strength and stiffness at low density. The material requirements are discussed of various industries, along with methods of orienting and distributing fibers, mold configurations, and processing parameters. Processing and material parameters such as resin viscosity, perform compaction and permeability, and tool design concepts are discussed. Experimental methods to measure preform compaction and permeability are presented.

  18. Cost-effective lightweight mirrors for aerospace and defense

    Science.gov (United States)

    Woodard, Kenneth S.; Comstock, Lovell E.; Wamboldt, Leonard; Roy, Brian P.

    2015-05-01

    The demand for high performance, lightweight mirrors was historically driven by aerospace and defense (A&D) but now we are also seeing similar requirements for commercial applications. These applications range from aerospace-like platforms such as small unmanned aircraft for agricultural, mineral and pollutant aerial mapping to an eye tracking gimbaled mirror for optometry offices. While aerospace and defense businesses can often justify the high cost of exotic, low density materials, commercial products rarely can. Also, to obtain high performance with low overall optical system weight, aspheric surfaces are often prescribed. This may drive the manufacturing process to diamond machining thus requiring the reflective side of the mirror to be a diamond machinable material. This paper summarizes the diamond machined finishing and coating of some high performance, lightweight designs using non-exotic substrates to achieve cost effective mirrors. The results indicate that these processes can meet typical aerospace and defense requirements but may also be competitive in some commercial applications.

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

    Science.gov (United States)

    Jayaratne, K. S. U.

    2015-01-01

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

  20. Cost-Effectiveness Analysis in Practice: Interventions to Improve High School Completion

    Science.gov (United States)

    Hollands, Fiona; Bowden, A. Brooks; Belfield, Clive; Levin, Henry M.; Cheng, Henan; Shand, Robert; Pan, Yilin; Hanisch-Cerda, Barbara

    2014-01-01

    In this article, we perform cost-effectiveness analysis on interventions that improve the rate of high school completion. Using the What Works Clearinghouse to select effective interventions, we calculate cost-effectiveness ratios for five youth interventions. We document wide variation in cost-effectiveness ratios between programs and between…

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

    Science.gov (United States)

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

    2014-01-01

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

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

    NARCIS (Netherlands)

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

    2007-01-01

    OBJECTIVE: To assess the population-level costs, effects and cost-effectiveness of different alcohol and tobacco control strategies in Estonia. DESIGN: A WHO cost-effectiveness modelling framework was used to estimate the total costs and effects of interventions. Costs were assessed in Estonian Kroo

  3. UAS remote sensing for precision agriculture: An independent assessment

    Science.gov (United States)

    Small Unmanned Aircraft Systems (sUAS) are recognized as potentially important remote-sensing platforms for precision agriculture. However, research is required to determine which sensors and data processing methods are required to use sUAS in an efficient and cost-effective manner. Oregon State U...

  4. Aerial imaging with manned aircraft for precision agriculture

    Science.gov (United States)

    Over the last two decades, numerous commercial and custom-built airborne imaging systems have been developed and deployed for diverse remote sensing applications, including precision agriculture. More recently, unmanned aircraft systems (UAS) have emerged as a versatile and cost-effective platform f...

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

    Science.gov (United States)

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

    2015-10-01

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

  6. Reducing Wildlife Damage with Cost-Effective Management Programmes.

    Directory of Open Access Journals (Sweden)

    Cheryl R Krull

    Full Text Available Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control, with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation

  7. Cost-Effectiveness of Maintenance Hemodialysis in Japan.

    Science.gov (United States)

    Takura, Tomoyuki; Nakanishi, Takeshi; Kawanishi, Hideki; Nitta, Kosaku; Akizawa, Tadao; Hiramatsu, Makoto; Kawasaki, Tadayuki; Kukita, Kazutaka; Soejima, Hidehisa; Hirakata, Hideki; Yoshida, Toyohiko; Miyamoto, Takashi; Takahashi, Susumu

    2015-10-01

    The cost-effectiveness according to primary disease or dialysis duration has never been analyzed with respect to maintenance hemodialysis (MHD). Study candidates were > 20 years of age and had received hemodialysis for at least 6 months. Hemodialysis patients were prospectively observed for 36 months, and patient utility was assessed based on the Euro-QOL 5-dimensions (EQ-5D), from which the quality adjusted life years (QALYs) were estimated. Medical costs were calculated based on medical service fees. The cost-effectiveness defined as the incremental cost utility ratio (ICUR) was analyzed from a social perspective. A total of 29 patients (mean age; 59.9 ± 13.1 years) undergoing 437 dialysis sessions were analyzed. Utility based upon the EQ-5D score was 0.75 ± 0.21, and the estimated total medical cost for one year of MHD treatment was 4.52 ± 0.88 US$10 000. ICUR was 6.88 ± 4.47 US$10 000/QALY on average, and when comparing ICUR based on the causes of kidney failure, the value for diabetic nephropathy was found to be higher than that for glomerulonephritis (8.17 ± 6.28 vs. 6.82 ± 4.07). ICUR after 36 months observation increased mainly in the patients below 65 years of age (All; P MHD is a treatment that could improve the socioeconomic state of elderly patients with end-stage kidney disease (ESKD), but the ICUR for diabetic nephropathy was higher than that for glomerulonephritis.

  8. Reducing Wildlife Damage with Cost-Effective Management Programmes.

    Science.gov (United States)

    Krull, Cheryl R; Stanley, Margaret C; Burns, Bruce R; Choquenot, David; Etherington, Thomas R

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return.

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

    LENUS (Irish Health Repository)

    Slattery, E

    2012-02-01

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

  10. A rapid, cost-effective method for analyzing organophosphorus pesticide metabolites in human urine for counter-terrorism response.

    Science.gov (United States)

    Weerasekera, Gayanga; Smith, Kimberly D; Needham, Larry L; Barr, Dana B

    2008-01-01

    Organophosphorus (OP) pesticides are used as insecticides in agriculture and pest control and are often called "junior strength" nerve agents because they share the same mechanism of toxicity. OP pesticides are metabolized to dialkylphosphates and other metabolites, which are excreted in urine. In case of a terrorism incident involving widely available OP pesticides, an occurrence that may be likely given their widespread availability, a rapid, accurate, and cost-effective method for detecting exposure is required. We have evaluated several analytical methods to determine the most reliable and cost-effective methods for incident response. Our comparisons have included different internal standards (isotopically labeled standards versus chemically similar surrogate standards), different isolation techniques (some of which are automatable), and different analysis platforms. We found that isotopically labeled standards were a necessity to provide accurate quantification; the chemically similar surrogate was not suitable as an internal standard. The most sensitive and precise method uses isotopically labeled standards with gas chromatography-tandem mass spectrometry analysis. However, the most cost-effective method employed isotopically labeled standards with gas chromatography-single quadrupole-mass spectrometry using a less expensive mass selective detector. Because this method is lower in cost, it may be a more viable option for equipping multiple laboratories with chemical-terrorism response capabilities.

  11. Meningococcal serogroup A, C, W₁₃₅ and Y conjugated vaccine: a cost-effectiveness analysis in the Netherlands.

    Directory of Open Access Journals (Sweden)

    Hiltsje Hepkema

    Full Text Available BACKGROUND: In 2002, vaccination with a serogroup C meningococcal conjugate vaccine (MenC was introduced in the Netherlands for all children aged 14 months. Despite its success, herd immunity may wane over time. Recently, a serogroup A,C,W135,Y meningococcal conjugate vaccine (MenACWY was licensed for use in subjects of 12 months of age and above. OBJECTIVES: To evaluate the cost-effectiveness of meningococcal vaccination at 14 months and an additional vaccination at the age of 12 years, both with the MenACWY vaccine. METHODS: A decision analysis cohort model, with 185,000 Dutch newborns, was used to evaluate the cost-effectiveness of different immunization strategies. For strategies including a vaccination at 12 years of age, an additional cohort with adolescents aged 12 years was followed. The incremental cost-effectiveness ratio (ICER was estimated for the current disease incidence and for a scenario when herd immunity is lost. RESULTS: Vaccination with MenACWY at 14 months is cost-saving. Vaccinating with MenACWY at 14 months and at 12 years would prevent 7 additional cases of meningococcal serogroup A,C,W135,Y disease in the birth cohort and adolescent cohort followed for 99 years compared to the current vaccine schedule of a single vaccination with MenC at 14 months. With the current incidence, this strategy resulted in an ICER of €635,334 per quality adjusted life year. When serogroup C disease incidence returns to pre-vaccination levels due to a loss of vaccine-induced herd-immunity, vaccination with MenACWY at 14 months and at 12 years would be cost-saving. CONCLUSIONS: Routine vaccination with MenACWY is cost-saving. With the current epidemiology, a booster-dose with MenACWY is not likely cost-effective. When herd immunity is lost, a booster-dose has the potential of being cost-effective. A dynamic model should be developed for more precise estimation of the cost-effectiveness of the prevention of disappearance of herd immunity.

  12. Health Economic Assessment: Cost-Effectiveness Thresholds and Other Decision Criteria

    Directory of Open Access Journals (Sweden)

    Steven Simoens

    2010-04-01

    Full Text Available An article published in this Journal argued that New Zealand does not apply a cost-effectiveness threshold because medicines are funded within a fixed budget and because cost-effectiveness is only one of nine criteria that inform decisions. This Comment has explained that, from a theoretical perspective, the cost-effectiveness threshold model is not inconsistent with these two arguments. The observed annual variation in incremental cost-effectiveness ratios in New Zealand may originate from yearly differences in new medicines that request reimbursement and in the budget size, and from the fact that decision makers take into account other decision criteria in addition to cost-effectiveness.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-10-29

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

  14. Renal transplantation vs hemodialysis: Cost-effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Perović Saša

    2009-01-01

    Full Text Available Background/Aim. Chronic renal insufficiency (CRI, diabetes, hypertension, autosomal dominant polycystic kidney disease (ADPKD are the main reasons for starting dialysis treatment in patients having kidney function failure. At present, dialysis treatments are performed in about 4,100 patients at 46 institutions in Serbia, out of which 90% are hemodialyses. At end-stage renal disease (ESRD the only correct selection is kidney transplatation. The basic aim of the planned research was to compare ratio of costs and effects (Cost Effectiveness Analysis - CEA of hemodialysis and kidney transplantation in patients at ESRD. Methods. As the main issue of treatment in patients from both groups the life quality measured by the validated McGill Questionary, was used. The study included 150 patients totally, divided into two groups. The study group consisted of 50 patients with kidney transplantation performed at the Clinical Center of Serbia and the control group consisted of 100 patients on hemodialysis at Clinical Center of Serbia, Clinical Hospital Center Zemun, Clinical Hospital Center 'Zvezdara', Clinical Center Kragujevac and Health Center 'Studenica', Kraljevo, comparable with respect to sex, age and length of treatment with the study group. Results. Effect of kidney transplantation in relation to hemodialysis being selection of treatment is expressed in the form of incremental ratio of costs and effects (Incremental Cost-Effectiveness Ratio - ICER. It is clear from the enclosed tables that the strategy of kidney transplantation is far more profitable considering the fact that it represents saving of EUR 132,256.25 per one year of contribution Quality Adjusted Life Years (QALY within the period of 10 years. According to all aspects of live quality (physical symptoms and problems, physical well-being, psychological symptoms, existential well-being and support, difference is statistically important in favor of transplant patents. Conclusion. The costs

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

    Science.gov (United States)

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

    2015-03-01

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

  16. Cost-Effectiveness Analysis of Infrapopliteal Drug-Eluting Stents

    Energy Technology Data Exchange (ETDEWEB)

    Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr; Karnabatidis, Dimitris; Diamantopoulos, Athanasios; Spiliopoulos, Stavros; Siablis, Dimitris [Patras University Hospital, Department of Interventional Radiology, School of Medicine (Greece)

    2013-02-15

    IntroductionThere are no cost-utility data about below-the-knee placement of drug-eluting stents. The authors determined the cost-effectiveness of infrapopliteal drug-eluting stents for critical limb ischemia (CLI) treatment. The event-free individual survival outcomes defined by the absence of any major events, including death, major amputation, and target limb repeat procedures, were reconstructed on the basis of two published infrapopliteal series. The first included spot Bail-out use of Sirolimus-eluting stents versus bare metal stents after suboptimal balloon angioplasty (Bail-out SES).The second was full-lesion Primary Everolimus-eluting stenting versus plain balloon angioplasty and bail-out bare metal stenting as necessary (primary EES). The number-needed-to-treat (NNT) to avoid one major event and incremental cost-effectiveness ratios (ICERs) were calculated for a 3-year postprocedural period for both strategies. Overall event-free survival was significantly improved in both strategies (hazard ratio (HR) [confidence interval (CI)]: 0.68 [0.41-1.12] in Bail-out SES and HR [CI]: 0.53 [0.29-0.99] in Primary EES). Event-free survival gain per patient was 0.89 (range, 0.11-3.0) years in Bail-out SES with an NNT of 4.6 (CI: 2.5-25.6) and a corresponding ICER of 6,518 Euro-Sign (range 1,685-10,112 Euro-Sign ). Survival gain was 0.91 (range 0.25-3.0) years in Primary EES with an NNT of 2.7 (CI: 1.7-5.8) and an ICER of 11,581 Euro-Sign (range, 4,945-21,428 Euro-Sign ) per event-free life-year gained. Two-way sensitivity analysis showed that stented lesion length >10 cm and/or DES list price >1000 Euro-Sign were associated with the least economically favorable scenario in both strategies. Both strategies of bail-out SES and primary EES placement in the infrapopliteal arteries for CLI treatment exhibit single-digit NNT and relatively low corresponding ICERs.

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

    Directory of Open Access Journals (Sweden)

    Soile Oinonen

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

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

    Science.gov (United States)

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

    2007-02-01

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

  19. A more cost-effective method of preoperative computerized imaging.

    Science.gov (United States)

    Webber, W B

    1989-07-01

    Stimulated by the explosive expansion of the computerized desk top publishing industry during the past few years, microcomputer hardware and software are evolving at a staggering rate. Memory is rapidly increasing, and prices are declining. I have found that with the hardware and software described in this paper, I was able to obtain, in a much more cost-effective manner, as useful preoperative information for my practice as I could obtain with more expensive "turnkey" (only one use) computerized imaging systems. This type of microcomputer, of course, is not limited to just the imaging system, but can be used for a variety of other programs as well, such as word processing, slide labeling and production, spreadsheet functions, billing and filing, and numerous business and other applications. The ease of use with readily available 35-mm slides of my patients has greatly enhanced the appeal of this system. Computerized imaging, when used as an educational tool, can be very helpful in preoperative planning, resident teaching, and for illustration and discussion of a patient's proposed surgery. The electronic imaging disclaimer compiled by the American Society of Plastic and Reconstructive Surgeons has been extremely helpful in clarifying the limits of computerized imaging and reducing any false expectations that my patients might have. All of us are experiencing the dawn of a very exciting evolution.

  20. The High Value CVT Concept--Cost Effective and Powerful

    Institute of Scientific and Technical Information of China (English)

    A. Englisch,; A. Teubert; A. Gotz; E. Muller; E. Simon; B. Walter; A. Baumgartner

    2011-01-01

    Based on the comprehensive comparison of vehicle performance in economy,engine power,driving smoothness,and efficiency cost as well as pollutant emission etc,the paper discussed the high value CVT concept from an angle of the cost effective and powerful for vehicle.In the paper,it researched the related technical detail in CVT.By means of realizing the continuous change in transmission ratio,it could obtain the optimal matching between transmission system and engine operating mode,and enhance the characteristic of fuel oil in economy,and also improve the convenience in manipulation for driver and make passenger comfortable.For easy to understand the concept,the paper made the comparison analysis in many aspects such as performance,transmission specification,high value CVT hybrid,orifice torque sensor,hydraulic system,high value CVT em,new chain portfolio and assessment of the high value CVT on the NEDC.Finally it showed the potential advantages of CVT technology development,and proposed future developing trends to realize technical scheme of high value CVT.

  1. DEVELOPMENT AND MANUFACTURE OF COST EFFECTIVE COMPOSITE DRILL PIPE

    Energy Technology Data Exchange (ETDEWEB)

    James C. Leslie; Jeffrey R. Jean; Hans Neubert; Lee Truong

    2001-10-30

    This technical report presents the engineering research and data accomplishments that have transpired to date in support of the development of Cost Effective Composite Drill Pipe (CDP). The report discusses and illustrates all progress in the first two years of this NETL/DOE supported program. The following have been accomplished and are reported in detail herein: (1) Specifications for both 5 5/16 inch and 3 3/8 inch composite drill pipe have been finalized. (2) All basic laboratory testing has been completed and has provide sufficient data for the selection of materials for the composite tubing, adhesives, and abrasion coatings. (3) Successful demonstration of composite/metal joint interfacial connection. (4) Upgrade of facilities to provide a functional pilot plant manufacturing facility. (5) Arrangements to have the 3 3/8 inch CDP used in a drilling operation early in C.Y. 2002. (6) Arrangements to have the 5 5/16 inch CDP marketed and produced by a major drill pipe manufacturer.

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

    Science.gov (United States)

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

    2016-12-01

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

  3. Climate targets and cost-effective climate stabilization pathways

    Science.gov (United States)

    Held, H.

    2015-08-01

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

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

    Science.gov (United States)

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

    2007-06-01

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

  5. Time Overrun and Cost Effectiveness in the Construction Industry

    Directory of Open Access Journals (Sweden)

    T.Subramani

    2014-06-01

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

  6. (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.

  7. Reliable and cost-effective serodiagnosis of rheumatoid arthritis.

    Science.gov (United States)

    Meyer, Pieter W A; Ally, Mahmood M T M; Anderson, Ronald

    2016-06-01

    Early diagnosis of patients with rheumatoid arthritis (RA) optimises therapeutic benefit and the probability of achieving disease remission. Notwithstanding clinical acumen, early diagnosis is dependent on access to reliable serodiagnostic procedures, as well as on the discerning application and interpretation of these. In the case of RA, however, no disease-specific serodiagnostic procedure is available due to the multi-factorial and polygenic nature of this autoimmune disorder. This has resulted in the development of an array of serodiagnostic procedures based on the detection of autoantibodies reactive with various putative autoantigens. Other procedures based on measurement of elevations in the concentrations of systemic biomarkers of inflammation, most commonly acute phase reactants and cytokines/chemokines, are used as objective indices of disease activity. Following a brief overview of RA research in African populations, the current review is focused on those autoantibodies/biomarkers, specifically rheumatoid factor, anti-citrullinated peptide antibodies and C-reactive protein, which are currently recognised as being the most reliable and cost-effective with respect to disease prediction and diagnosis, as well as in monitoring activity and outcome.

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

    Science.gov (United States)

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

    2016-01-01

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

  9. Mobile source emission control cost-effectiveness: Issues, uncertainties, and results

    Energy Technology Data Exchange (ETDEWEB)

    Wang, M.Q. [Argonne National Lab., IL (United States). Center for Transportation Research

    1994-12-01

    Emissions from mobile sources undoubtedly contribute to US urban air pollution problems. Consequently, mobile source control measures, ranging from vehicle emission standards to reducing vehicle travel, have been adopted or proposed to help attain air quality standards. To rank various mobile source control measures, various government agencies and private organizations calculate cost-effectiveness in dollars per ton of emissions reduced. Arguments for or against certain control measures are often made on the basis of the calculated cost-effectiveness. Yet, different studies may yield significantly different cost-effectiveness results, because of the various methodologies used and assumptions regarding the values of costs and emission reductions. Because of the methodological differences, the cost-effectiveness results may not be comparable between studies. Use of incomparable cost-effectiveness results may result in adoption of ineffective control measures. This paper first discusses some important methodological issues involved in cost-effectiveness calculation for mobile sources and proposes appropriate, systematic methods for dealing with these issues. Various studies have been completed recently to evaluate the cost-effectiveness of mobile source emission control measures. These studies resulted in wide variations in the cost-effectiveness for same control measures. Methodological assumptions used in each study are presented and, based on the proposed methods for cost-effectiveness calculation, adjustments are applied to the original estimates in each study to correct inappropriate methodological assumptions and to make the studies comparable. Finally, mobile source control measures are ranked on the basis of the adjusted cost-effectiveness estimates.

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

    Directory of Open Access Journals (Sweden)

    Justin Ji-Yuen Siu MD

    2016-10-01

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

  11. A cost-effective climastrategy; En omkostningseffektiv klimastrategi

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2003-02-01

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

  12. Chromogenic media for urine cultures can be cost-effective

    Directory of Open Access Journals (Sweden)

    Matjaž J. Retelj

    2007-03-01

    Full Text Available Background: Chromogenic media for diagnostic urinary bacteriology have several advantages over traditional media, such as cysteine-lactose-electrolyte deficient (CLED medium. Chromogenic media allow for easier recognition of mixed growth, save time, reduce workload and provide higher detection rates. However, the cost of chromogenic media is significantly higher compared to CLED and performance of chromogenic media varies depending on the manufacturer. In the present study, performance, turn-around time and cost of Uriselect4 chromogenic medium was compared to CLED.Methods: For performance analysis, 351 midstream urine (MSU samples from September 2005 to December 2005 were directly plated in parallel on Uriselect4 and CLED agar using the calibrated loop technique. Isolates on Uriselect4 were presumptively identified according to the product insert. For cost-effectiveness analysis, we included 1,972 consecutive MSU samples from May 2005 to July 2006. We compared the cost of required materials as well as technologists’ or specialists’ time for each medium examined.Results: No significant differences were found between the isolation rates of urinary pathogens on the studied media. The procedure using chromogenic media for uropathogens is slightly cheaper than the procedure using CLED, considering the proportion of bacteriuria positive samples (50.5 % and the distribution of taxa among isolates (namely Escherichia coli with 59.6 % observed in our laboratory. At the current isolation proportion in MSU samples processed in our laboratory, the average time to reporting results could be decreased by 0.3 days.Conclusions: Use of chromogenic media for urine investigations offers multiple advantages without increasing costs compared to procedures using CLED.

  13. Cost-effective electric vehicle charging infrastructure siting for Delhi

    Science.gov (United States)

    Sheppard, Colin J. R.; Gopal, Anand R.; Harris, Andrew; Jacobson, Arne

    2016-06-01

    Plug-in electric vehicles (PEVs) represent a substantial opportunity for governments to reduce emissions of both air pollutants and greenhouse gases. The Government of India has set a goal of deploying 6-7 million hybrid and PEVs on Indian roads by the year 2020. The uptake of PEVs will depend on, among other factors like high cost, how effectively range anxiety is mitigated through the deployment of adequate electric vehicle charging stations (EVCS) throughout a region. The Indian Government therefore views EVCS deployment as a central part of their electric mobility mission. The plug-in electric vehicle infrastructure (PEVI) model—an agent-based simulation modeling platform—was used to explore the cost-effective siting of EVCS throughout the National Capital Territory (NCT) of Delhi, India. At 1% penetration in the passenger car fleet, or ˜10 000 battery electric vehicles (BEVs), charging services can be provided to drivers for an investment of 4.4 M (or 440/BEV) by siting 2764 chargers throughout the NCT of Delhi with an emphasis on the more densely populated and frequented regions of the city. The majority of chargers sited by this analysis were low power, Level 1 chargers, which have the added benefit of being simpler to deploy than higher power alternatives. The amount of public infrastructure needed depends on the access that drivers have to EVCS at home, with 83% more charging capacity required to provide the same level of service to a population of drivers without home chargers compared to a scenario with home chargers. Results also depend on the battery capacity of the BEVs adopted, with approximately 60% more charging capacity needed to achieve the same level of service when vehicles are assumed to have 57 km versus 96 km of range.

  14. Mechanoluminescence torque transducer integrated with cost-effective luminescence sensor and UV LEDs

    Science.gov (United States)

    Kim, Gi-Woo; Kim, Ji-Sik; Yun, Jong-Hwan; Cho, Min-Young

    2015-04-01

    This paper presents a preliminary study investigating the development of a new type of non-contacting torque sensor based on the mechanoluminescence (ML) of a microparticles, such as ZnS:Cu. Typically, applications of ML microparticles have been used in a stress sensor applications successfully, in which these particles are applied to realtime visualization of the stress distribution of cracks, impacts, and ML light generation. Kim et al. demonstrated their potentials of ML microparticles by successfully measuring the sinusoidal torque applied to a rotational shaft through the measurement of the ML intensity signature using a photomultiplier tube (PMT) sensor, which can be widely used in various industrial areas such as automotives, robotics, rotors, and turbines. To show their further potential applications, a cost-effective luminescence sensor and UV LEDs are integrated, and used for detecting the variation of ML intensity in this study. In addition, precision sinusoidal torque waveform with high frequency up to 15 Hz is used to investigate the frequency-dependent hysteresis phenomenon.

  15. Estimation of Physical Human-Robot Interaction Using Cost-Effective Pneumatic Padding

    Directory of Open Access Journals (Sweden)

    André Wilkening

    2016-08-01

    Full Text Available The idea to use a cost-effective pneumatic padding for sensing of physical interaction between a user and wearable rehabilitation robots is not new, but until now there has not been any practical relevant realization. In this paper, we present a novel method to estimate physical human-robot interaction using a pneumatic padding based on artificial neural networks (ANNs. This estimation can serve as rough indicator of applied forces/torques by the user and can be applied for visual feedback about the user’s participation or as additional information for interaction controllers. Unlike common mostly very expensive 6-axis force/torque sensors (FTS, the proposed sensor system can be easily integrated in the design of physical human-robot interfaces of rehabilitation robots and adapts itself to the shape of the individual patient’s extremity by pressure changing in pneumatic chambers, in order to provide a safe physical interaction with high user’s comfort. This paper describes a concept of using ANNs for estimation of interaction forces/torques based on pressure variations of eight customized air-pad chambers. The ANNs were trained one-time offline using signals of a high precision FTS which is also used as reference sensor for experimental validation. Experiments with three different subjects confirm the functionality of the concept and the estimation algorithm.

  16. Cost-Effectiveness of Old and New Technologies for Aneuploidy Screening.

    Science.gov (United States)

    Sinkey, Rachel G; Odibo, Anthony O

    2016-06-01

    Cost-effectiveness analyses allow assessment of whether marginal gains from new technology are worth increased costs. Several studies have examined cost-effectiveness of Down syndrome (DS) screening and found it to be cost-effective. Noninvasive prenatal screening also appears to be cost-effective among high-risk women with respect to DS screening, but not for the general population. Chromosomal microarray (CMA) is a genetic sequencing method superior to but more expensive than karyotype. In light of CMAs greater ability to detect genetic abnormalities, it is cost-effective when used for prenatal diagnosis of an anomalous fetus. This article covers methodology and salient issues of cost-effectiveness. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2008-01-01

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

  18. Cost-effectiveness of early intervention in first-episode psychosis

    DEFF Research Database (Denmark)

    Hastrup, Lene Halling; Kronborg, Christian; Bertelsen, Mette

    2013-01-01

    BACKGROUND: Information about the cost-effectiveness of early intervention programmes for first-episode psychosis is limited. AIMS: To evaluate the cost-effectiveness of an intensive early-intervention programme (called OPUS) (trial registration NCT00157313) consisting of enriched assertive...... community treatment, psychoeducational family treatment and social skills training for individuals with first-episode psychosis compared with standard treatment. METHOD: An incremental cost-effectiveness analysis of a randomised controlled trial, adopting a public sector perspective was undertaken. RESULTS...

  19. Palm oil: a healthful and cost-effective dietary component.

    Science.gov (United States)

    Ong, A S H; Goh, S H

    2002-03-01

    Palm oil is an excellent choice for food manufacturers because of its nutritional benefits and versatility. The oil is highly structured to contain predominantly oleic acid at the sn2-position in the major triacylglycerols to account for the beneficial effects described in numerous nutritional studies. Oil quality and nutritional benefits have been assured for the variety of foods that can be manufactured from the oil directly or from blends with other oils while remaining trans-free. The oxidative stability coupled with the cost-effectiveness is unparalleled among cholesterol-free oils, and these values can be extended to blends of polyunsaturated oils to provide long shelf-life. Presently the supply of genetic-modification-free palm oil is assured at economic prices, since the oil palm is a perennial crop with unparalleled productivity. Numerous studies have confirmed the nutritional value of palm oil as a result of the high monounsaturation at the crucial 2-position of the oil's triacylglycerols, making the oil as healthful as olive oil. It is now recognized that the contribution of dietary fats to blood lipids and cholesterol modulation is a consequence of the digestion, absorption, and metabolism of the fats. Lipolytic hydrolysis of palm oil glycerides containing predominantly oleic acid at the 2 position and palmitic and stearic acids at the 1 and 3 positions allows for the ready absorption of the 2-monoacrylglycerols while the saturated free fatty acids remain poorly absorbed. Dietary palm oil in balanced diets generally reduced blood cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides while raising the high-density lipoprotein (HDL) cholesterol. Improved lipoprotein(a) and apo-A1 levels were also demonstrated from palm oil diets; an important benefits also comes from the lowering of blood triglycerides (or reduced fat storage) as compared with those from polyunsaturated fat diets. Virgin palm oil also provides carotenes apart from

  20. Cost effective aluminum beryllium mirrors for critical optics applications

    Science.gov (United States)

    Say, Carissa; Duich, Jack; Huskamp, Chris; White, Ray

    2013-09-01

    The unique performance of aluminum-beryllium frequently makes it an ideal material for manufacturing precision optical-grade metal mirrors. Traditional methods of manufacture utilize hot-pressed powder block in billet form which is subsequently machined to final dimensions. Complex component geometries such as lightweighted, non-plano mirrors require extensive tool path programming, fixturing, and CNC machining time and result in a high buy-to-fly ratio (the ratio of the mass of raw material purchased to the mass of the finished part). This increases the cost of the mirror structure as a significant percentage of the procurement cost is consumed in the form of machining, tooling, and scrap material that do not add value to the final part. Inrad Optics, Inc. and IBC Advanced Alloys Corp. undertook a joint study to evaluate the suitability of investment-cast Beralcast® 191 and 363 aluminum-beryllium as a precision mirror substrate material. Net shape investment castings of the desired geometry minimizes machining to just cleanup stock, thereby reducing the recurring procurement cost while still maintaining performance. The thermal stability of two mirrors, (one each of Beralcast® 191 and Beralcast® 363), was characterized from -40°F to +150°F. A representative pocketed mirror was developed, including the creation of a relevant geometry and production of a cast component to validate the approach. Information from the demonstration unit was used as a basis for a comparative cost study of the representative mirror produced in Beralcast® and one machined from a billet of AlBeMet® 162 (AlBeMet® is a registered trademark of Materion Corporation). The technical and financial results of these studies will be discussed in detail.

  1. Technology strategy for cost-effective drilling and intervention; Technology Target Areas; TTA4 - Cost effective drilling and intervention

    Energy Technology Data Exchange (ETDEWEB)

    2007-07-01

    The main goals of the OG21 initiative are to (1) develop new technology and knowledge to increase the value creation of Norwegian oil and gas resources and (2) enhance the export of Norwegian oil and gas technology. The OG21 Cost-effective Drilling and Intervention (CEDI) Technology Target Area (TTA) has identified some key strategic drilling and well intervention needs to help meet the goals of OG21. These key strategic drilling and well intervention needs are based on a review of present and anticipated future offshore-Norway drilling and well intervention conditions and the Norwegian drilling and well intervention industry. A gap analysis has been performed to assess the extent to which current drilling and well intervention research and development and other activities will meet the key strategic needs. Based on the identified strategic drilling and well intervention needs and the current industry res each and development and other activities, the most important technology areas for meeting the OG21 goals are: environment-friendly and low-cost exploration wells; low-cost methods for well intervention/sidetracks; faster and extended-reach drilling; deep water drilling, completion and intervention; offshore automated drilling; subsea and sub-ice drilling; drilling through basalt and tight carbonates; drilling and completion in salt formation. More specific goals for each area: reduce cost of exploration wells by 50%; reduce cost for well intervention/sidetracks by 50%; increase drilling efficiency by 40%; reduce drilling cost in deep water by 40 %; enable offshore automated drilling before 2012; enable automated drilling from seabed in 2020. Particular focus should be placed on developing new technology for low-cost exploration wells to stem the downward trends in the number of exploration wells drilled and the volume of discovered resources. The CEDI TTA has the following additional recommendations: The perceived gaps in addressing the key strategic drilling and

  2. On the potential cost effectiveness of scientific audits.

    Science.gov (United States)

    Click, J L

    1989-09-01

    inefficient process for uncovering scientific fraud (5, 6, 9). Data from a survey of university scientists was also presented, indicating ". . . a reluctance to take prompt, corrective action not only when an investigator suspects another of misconduct but also should the investigator discover flaws in his or her own published reports-whether the flaws were the result of honest error or fraud"; (10). The uncritical acceptance by established scientists that the self-correcting process works compounds the problem. The Editor of Science has written that";. . . 99.9999 percent of reports are accurate and truthful. . ."; (8). If indeed only 0.0001% of published reports were inaccurate or untruthful, there would be little justification for scientific audits. However, congressional testimony from the National Institutes of Health (NIH) revealed that";. . . the NIH Director's office has handled an average of 15-20 allegations and reports of misconduct annually in its extramural programs, which supports the work of approximately 50,000 scientists"; (11). As I shall attempt to demonstrate, since NIH alone receives fraud-related complaints concerning the work of at least 0.03% of scientists it supports in other institutions, and since evidence indicates that the incidence of fraud is considerably greater than 0.03% (10, 12), the need to audit data is justifiable on the basis of being cost effective.

  3. New tools for cost-effective delivery of breast imaging.

    Science.gov (United States)

    Kolb, Gerald R

    2002-01-01

    Breast imaging has a deserved reputation as a very difficult financial proposition for hospitals. Regulation, low reimbursement, costly new technologies and staff shortages all combine to create an operational environment that is difficult, at best. While it may not be possible for every hospital to make breast imaging profitable, it is the obligation of every hospital to make this and all service lines as cost-effective as possible. While the typical care episode in a hospital will include several different services or procedures, the breast-imaging patient is typically in the department or breast center for a single procedure. Consequently, all of the administrative and facility costs of the patient encounter must be borne by the reimbursement for the single procedure. Breast imaging involves relatively expensive technology and highly-trained, and costly, technologists in its delivery. The costs of these inputs are relatively fixed; therefore material improvement can only be realized through the redesign of process. Analysis of the process of care delivery is critical to any discussion of the economics of breast imaging. Breast imaging can basically be divided into two categories: screening mammography and diagnostic procedures. This is a very important distinction, because screening mammography requires only general supervision, while the balance of breast imaging requires the direct supervision of the physician. Decoupling the physician from the examination allows the organization of screening delivery programs in highly efficient, high-throughput systems. On the diagnostic side of breast imaging, the primary economic enhancement that can be realized is from the delivery of more than one procedure during the patient visit. Mammography has high fixed costs (technology and technologist) and, where high fixed costs are found, profitability is determined by process and volume. Where process can be optimized to a level that will allow a positive return for each

  4.  Cost-effectiveness of medicine vs. endoscopy for dyspeptic patients

    DEFF Research Database (Denmark)

    Kjeldsen, Hans Christian; Lauritzen, Torsten; Christensen, Bo

      Background: Decision analyses conclude that empirical anti-secretory therapy is more cost-effective than endoscopy for managing patients with dyspepsia however RCTs including economic evaluation come to diverging results Aim: to compare the cost-effectiveness of two strategies for management of...

  5. Cost-effectiveness of HIV screening of patients attending clinics for sexually transmitted diseases in Amsterdam

    NARCIS (Netherlands)

    Bos, JM; Fennema, JSA; Postma, MJ

    2001-01-01

    Objective: To estimate the cost-effectiveness of universal HIV screening of patients attending a clinic for sexually transmitted diseases (STD) in Amsterdam. Design: Cost effectiveness analysis. Methods: A Bernoulli model for the secondary transmission of HIV was linked with epidemiological data on

  6. Cost-effectiveness of a randomised trial of physical activity in Alzheimer's disease

    DEFF Research Database (Denmark)

    Sopina, Elizaveta; Sørensen, Jan; Beyer, Nina

    2017-01-01

    Objectives To explore the cost-effectiveness of a supervised moderate-To-high intensity aerobic exercise programme in people diagnosed with Alzheimer's disease (AD) and estimate incremental cost-effectiveness ratios (ICER) using participant-reported and proxy-reported measures of health...

  7. 10 CFR 436.42 - Evaluation of Life-Cycle Cost Effectiveness.

    Science.gov (United States)

    2010-01-01

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

  8. Universal HIV screening of pregnant women in England : cost effectiveness analysis

    NARCIS (Netherlands)

    Postma, Maarten; Beck, E J; Mandalia, S; Sherr, L; Walters, M D; Houweling, H; Jager, Johannes C

    1999-01-01

    OBJECTIVE: To estimate the cost effectiveness of universal, voluntary HIV screening of pregnant women in England. DESIGN: Cost effectiveness analysis. Cost estimates of caring for HIV positive children were based on the stage of HIV infection and calculated using data obtained from a London hospital

  9. Prevention, screening and treatment of colorectal cancer: a global and regional generalized cost effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Johns Benjamin P

    2010-03-01

    Full Text Available Abstract Background Regional generalized cost-effectiveness estimates of prevention, screening and treatment interventions for colorectal cancer are presented. Methods Standardised WHO-CHOICE methodology was used. A colorectal cancer model was employed to provide estimates of screening and treatment effectiveness. Intervention effectiveness was determined via a population state-transition model (PopMod that simulates the evolution of a sub-regional population accounting for births, deaths and disease epidemiology. Economic costs of procedures and treatment were estimated, including programme overhead and training costs. Results In regions characterised by high income, low mortality and high existing treatment coverage, the addition of screening to the current high treatment levels is very cost-effective, although no particular intervention stands out in cost-effectiveness terms relative to the others. In regions characterised by low income, low mortality with existing treatment coverage around 50%, expanding treatment with or without screening is cost-effective or very cost-effective. Abandoning treatment in favour of screening (no treatment scenario would not be cost effective. In regions characterised by low income, high mortality and low treatment levels, the most cost-effective intervention is expanding treatment. Conclusions From a cost-effectiveness standpoint, screening programmes should be expanded in developed regions and treatment programmes should be established for colorectal cancer in regions with low treatment coverage.

  10. Cost-effectiveness of HIV screening of patients attending clinics for sexually transmitted diseases in Amsterdam

    NARCIS (Netherlands)

    Bos, JM; Fennema, JSA; Postma, MJ

    2001-01-01

    Objective: To estimate the cost-effectiveness of universal HIV screening of patients attending a clinic for sexually transmitted diseases (STD) in Amsterdam. Design: Cost effectiveness analysis. Methods: A Bernoulli model for the secondary transmission of HIV was linked with epidemiological data on

  11. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for North Carolina

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in North Carolina. Moving to the 2015 IECC from the 2012 North Carolina State Code base code is cost-effective for residential buildings in all climate zones in North Carolina.

  12. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for New Hampshire

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in New Hampshire. Moving to the 2015 IECC from the 2010 New Hampshire State Code base code is cost-effective for residential buildings in all climate zones in New Hampshire.

  13. Cost-Effectiveness Analysis of the Residential Provisions of the 2015 IECC for New Jersey

    Energy Technology Data Exchange (ETDEWEB)

    Mendon, Vrushali V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhao, Mingjie [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Zachary T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Poehlman, Eric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-02-15

    The 2015 IECC provides cost-effective savings for residential buildings in New Jersey. Moving to the 2015 IECC from the 2015 New Jersey State Code base code is cost-effective for residential buildings in all climate zones in New Jersey.

  14. Cost-effectiveness of renal denervation therapy for the treatment of resistant hypertension in The Netherlands

    NARCIS (Netherlands)

    Henry, Thea L.; de Brouwer, Bonnie F.E.; van Keep, Marjolein M.L.; Blankestijn, Peter J.; Bots, Michiel L.; Koffijberg, Hendrik

    2015-01-01

    Objectives: Safety and efficacy data for catheter-based renal denervation (RDN) in the treatment of resistant hypertension have been used to estimate the cost-effectiveness of this approach. However, there are no Dutch-specific analyses. This study examined the cost-effectiveness of RDN from the

  15. Cost-effectiveness of renal denervation therapy for the treatment of resistant hypertension in the Netherlands

    NARCIS (Netherlands)

    Henry, Thea L.; De Brouwer, Bonnie F E; Van Keep, Marjolijn M L; Blankestijn, Peter J.; Bots, Michiel L.; Koffijberg, Hendrik

    2015-01-01

    Objectives: Safety and efficacy data for catheter-based renal denervation (RDN) in the treatment of resistant hypertension have been used to estimate the cost-effectiveness of this approach. However, there are no Dutch-specific analyses. This study examined the cost-effectiveness of RDN from the

  16. Cost-effectiveness of cervical cancer screening: Cytology versus human papillomavirus DNA testing

    NARCIS (Netherlands)

    J.M. van Rosmalen (Joost); I.M.C.M. de Kok (Inge); M. van Ballegooijen (Marjolein)

    2012-01-01

    textabstractObjective To determine the most cost-effective screening programme for cervical cancer. Design Cost-effectiveness analysis from a societal perspective. Setting The Netherlands. Population Dutch women who have not been invited for human papillomavirus (HPV) vaccination. Methods We calibra

  17. Cost-effectiveness of cervical cancer screening: Cytology versus human papillomavirus DNA testing

    NARCIS (Netherlands)

    J.M. van Rosmalen (Joost); I.M.C.M. de Kok (Inge); M. van Ballegooijen (Marjolein)

    2012-01-01

    textabstractObjective To determine the most cost-effective screening programme for cervical cancer. Design Cost-effectiveness analysis from a societal perspective. Setting The Netherlands. Population Dutch women who have not been invited for human papillomavirus (HPV) vaccination. Methods We calibra

  18. Cost-Effectiveness Analysis of Early Reading Programs: A Demonstration with Recommendations for Future Research

    Science.gov (United States)

    Hollands, Fiona M.; Kieffer, Michael J.; Shand, Robert; Pan, Yilin; Cheng, Henan; Levin, Henry M.

    2016-01-01

    We review the value of cost-effectiveness analysis for evaluation and decision making with respect to educational programs and discuss its application to early reading interventions. We describe the conditions for a rigorous cost-effectiveness analysis and illustrate the challenges of applying the method in practice, providing examples of programs…

  19. Cost-effectiveness of salpingotomy and salpingectomy in women with tubal pregnancy (a randomized controlled trial)

    NARCIS (Netherlands)

    Broekmans, FJM; Mol, F.; Mello, N.M.; Strandell, Annika; Strandell, Karin; Jurkovic, Davor; Ross, Jackie; Barnhart, K.; Yalcinkaya, Tamer; Verhoeve, H.R.; Graziosi, G.C.M.; Koks, Carolien A M; Klinte, Ingmar; Hogstrom, Lars; Janssen, Ineke; Kragt, Harry; Hoek, Annemieke; Trimbos-Kemper, Trudy; Willemsen, Wim; Ankum, W.M.; Mol, Benwillem; Wely, M.; van der Veen, Fulco; Hajenius, Petra J

    2015-01-01

    STUDY QUESTION: Is salpingotomy cost effective compared with salpingectomy in women with tubal pregnancy and a healthy contralateral tube? SUMMARY ANSWER: Salpingotomy is not cost effective over salpingectomy as a surgical procedure for tubal pregnancy, as its costs are higher without a better ongoi

  20. Cost-effectiveness of HIV screening of blood donations in Accra (Ghana)

    NARCIS (Netherlands)

    van Hulst, Marinus; Sagoe, Kwamena W. C.; Vermande, Jacobien E.; van der Schaaf, Ido P.; Adriani, Willem P. A. van der Tuuk; Torpey, Kwasi; Ansah, Justina; Mingle, Julius A. A.; Sibinga, Cees Th. Smit; Postma, Maarten J.

    2008-01-01

    Objectives: Areas with high HIV-incidence rates compared to the developed world may benefit from additional testing in blood banks and may show more favorable cost-effectiveness ratios. We evaluated the cost-effectiveness of adding p24 antigen, mini pool nucleic acid amplification testing (MP-NAT),

  1. Implementing a Cost Effectiveness Analyzer for Web-Supported Academic Instruction: A Campus Wide Analysis

    Science.gov (United States)

    Cohen, Anat; Nachmias, Rafi

    2009-01-01

    This paper describes the implementation of a quantitative cost effectiveness analyzer for Web-supported academic instruction that was developed in Tel Aviv University during a long term study. The paper presents the cost effectiveness analysis of Tel Aviv University campus. Cost and benefit of 3,453 courses were analyzed, exemplifying campus-wide…

  2. Cost-Effectiveness of a Community-Based Exercise Programme in COPD Self-Management

    NARCIS (Netherlands)

    Zwerink, Marlies; Effing, Tanja; Kerstjens, Huib A. M.; van der Valk, Paul; Brusse-Keizer, Marjolein; van der Palen, Job

    2016-01-01

    Introduction: Information regarding cost-effectiveness of community-based exercise programmes in COPD is scarce. Therefore, we have investigated whether a community-based exercise programme is a cost-effective component of self-management for patients with COPD after 2 years of follow-up. Methods: A

  3. Living renal donors: optimizing the imaging strategy--decision- and cost-effectiveness analysis

    NARCIS (Netherlands)

    Y.S. Liem (Ylian Serina); M.C.J.M. Kock (Marc); W. Weimar (Willem); K. Visser (Karen); M.G.M. Hunink (Myriam); J.N.M. IJzermans (Jan)

    2003-01-01

    textabstractPURPOSE: To determine the most cost-effective strategy for preoperative imaging performed in potential living renal donors. MATERIALS AND METHODS: In a decision-analytic model, the societal cost-effectiveness of digital subtraction angiography (DSA), gadolinium-enhanced

  4. Cost effectiveness of guideline advice for children with asthma : a literature review

    NARCIS (Netherlands)

    Feenstra, Talitha L; Rutten-Van Mölken, Maureen P M H; Jager, Johannes C; Van Essen-Zandvliet, Liesbeth E M

    2002-01-01

    Asthma is an important chronic disease among children. This study reviews the cost effectiveness of interventions in the long-term care of asthmatic children and compares these results with treatment advice in four current guidelines. Cost-effectiveness studies were searched for in Medline, Embase,

  5. Universal HIV screening of pregnant women in England : cost effectiveness analysis

    NARCIS (Netherlands)

    Postma, Maarten; Beck, E J; Mandalia, S; Sherr, L; Walters, M D; Houweling, H; Jager, Johannes C

    1999-01-01

    OBJECTIVE: To estimate the cost effectiveness of universal, voluntary HIV screening of pregnant women in England. DESIGN: Cost effectiveness analysis. Cost estimates of caring for HIV positive children were based on the stage of HIV infection and calculated using data obtained from a London hospital

  6. Cost-effectiveness of newborn screening for cystic fibrosis determined with real-life data

    NARCIS (Netherlands)

    Ploeg, C.P.B. van der; Akker-van Marle, M.E. van den; Vernooij-van Langen, A.M.M.; Elvers, L.H.; Gille, J.J.P.; Verkerk, P.H.; Dankert-Roelse, J.E.; Loeber, J.G.; Triepels, R.H.; Pal, S.M. van der; Dompeling, E.; Pals, G.; Gulmans, V.A.M.; Oey-Spauwen, M.J.W.; Wijnands, Y.H.H.M.; Castricum, L.M.; Arets, H.G.M.; Ent, C.K. van der; Tiddens, H.A.W.M.; Rijke, Y.B. de; Yntema, J.B.

    2015-01-01

    BACKGROUND: Previous cost-effectiveness studies using data from the literature showed that newborn screening for cystic fibrosis (NBSCF) is a good economic option with positive health effects and longer survival. METHODS: We used primary data to compare cost-effectiveness of four screening strategie

  7. Cost-effectiveness of newborn screening for cystic fibrosis determined with real-life data

    NARCIS (Netherlands)

    van der Ploeg, C. P B; van den Akker-van Marle, M. E.; Vernooij-van Langen, A. M M; Elvers, L. H.; Gille, J. J P; Verkerk, P. H.; Dankert-Roelse, J. E.; Dankert-Roelse, J. E.; Vernooij-van Langen, A. M M; Loeber, J. G.; Elvers, L. H.; Triepels, R. H.; Gille, J. J P; Van der Ploeg, C. P B; van der Pal, S. M.; Dompeling, E.; Pals, G.; van den Akker van Marle, M. E.; Gulmans, V. A M; Oey-Spauwen, M. J W; Wijnands, Y. H H M; Castricum, L. M.; Arets, H. G M; van der Ent, C. K.; Tiddens, H. A W M; de Rijke, Y. B.; Yntema, J. B.

    2015-01-01

    Background: Previous cost-effectiveness studies using data from the literature showed that newborn screening for cystic fibrosis (NBSCF) is a good economic option with positive health effects and longer survival. Methods: We used primary data to compare cost-effectiveness of four screening strategie

  8. Class Size Reduction or Rapid Formative Assessment?: A Comparison of Cost-Effectiveness

    Science.gov (United States)

    Yeh, Stuart S.

    2009-01-01

    The cost-effectiveness of class size reduction (CSR) was compared with the cost-effectiveness of rapid formative assessment, a promising alternative for raising student achievement. Drawing upon existing meta-analyses of the effects of student-teacher ratio, evaluations of CSR in Tennessee, California, and Wisconsin, and RAND cost estimates, CSR…

  9. Cost-effectiveness of renal denervation therapy for the treatment of resistant hypertension in The Netherlands

    NARCIS (Netherlands)

    Henry, Thea L.; Brouwer, de Bonnie F.E.; Keep, van Marjolein M.L.; Blankestijn, Peter J.; Bots, Michiel L.; Koffijberg, Hendrik

    2015-01-01

    Objectives: Safety and efficacy data for catheter-based renal denervation (RDN) in the treatment of resistant hypertension have been used to estimate the cost-effectiveness of this approach. However, there are no Dutch-specific analyses. This study examined the cost-effectiveness of RDN from the per

  10. Cost-Effectiveness Analysis of Various Methods of Instruction in Developmental Mathematics.

    Science.gov (United States)

    Carman, Robert A.

    This paper examined in a critical fashion the existing applications of cost-effectiveness analysis in education, particularly the study of instructional effectiveness in the community college. Various schemes for measuring costs of instruction such as cost benefit analysis, cost-effectiveness analysis and planning programming budgeting systems…

  11. Manual on Cost-Effectiveness of Training Modalities in Population Education. Population Education Programme Service Series.

    Science.gov (United States)

    United Nations Educational, Scientific and Cultural Organization, Bangkok (Thailand). Principal Regional Office for Asia and the Pacific.

    This manual is the result of a regional training workshop on the cost-effectiveness of different training strategies in population education by Unesco in Kathmandu, Nepal, June 1-8, 1987. The purpose of the manual is to enable project staff to initiate studies to determine cost-effective training strategies in population growth control education.…

  12. Cost-effectiveness and evidence-based policy : Steering on social Impact

    NARCIS (Netherlands)

    van Yperen, Tom

    2016-01-01

    Introduction - The cost-effectiveness of many services is unknown. Because the demand for services is growing, whereas budgets are cut, the issue how to enhance the cost-effectiveness of Child and Youth Care is urgent in day to day politics and practice. The NJi developed a working model that helps

  13. Practical implications of differential discounting in cost-effectiveness analyses with varying numbers of cohorts

    NARCIS (Netherlands)

    O'Mahony, J.F.; de Kok, I.M.; van Rosmalen, Joost; Habbema, J.D.; Brouwer, Werner; van Ballegooijen, Marjolein

    2011-01-01

    OBJECTIVE: To call attention to the influence of the number of birth-cohorts used in cost-effectiveness analysis (CEA) models on incremental cost-effectiveness ratios (ICERs) under differential discounting. METHODS: The consequences of increasing the number of birth-cohorts are demonstrated using a

  14. Cost effectiveness of abdominal aortic aneurysm screening and rescreening in men in a modern context

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Laustsen, Jesper; Lindholt, Jes Sanddal

    2012-01-01

    To assess the cost effectiveness of different screening strategies for abdominal aortic aneurysm in men, from the perspective of a national health service.......To assess the cost effectiveness of different screening strategies for abdominal aortic aneurysm in men, from the perspective of a national health service....

  15. Cost effectiveness of treatments for wet age-related macular degeneration.

    Science.gov (United States)

    Mitchell, Paul; Annemans, Lieven; White, Richard; Gallagher, Meghan; Thomas, Simu

    2011-02-01

    Age-related macular degeneration (AMD) is a leading cause of blindness in people aged ≥50 years. Wet AMD in particular has a major impact on patient quality of life and imposes substantial burdens on healthcare systems. This systematic review examined the cost-effectiveness data for current therapeutic options for wet AMD. PubMed and EMBASE databases were searched for all articles reporting original cost-effectiveness analyses of wet AMD treatments. The Centre for Reviews and Dissemination and Cochrane Library databases were searched for all wet AMD health technology assessments (HTAs). Overall, 44 publications were evaluated in full and included in this review. A broad range of cost-effectiveness analyses were identified for the most commonly used therapies for wet AMD (pegaptanib, ranibizumab and photodynamic therapy [PDT] with verteporfin). Three studies evaluated the cost effectiveness of bevacizumab in wet AMD. A small number of analyses of other treatments, such as laser photocoagulation and antioxidant vitamins, were also found. Ranibizumab was consistently shown to be cost effective for wet AMD in comparison with all the approved wet AMD therapies (four of the five studies identified showed ranibizumab was cost effective vs usual care, PDT or pegaptanib); however, there was considerable variation in the methodology for cost-effectiveness modelling between studies. Findings from the HTAs supported those from the PubMed and EMBASE searches; of the seven HTAs that included ranibizumab, six (including HTAs for Australia, Canada and the UK) concluded that ranibizumab was cost effective for the treatment of wet AMD; most compared ranibizumab with PDT and/or pegaptanib. By contrast, HTAs at best generally recommended pegaptanib or PDT for restricted use in subsets of patients with wet AMD. In the literature analyses, pegaptanib was found to be cost effective versus usual/best supportive care (including PDT) or no treatment in one of five studies; the other four

  16. Cost-effective monitoring of ground motion by joint use of a single-frequency GPS and a MEMS accelerometer

    Science.gov (United States)

    Tu, Rui; Wang, Rongjiang; Ge, Maorong; Walter, Thomas R.; Ramatschi, Markus; Milkereit, Claus; Bindi, Dino; Dahm, Torsten

    2014-05-01

    Real-time detection and precise estimation of strong ground motion are crucial for rapid assessment and early warning of geohazards such as earthquakes, landslides, and volcanic activity. This challenging task can be accomplished by combining GPS and accelerometer measurements because of their complementary capabilities to resolve broadband ground motion signals. However, for implementing an operational monitoring network of such joint measurement systems, cost-effective techniques need to be developed and rigorously tested. We propose a new approach for joint processing of single-frequency GPS and MEMS (micro-electro-mechanical systems) accelerometer data in real time. To demonstrate the performance of our method, we describe results from outdoor experiments under controlled conditions. For validation, we analysed dual-frequency GPS data and images recorded by a video camera. The results of the different sensors agree very well, suggesting that real-time broadband information of ground motion can be provided by using single-frequency GPS and MEMS accelerometers. Reference: Tu, R., R. Wang, M. Ge, T. R. Walter, M. Ramatschi, C. Milkereit, D. Bindi, and T. Dahm (2013), Cost-effective monitoring of ground motion related to earthquakes, landslides, or volcanic activity by joint use of a single-frequency GPS and a MEMS accelerometer, Geophysical Research Letters, 40, 3825-3829, doi:10.1002/grl.50653.

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

    Science.gov (United States)

    Kelly, P G; Smales, R J

    2004-05-22

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

  18. Cost-effectiveness of Acupuncture for Chronic Nonspecific Low Back Pain.

    Science.gov (United States)

    Taylor, Penny; Pezzullo, Lynne; Grant, Suzanne J; Bensoussan, Alan

    2014-09-01

    Cost-effectiveness is a major criterion underpinning decisions in mainstream health care. Acupuncture is increasingly used in patients with chronic lower back pain (LBP), but there is a lack of evidence on cost-effectiveness. The objective of this study was to assess the cost-effectiveness of acupuncture in alleviating chronic LBP either alone or in conjunction with standard care compared with patients receiving routine care, and/or sham. To determine effectiveness, we undertook meta-analyses which found a significant improvement in pain in those receiving acupuncture and standard care compared with those receiving standard care alone. For acupuncture and standard care vs. standard care and sham, a weak positive effect was found for weeks 12 to 16, but this was not significant. For acupuncture alone vs. standard care alone, a significant positive effect was found at week 8, but not at weeks 26 or 52. The main outcome parameters for our cost-effectiveness analysis were the incremental cost-effectiveness ratio (ICER) of acupuncture treatment presented as cost (A$) per disability-adjusted life-year (DALY) saved. The WHO benchmark for a very highly cost-effective intervention is one that costs less than gross domestic product per capita per quality-adjusted life-year (QALY) gained or DALY averted, or less than around $A52,000 in 2009 (the base year for the analysis). According to this threshold, acupuncture as a complement to standard care for relief of chronic LBP is highly cost-effective, costing around $48,562 per DALY avoided. When comorbid depression is alleviated at the same rate as pain, cost is around $18,960 per DALY avoided. Acupuncture as a substitute for standard care was not found to be cost-effective unless comorbid depression was included. According to the WHO cost-effectiveness threshold values, acupuncture is a cost-effective treatment strategy in patients with chronic LBP.

  19. Maximizing cost-effectiveness by adjusting treatment strategy according to glaucoma severity

    Science.gov (United States)

    Guedes, Ricardo Augusto Paletta; Guedes, Vanessa Maria Paletta; Gomes, Carlos Eduardo de Mello; Chaoubah, Alfredo

    2016-01-01

    Abstract Background: The aim of this study is to determine the most cost-effective strategy for the treatment of primary open-angle glaucoma (POAG) in Brazil, from the payer's perspective (Brazilian Public Health System) in the setting of the Glaucoma Referral Centers. Methods: Study design was a cost-effectiveness analysis of different treatment strategies for POAG. We developed 3 Markov models (one for each glaucoma stage: early, moderate and advanced), using a hypothetical cohort of POAG patients, from the perspective of the Brazilian Public Health System (SUS) and a horizon of the average life expectancy of the Brazilian population. Different strategies were tested according to disease severity. For early glaucoma, we compared observation, laser and medications. For moderate glaucoma, medications, laser and surgery. For advanced glaucoma, medications and surgery. Main outcome measures were ICER (incremental cost-effectiveness ratio), medical direct costs and QALY (quality-adjusted life year). Results: In early glaucoma, both laser and medical treatment were cost-effective (ICERs of initial laser and initial medical treatment over observation only, were R$ 2,811.39/QALY and R$ 3,450.47/QALY). Compared to observation strategy, the two alternatives have provided significant gains in quality of life. In moderate glaucoma population, medical treatment presented the highest costs among treatment strategies. Both laser and surgery were highly cost-effective in this group. For advanced glaucoma, both tested strategies were cost-effective. Starting age had a great impact on results in all studied groups. Initiating glaucoma therapy using laser or surgery were more cost-effective, the younger the patient. Conclusion: All tested treatment strategies for glaucoma provided real gains in quality of life and were cost-effective. However, according to the disease severity, not all strategies provided the same cost-effectiveness profile. Based on our findings, there should be a

  20. Cost-effectiveness of integrated collaborative care for comorbid major depression in patients with cancer☆

    Science.gov (United States)

    Duarte, A.; Walker, J.; Walker, S.; Richardson, G.; Holm Hansen, C.; Martin, P.; Murray, G.; Sculpher, M.; Sharpe, M.

    2015-01-01

    Objectives Comorbid major depression is associated with reduced quality of life and greater use of healthcare resources. A recent randomised trial (SMaRT, Symptom Management Research Trials, Oncology-2) found that a collaborative care treatment programme (Depression Care for People with Cancer, DCPC) was highly effective in treating depression in patients with cancer. This study aims to estimate the cost-effectiveness of DCPC compared with usual care from a health service perspective. Methods Costs were estimated using UK national unit cost estimates and health outcomes measured using quality-adjusted life-years (QALYs). Incremental cost-effectiveness of DCPC compared with usual care was calculated and scenario analyses performed to test alternative assumptions on costs and missing data. Uncertainty was characterised using cost-effectiveness acceptability curves. The probability of DCPC being cost-effective was determined using the UK National Institute for Health and Care Excellence's (NICE) cost-effectiveness threshold range of £20,000 to £30,000 per QALY gained. Results DCPC cost on average £631 more than usual care per patient, and resulted in a mean gain of 0.066 QALYs, yielding an incremental cost-effectiveness ratio of £9549 per QALY. The probability of DCPC being cost-effective was 0.9 or greater at cost-effectiveness thresholds above £20,000 per QALY for the base case and scenario analyses. Conclusions Compared with usual care, DCPC is likely to be cost-effective at the current thresholds used by NICE. This study adds to the weight of evidence that collaborative care treatment models are cost-effective for depression, and provides new evidence regarding their use in specialist medical settings. PMID:26652589

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

    Science.gov (United States)

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

    2014-05-01

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

  2. Moving Beyond GDP: Cost Effectiveness of Cochlear Implantation and Deaf Education in Latin America.

    Science.gov (United States)

    Emmett, Susan D; Tucci, Debara L; Bento, Ricardo F; Garcia, Juan M; Juman, Solaiman; Chiossone-Kerdel, Juan A; Liu, Ta J; de Muñoz, Patricia Castellanos; Ullauri, Alejandra; Letort, Jose J; Mansilla, Teresita; Urquijo, Diana P; Aparicio, Maria L; Gong, Wenfeng; Francis, Howard W; Saunders, James E

    2016-09-01

    Cochlear implantation (CI) and deaf education are cost effective management strategies of childhood profound sensorineural hearing loss in Latin America. CI has been widely established as cost effective in North America and Europe and is considered standard of care in those regions, yet cost effectiveness in other economic environments has not been explored. With 80% of the global hearing loss burden existing in low- and middle-income countries, developing cost effective management strategies in these settings is essential. This analysis represents the continuation of a global assessment of CI and deaf education cost effectiveness. Brazil, Colombia, Ecuador, Guatemala, Paraguay, Trinidad and Tobago, and Venezuela participated in the study. A Disability Adjusted Life Years model was applied with 3% discounting and 10-year length of analysis. Experts from each country supplied cost estimates from known costs and published data. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the World Health Organization standard of cost effectiveness ratio/gross domestic product per capita (CER/GDP)GDP 0.07-0.93). CI was cost effective in all countries (CER/GDP 0.69-2.96), with borderline cost effectiveness in the Guatemalan sensitivity analysis (Max CER/GDP 3.21). Both cochlear implantation and deaf education are widely cost effective in Latin America. In the lower-middle income economy of Guatemala, implant cost may have a larger impact. GDP is less influential in the middle- and high-income economies included in this study.

  3. Micromachined Precision Inertial Instruments

    Science.gov (United States)

    2003-11-01

    and vacuum packaging techniques to achieve degree-per-hour inertial micro-gyroscopes. A single-wafer, all-silicon, high aspect-ratio p...Although vacuum packaging substantially reduces the mechanical noise of a surface micromachined accelerometer and lowers the output noise floor...it is desirable to operate sensors in atmosphere since vacuum packaging is not cost effective [15]. Figure 10: Performance improvements for In

  4. Screening, prevention and treatment of cervical cancer -- a global and regional generalized cost-effectiveness analysis.

    Science.gov (United States)

    Ginsberg, Gary Michael; Edejer, Tessa Tan-Torres; Lauer, Jeremy A; Sepulveda, Cecilia

    2009-10-09

    The paper calculates regional generalized cost-effectiveness estimates of screening, prevention, treatment and combined interventions for cervical cancer. Using standardised WHO-CHOICE methodology, a cervical cancer model was employed to provide estimates of screening, vaccination and treatment effectiveness. Intervention effectiveness was determined via a population state-transition model (PopMod) that simulates the evolution of a sub-regional population accounting for births, deaths and disease epidemiology. Economic costs of procedures and treatment were estimated, including programme overhead and training costs. In regions characterized by high income, low mortality and high existing treatment coverage, the addition of any screening programme to the current high treatment levels is very cost-effective. However, based on projections of the future price per dose (representing the economic costs of the vaccination excluding monopolistic rents and vaccine development cost) vaccination is the most cost-effective intervention. In regions characterized by low income, low mortality and existing treatment coverage around 50%, expanding treatment with or without combining it with screening appears to be cost-effective or very cost-effective. Abandoning treatment in favour of screening in a no-treatment scenario would not be cost-effective. Vaccination is usually the most cost-effective intervention. Penta or tri-annual PAP smears appear to be cost-effective, though when combined with HPV-DNA testing they are not cost-effective. In regions characterized by low income, high mortality and low treatment levels, expanding treatment with or without adding screening would be very cost-effective. A one off vaccination plus expanding treatment was usually very cost-effective. One-off PAP or VIA screening at age 40 are more cost-effective than other interventions though less effective overall. From a cost-effectiveness perspective, consideration should be given to implementing

  5. Precision performance lamp technology

    Science.gov (United States)

    Bell, Dean A.; Kiesa, James E.; Dean, Raymond A.

    1997-09-01

    A principal function of a lamp is to produce light output with designated spectra, intensity, and/or geometric radiation patterns. The function of a precision performance lamp is to go beyond these parameters and into the precision repeatability of performance. All lamps are not equal. There are a variety of incandescent lamps, from the vacuum incandescent indictor lamp to the precision lamp of a blood analyzer. In the past the definition of a precision lamp was described in terms of wattage, light center length (LCL), filament position, and/or spot alignment. This paper presents a new view of precision lamps through the discussion of a new segment of lamp design, which we term precision performance lamps. The definition of precision performance lamps will include (must include) the factors of a precision lamp. But what makes a precision lamp a precision performance lamp is the manner in which the design factors of amperage, mscp (mean spherical candlepower), efficacy (lumens/watt), life, not considered individually but rather considered collectively. There is a statistical bias in a precision performance lamp for each of these factors; taken individually and as a whole. When properly considered the results can be dramatic to the system design engineer, system production manage and the system end-user. It can be shown that for the lamp user, the use of precision performance lamps can translate to: (1) ease of system design, (2) simplification of electronics, (3) superior signal to noise ratios, (4) higher manufacturing yields, (5) lower system costs, (6) better product performance. The factors mentioned above are described along with their interdependent relationships. It is statistically shown how the benefits listed above are achievable. Examples are provided to illustrate how proper attention to precision performance lamp characteristics actually aid in system product design and manufacturing to build and market more, market acceptable product products in the

  6. Concepts for Cost-Effective Enhanced Cryosat Continuity: Opportunity in the Iridium PRIME Context

    Science.gov (United States)

    Le Roy, Y.; Caubet, E.; Silverstrin, P.; Legrand, C.

    2016-08-01

    The Iridium-PRIME offer, recently initiated by the Iridium company, consists in hosting payloads on customized low cost Iridium-NEXT platforms on which the main telecom mission antenna (L-band) is removed. This leaves significant resources in terms of mass, volume and power consumption to host up to three payloads on these customized platforms. The Iridium-PRIME satellites will be inserted in the Iridium-NEXT constellation to take benefit of the low cost operation service (command, control and data telemetry through the life time of the Iridium-PRIME mission). Given the synergy between schedules of the Iridium-PRIME program (launches starting around 2020) and of a possible CryoSat Follow-On (FO) mission (launch around 2022) and the adequacy of the available on-board resources for such a mission, ESA tasked Thales Alenia Space, as responsible for the SIRAL radar instrument of the currently in-orbit CryoSat mission, to study the feasibility of a concept for enhanced continuity of CryoSat on an Iridium- PRIME satellite as potential low-cost fast-track solution. The study aimed to define a cost-effective topographic payload including not only the SIRAL radar but also the necessary sub-systems to retrieve the SIRAL antenna baseline attitude (star trackers) with high accuracy and to perform a Precise Orbit Determination (POD). All these aspects are presented in this paper. In addition, possible evolutions/improvements of the Ku-band radar instrument were analysed and are presented: adding a Ka-band nadir measurement capability and a Ku-band or Ka-band wide swath mode measurement capability. The transmission issue for the SIRAL science data is also discussed in the paper.

  7. Using propensity scores to estimate the cost-effectiveness of medical therapies.

    Science.gov (United States)

    Indurkhya, Alka; Mitra, Nandita; Schrag, Deborah

    2006-05-15

    The cost-effectiveness ratio is a popular statistic that is used by policy makers to decide which programs are cost-effective in the public health sector. Recently, the net monetary benefit has been proposed as an alternative statistical summary measure to overcome the limitations associated with the cost-effectiveness ratio. Research on using the net monetary benefit to assess the cost-effectiveness of therapies in non-randomized studies has yet to be done. Propensity scores are useful in estimating adjusted effectiveness of programs that have non-randomized or quasi-experimental designs. This article introduces the use of propensity score adjustment in cost-effectiveness analyses to estimate net monetary benefits for non-randomized studies. The uncertainty associated with the net monetary benefit estimate is evaluated using cost-effectiveness acceptability curves. Our method is illustrated by applying it to SEER-Medicare data for muscle invasive bladder cancer to determine the most cost-effective treatment protocol.

  8. A cost-effectiveness analysis of two different antimicrobial stewardship programs.

    Science.gov (United States)

    Okumura, Lucas Miyake; Riveros, Bruno Salgado; Gomes-da-Silva, Monica Maria; Veroneze, Izelandia

    2016-01-01

    There is a lack of formal economic analysis to assess the efficiency of antimicrobial stewardship programs. Herein, we conducted a cost-effectiveness study to assess two different strategies of Antimicrobial Stewardship Programs. A 30-day Markov model was developed to analyze how cost-effective was a Bundled Antimicrobial Stewardship implemented in a university hospital in Brazil. Clinical data derived from a historical cohort that compared two different strategies of antimicrobial stewardship programs and had 30-day mortality as main outcome. Selected costs included: workload, cost of defined daily doses, length of stay, laboratory and imaging resources used to diagnose infections. Data were analyzed by deterministic and probabilistic sensitivity analysis to assess model's robustness, tornado diagram and Cost-Effectiveness Acceptability Curve. Bundled Strategy was more expensive (Cost difference US$ 2119.70), however, it was more efficient (US$ 27,549.15 vs 29,011.46). Deterministic and probabilistic sensitivity analysis suggested that critical variables did not alter final Incremental Cost-Effectiveness Ratio. Bundled Strategy had higher probabilities of being cost-effective, which was endorsed by cost-effectiveness acceptability curve. As health systems claim for efficient technologies, this study conclude that Bundled Antimicrobial Stewardship Program was more cost-effective, which means that stewardship strategies with such characteristics would be of special interest in a societal and clinical perspective.

  9. Cost-effectiveness of interventions to prevent HIV and STDs among women: a randomized controlled trial.

    Science.gov (United States)

    Ruger, Jennifer Prah; Abdallah, Arbi Ben; Ng, Nora Y; Luekens, Craig; Cottler, Linda

    2014-10-01

    Injection drug use is a leading transmission route of HIV and STDs, and disease prevention among drug users is an important public health concern. This study assesses cost-effectiveness of behavioral interventions for reducing HIV and STDs infections among injection drug-using women. Cost-effectiveness analysis was conducted from societal and provider perspectives for randomized trial data and Bernoullian model estimates of infections averted for three increasingly intensive interventions: (1) NIDA's standard intervention (SI); (2) SI plus a well woman exam (WWE); and (3) SI, WWE, plus four educational sessions (4ES). Trial results indicate that 4ES was cost-effective relative to WWE, which was dominated by SI, for most diseases. Model estimates, however, suggest that WWE was cost-effective relative to SI and dominated 4ES for all diseases. Trial and model results agree that WWE is cost-effective relative to SI per hepatitis C infection averted ($109 308 for in trial, $6 016 in model) and per gonorrhea infection averted ($9 461 in trial, $14 044 in model). In sensitivity analysis, trial results are sensitive to 5 % change in WWE effectiveness relative to SI for hepatitis C and HIV. In the model, WWE remained cost-effective or cost-saving relative to SI for HIV prevention across a range of assumptions. WWE is cost-effective relative to SI for preventing hepatitis C and gonorrhea. WWE may have similar effects as the costlier 4ES.

  10. The cost-effectiveness of health communication programs: what do we know?

    Science.gov (United States)

    Hutchinson, Paul; Wheeler, Jennifer

    2006-01-01

    While a considerable body of evidence has emerged supporting the effectiveness of communication programs in augmenting health, only a very small subset of studies has examined also whether these programs are cost-effective, that is, whether they achieve greater health gains for available financial resources than alternative interventions. In this article, we examine the available literature on the cost-effectiveness of health behavior change communication programs, focusing on communication interventions involving mass media, and, to a lesser extent, community mobilization and interpersonal communication or counseling. Our objective is to identify the state of past and current research efforts of the cost-effectiveness of behavior change communication programs. This review makes three principal conclusions. First, the analysis of the cost-effectiveness of health communication programs commonly has not been performed. Second, the studies reviewed here have utilized a considerable diversity of methods and have reflected varying levels of quality and adherence to standard cost-effectiveness methodologies. This leads to problems of transparency, comparability, and generalizability. Third, while the available studies generally are indicative of the cost-effectiveness of communication interventions relative to alternatives, the evidence base clearly needs to be expanded by additional rigorous cost-effectiveness analyses.

  11. The cost-effectiveness of pentavalent rotavirus vaccination in England and Wales.

    Science.gov (United States)

    Atkins, Katherine E; Shim, Eunha; Carroll, Stuart; Quilici, Sibilia; Galvani, Alison P

    2012-11-01

    Rotavirus vaccines have shown great potential for reducing the disease burden of the major cause of severe childhood gastroenteritis. The decision regarding whether rotavirus vaccination will be introduced into the national immunization program is currently being reviewed. The conclusions of previous evaluations of rotavirus vaccination cost-effectiveness contradict each other. This is the first analysis to incorporate a dynamic transmission model to assess the cost-effectiveness of rotavirus vaccination in England and Wales. Most previously reported models do not include herd protection, and thus may underestimate the cost-effectiveness of vaccination against rotavirus. We incorporate a dynamic model of rotavirus transmission in England and Wales into a cost-effectiveness analysis to determine the probability that the pentavalent rotavirus vaccination will be cost-effective over a range of full-course vaccine prices. This novel approach allows the cost-effectiveness analysis to include a feasible level of herd protection provided by a vaccination program. Our base case model predicts that pentavalent rotavirus vaccination is likely to be cost-effective in England and Wales at £ 60 per course. In some scenarios the vaccination is predicted to be not only cost-effective but also cost-saving. These savings could be generated within ten years after vaccine introduction. Our budget impact analysis demonstrates that for the realistic base case scenarios, 58-96% of the cost outlay for vaccination will be recouped within the first four years of a program. Our results indicate that rotavirus vaccination would be beneficial to public health and could be economically sound. Since rotavirus vaccination is not presently on the immunization schedule for England and Wales but is currently under review, this study can inform policymakers of the cost-effectiveness and budget impact of implementing a mass rotavirus vaccine strategy.

  12. GDP Matters: Cost Effectiveness of Cochlear Implantation and Deaf Education in Sub-Saharan Africa.

    Science.gov (United States)

    Emmett, Susan D; Tucci, Debara L; Smith, Magteld; Macharia, Isaac M; Ndegwa, Serah N; Nakku, Doreen; Mukara, Kaitesi B; Kaitesi, Mukara B; Ibekwe, Titus S; Mulwafu, Wakisa; Gong, Wenfeng; Francis, Howard W; Saunders, James E

    2015-09-01

    Cochlear implantation and deaf education are cost effective in Sub-Saharan Africa. Cost effectiveness of pediatric cochlear implantation has been well established in developed countries but is unknown in low resource settings, where access to the technology has traditionally been limited. With incidence of severe-to-profound congenital sensorineural hearing loss 5 to 6 times higher in low/middle-income countries than the United States and Europe, developing cost-effective management strategies in these settings is critical. Costs were obtained from experts in Nigeria, South Africa, Kenya, Rwanda, Uganda, and Malawi using known costs and published data, with estimation when necessary. A disability adjusted life years (DALY) model was applied using 3% discounting and 10-year length of analysis. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the WHO standard of cost-effectiveness ratio/gross domestic product per capita (CER/GDP) less than 3. Cochlear implantation was cost effective in South Africa and Nigeria, with CER/GDP of 1.03 and 2.05, respectively. Deaf education was cost effective in all countries investigated, with CER/GDP ranging from 0.55 to 1.56. The most influential factor in the sensitivity analysis was device cost, with the cost-effective threshold reached in all countries using discounted device costs that varied directly with GDP. Cochlear implantation and deaf education are equally cost effective in lower-middle and upper-middle income economies of Nigeria and South Africa. Device cost may have greater impact in the emerging economies of Kenya, Uganda, Rwanda, and Malawi.

  13. Precision Clock Evaluation Facility

    Data.gov (United States)

    Federal Laboratory Consortium — FUNCTION: Tests and evaluates high-precision atomic clocks for spacecraft, ground, and mobile applications. Supports performance evaluation, environmental testing,...

  14. Cost-effective strategies for rural community outreach, Hawaii, 2010-2011.

    Science.gov (United States)

    Pellegrin, Karen L; Barbato, Anna; Holuby, R Scott; Ciarleglio, Anita E; Taniguchi, Ronald

    2014-12-11

    Three strategies designed to maximize attendance at educational sessions on chronic disease medication safety in older adults in rural areas were implemented sequentially and compared for cost-effectiveness: 1) existing community groups and events, 2) formal advertisement, and 3) employer-based outreach. Cost-effectiveness was measured by comparing overall cost per attendee recruited and number of attendees per event. The overall cost per attendee was substantially higher for the formal advertising strategy, which produced the lowest number of attendees per event. Leveraging existing community events and employers in rural areas was more cost-effective than formal advertisement for recruiting rural community members.

  15. All-digital precision processing of ERTS images

    Science.gov (United States)

    Bernstein, R. (Principal Investigator)

    1975-01-01

    The author has identified the following significant results. Digital techniques have been developed and used to apply precision-grade radiometric and geometric corrections to ERTS MSS and RBV scenes. Geometric accuracies sufficient for mapping at 1:250,000 scale have been demonstrated. Radiometric quality has been superior to ERTS NDPF precision products. A configuration analysis has shown that feasible, cost-effective all-digital systems for correcting ERTS data are easily obtainable. This report contains a summary of all results obtained during this study and includes: (1) radiometric and geometric correction techniques, (2) reseau detection, (3) GCP location, (4) resampling, (5) alternative configuration evaluations, and (6) error analysis.

  16. Precision Teaching: An Introduction.

    Science.gov (United States)

    West, Richard P.; And Others

    1990-01-01

    Precision teaching is introduced as a method of helping students develop fluency or automaticity in the performance of academic skills. Precision teaching involves being aware of the relationship between teaching and learning, measuring student performance regularly and frequently, and analyzing the measurements to develop instructional and…

  17. The clinical and cost effectiveness of group art therapy for people with non-psychotic mental health disorders: a systematic review and cost-effectiveness analysis.

    Science.gov (United States)

    Uttley, Lesley; Stevenson, Matt; Scope, Alison; Rawdin, Andrew; Sutton, Anthea

    2015-07-07

    The majority of mental health problems are non-psychotic (e.g., depression, anxiety, and phobias). For some people, art therapy may be a more acceptable alternative form of psychological therapy than standard forms of treatment, such as talking therapies. This study was part of a health technology assessment commissioned by the National Institute for Health Research, UK and aimed to systematically appraise the clinical and cost-effective evidence for art therapy for people with non-psychotic mental health disorders. Comprehensive literature searches for studies examining art therapy in populations with non-psychotic mental health disorders were performed in May 2013. A quantitative systematic review of clinical effectiveness and a systematic review of studies evaluating the cost-effectiveness of group art therapy were conducted. Eleven randomised controlled trials were included (533 patients). Meta-analysis was not possible due to clinical heterogeneity and insufficient comparable data on outcome measures across studies. The control groups varied between studies but included: no treatment/wait-list, attention placebo controls and psychological therapy comparators. Art therapy was associated with significant positive changes relative to the control group in mental health symptoms in 7 of the 11 studies. A de novo model was constructed and populated with data identified from the clinical review. Scenario analyses were conducted allowing comparisons of group art therapy with wait-list control and group art therapy with group verbal therapy. Group art-therapy appeared cost-effective compared with wait-list control with high certainty although generalisability to the target population was unclear; group verbal therapy appeared more cost-effective than art therapy but there was considerable uncertainty and a sizeable probability that art therapy was more cost effective. From the limited available evidence art therapy was associated with positive effects compared with

  18. Twice-weighted multiple interval estimation of a marginal structural model to analyze cost-effectiveness.

    Science.gov (United States)

    Goldfeld, K S

    2014-03-30

    Cost-effectiveness analysis is an important tool that can be applied to the evaluation of a health treatment or policy. When the observed costs and outcomes result from a nonrandomized treatment, making causal inference about the effects of the treatment requires special care. The challenges are compounded when the observation period is truncated for some of the study subjects. This paper presents a method of unbiased estimation of cost-effectiveness using observational study data that is not fully observed. The method-twice-weighted multiple interval estimation of a marginal structural model-was developed in order to analyze the cost-effectiveness of treatment protocols for advanced dementia residents living nursing homes when they become acutely ill. A key feature of this estimation approach is that it facilitates a sensitivity analysis that identifies the potential effects of unmeasured confounding on the conclusions concerning cost-effectiveness.

  19. [Cost-effectiveness of Antipsychotics in the Maintenance Treatment of Schizophrenia in Colombia].

    Science.gov (United States)

    Quitian Reyes, Hoover; Arciniegas Barrera, Jair Alberto; Bohórquez Peñaranda, Adriana; Gómez Restrepo, Carlos

    2016-01-01

    Assess the cost-effectiveness of the antipsychotics for treatment of schizophrenia. A five-year Markov model was built form patients with schizophrenia on the stage of maintenance. Costs were taken from the perspective of the Colombian health care system (Sistema General de Seguridad Social en Salud). The effectiveness was measured in years of life under the same maintenance plan. The Markov model indicated clozapine as the as the most cost-effective alternative between the first line antipsychotics and haloperidol is it when comparing other antipsychotics. Clozapine it's the cost-effectiveness strategy among the first line of antipsychotics and haloperidol is it among the other antipsychotics. Strategies prioritizing the use of cost-effective antipsychotics could improve the resources allocation in the Colombian health care system. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  20. Cost-effectiveness of diagnostic strategies for patients with chest pain

    NARCIS (Netherlands)

    Kuntz, KM; Fleischmann, KE; Hunink, MGM; Douglas, PS

    1999-01-01

    Background: Many noninvasive tests exist to determine whether patients should undergo coronary angiography. The routine use of coronary angiography without previous noninvasive testing is typically not advocated. Objective: To determine the cost-effectiveness of diagnostic strategies for patients wi

  1. Cost effectiveness analysis of strategies for tuberculosis control in developing countries

    NARCIS (Netherlands)

    K. Floyd (Katherine); C. Dye; R.M.P.M. Baltussen (Rob)

    2005-01-01

    textabstractOBJECTIVE: To assess the costs and health effects of tuberculosis control interventions in Africa and South East Asia in the context of the millennium development goals. DESIGN: Cost effectiveness analysis based on an epidemiological model. SETTING: Analyses undertaken

  2. Cost Effectiveness of Integrated Medicine in Patients With Cancer Receiving Anticancer Chemotherapy

    OpenAIRE

    Coriat, Romain; Boudou-Rouquette, Pascaline; Durand, Jean-Philippe; Forgeot d'Arc, Priscille; Martin, Idalie; Mir, Olivier; Ropert, Stanislas; Alexandre, Jérôme; Goldwasser, François

    2012-01-01

    The hospital-home monitoring program is a cost-effective strategy for offering ambulatory chemotherapy treatment to patients with cancer and has become the authors' standard procedure for ambulatory chemotherapy.

  3. Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis

    DEFF Research Database (Denmark)

    Batwala, Vincent; Magnussen, Pascal; Hansen, Kristian Schultz

    2011-01-01

    ABSTRACT: BACKGROUND: Current Uganda National Malaria treatment guidelines recommend parasitological confirmation either by microscopy or rapid diagnostic test (RDT) before treatment with artemether-lumefantrine (AL). However, the cost-effectiveness of these strategies has not been assessed...

  4. Tuberculosis Control Priorities Defined by Using Cost-Effectiveness and Burden of Disease

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective To define TB control priorities using cost-effectiveness and burden of disease. Methods An assumed cohort of 2 000 cases was set up based on age-specific incidence of 794 newly registered smear-positive cases in Beijing in 1994. Prognostic trees and model diagrams of infectivity with natural history and DOTS intervention were constructed based on the epidemiological parameters. Results DOTS reduced 89.19 % of YLL, 78.90% of YLD, and 99.98% of infectivity BOD. One DALY could be saved with 45.70 Yuan by DOTS with 3% discount. Sensitivity analysis showed that discount had effect on CER. Weight of age was insensitive to CER. The higher the DOTS cured rate, the more the cost-effectiveness. Conclusions DOTS is a good cost-effectiveness TB control strategy. Cost-effectiveness and burden of disease can be used to define TB control priorities.

  5. Cost-effectiveness of rotavirus vaccination in the Netherlands; the results of a consensus model

    NARCIS (Netherlands)

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

    2011-01-01

    Background: Each year rotavirus gastroenteritis results in thousands of paediatric hospitalisations and primary care visits in the Netherlands. While two vaccines against rotavirus are registered, routine immunisation of infants has not yet been implemented. Existing cost-effectiveness studies showe

  6. Cost-effectiveness of rotavirus vaccination in the Netherlands; the results of a consensus model

    NARCIS (Netherlands)

    Rozenbaum, M.H.; Mangen, M.J.; Giaquinto, C.; Wilschut, J.C.; Hak, E.; Postma, M.J.; Groot, R. de

    2011-01-01

    BACKGROUND: Each year rotavirus gastroenteritis results in thousands of paediatric hospitalisations and primary care visits in the Netherlands. While two vaccines against rotavirus are registered, routine immunisation of infants has not yet been implemented. Existing cost-effectiveness studies showe

  7. Antibiotic prophylaxis for haematogenous bacterial arthritis in patients with joint disease: a cost effectiveness analysis

    NARCIS (Netherlands)

    P. Krijnen (Pieta); C.J. Kaandorp; E.W. Steyerberg (Ewout); D. van Schaardenburg (Dirkjan); H.J. Moens; J.D.F. Habbema (Dik)

    2001-01-01

    textabstractOBJECTIVE: To assess the cost effectiveness of antibiotic prophylaxis for haematogenous bacterial arthritis in patients with joint disease. METHODS: In a decision analysis, data from a prospective study on bacterial arthritis in 4907 patients with joint dise

  8. Cost-effectiveness of rotavirus vaccination in the Netherlands; the results of a consensus model

    NARCIS (Netherlands)

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

    2011-01-01

    Background: Each year rotavirus gastroenteritis results in thousands of paediatric hospitalisations and primary care visits in the Netherlands. While two vaccines against rotavirus are registered, routine immunisation of infants has not yet been implemented. Existing cost-effectiveness studies

  9. Cost-effectiveness of rotavirus vaccination in the Netherlands; the results of a consensus model

    NARCIS (Netherlands)

    Rozenbaum, M.H.; Mangen, M.J.; Giaquinto, C.; Wilschut, J.C.; Hak, E.; Postma, M.J.; Groot, R. de

    2011-01-01

    BACKGROUND: Each year rotavirus gastroenteritis results in thousands of paediatric hospitalisations and primary care visits in the Netherlands. While two vaccines against rotavirus are registered, routine immunisation of infants has not yet been implemented. Existing cost-effectiveness studies

  10. Economic evaluation of universal 7-valent pneumococcal conjugate vaccination in Taiwan: A cost-effectiveness analysis

    Directory of Open Access Journals (Sweden)

    David Bin Chia Wu

    2013-03-01

    Conclusion: Taking herd effect and indirect costs into account, PCV7 vaccination is cost-effective in Taiwan. Further pharmacoeconomic model should include herd effect in CEA of infectious disease research.

  11. Costs, effects, and savings of screening for cystic fibrosis gene carriers

    NARCIS (Netherlands)

    M.F. Wildhagen (Mark); H.B. Hilderink; J.G. Verzijl; J.B. Verheij (Joke); L. Kooij (Loes); T. Tijmstra; L.P. ten Kate; J.D.F. Habbema (Dik)

    1998-01-01

    textabstractSTUDY OBJECTIVE: Evaluating the costs, effects, and savings of several strategies for cystic fibrosis (CF) gene carrier screening. DESIGN: A general model for evaluating prenatal, preconceptional, school, and neonatal carrier screening was constructed. For p

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

    Science.gov (United States)

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

    2014-11-01

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

  13. Cost-effectiveness of cervical cancer prevention in Central and Eastern Europe and Central Asia.

    Science.gov (United States)

    Berkhof, Johannes; Bogaards, Johannes A; Demirel, Erhan; Diaz, Mireia; Sharma, Monisha; Kim, Jane J

    2013-12-31

    We studied the cost-effectiveness of cervical cancer prevention strategies in the Central and Eastern Europe and Central Asia (CEECA) region. The cost-effectiveness of human papillomavirus (HPV)16/18 vaccination of 12 year-old girls was calculated for 28 countries, under the assumption that vaccination prevents 70% of all cervical cancer cases and that cervical cancer and all-cause mortality rates are stable without vaccination. At three-dose vaccination costs of I$ 100 per vaccinated girl (currency 2005 international dollars), HPV16/18 vaccination was very cost-effective in 25 out of 28 countries using the country's gross domestic product (GDP) per capita as cost-effectiveness threshold (criterion by World Health Organization). A three-dose vaccination cost of I$ 100 is within the current range of vaccine costs in European immunization programs, and therefore our results indicate that HPV vaccination may be good value for money. To evaluate the cost-effectiveness of cervical cancer screening combined with vaccination, we calibrated a published simulation model to HPV genotype data collected in Slovenia, Poland, and Georgia. The screening interval was varied at 3, 6, and 10 years starting at age 25 or 30 and ending at age 60. In Slovenia and Poland, combined vaccination and 10-yearly HPV (DNA) screening (vaccination coverage 70%, screening coverage per round 70%) was very cost-effective when the cost of three-dose vaccination was I$ 100 per vaccinated girl. More intensive screening was very cost-effective when the screening coverage per round was 30% or 50%. In Georgia, 10-yearly Pap screening was very cost-effective in unvaccinated women. Vaccination combined with 10-yearly HPV screening was likely to be cost-effective if the three-dose vaccination cost was I$ 50 per vaccinated girl. To conclude, cervical cancer prevention strategies utilizing both HPV16/18 vaccination and HPV screening are very cost-effective in countries with sufficient resources. In low

  14. Cost-effectiveness analyses of training: a manager?s guide

    OpenAIRE

    O?Malley, Gabrielle; Marseille, Elliot; Weaver, Marcia R

    2013-01-01

    The evidence on the cost and cost-effectiveness of global training programs is sparse. This manager?s guide to cost-effectiveness analysis (CEA) is for professionals who want to recognize and support high quality CEA. It focuses on CEA of training in the context of program implementation or rapid program expansion. Cost analysis provides cost per output and CEA provides cost per outcome. The distinction between these two analyses is essential for making good decisions about value. A hypotheti...

  15. Cost-effectiveness analysis of interventions for migraine in four low- and middle-income countries

    OpenAIRE

    Linde, Mattias; Steiner, Timothy J.; Chisholm, Dan

    2015-01-01

    Background: Evidence of the cost and effects of interventions for reducing the global burden of migraine remains scarce. Our objective was to estimate the population-level cost-effectiveness of evidence-based migraine interventions and their contributions towards reducing current burden in low- and middle-income countries. Methods: Using a standard WHO approach to cost-effectiveness analysis (CHOICE), we modelled core set intervention strategies for migraine, taking account of cov...

  16. Cost-effectiveness analysis of interventions for migraine in four low- and middle-income countries

    OpenAIRE

    Linde, Mattias; Steiner, Timothy J.; Chisholm, Dan

    2015-01-01

    Background Evidence of the cost and effects of interventions for reducing the global burden of migraine remains scarce. Our objective was to estimate the population-level cost-effectiveness of evidence-based migraine interventions and their contributions towards reducing current burden in low- and middle-income countries. Methods Using a standard WHO approach to cost-effectiveness analysis (CHOICE), we modelled core set intervention strategies for migraine, taking account of coverage and effi...

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

    OpenAIRE

    Davoud Haseli; Nader Naghshineh; fatemeh Fahimnia

    2014-01-01

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

  18. Cost effectiveness of hepatitis A/B versus hepatitis B vaccination for US prison inmates.

    Science.gov (United States)

    Jacobs, R Jake; Rosenthal, Philip; Meyerhoff, Allen S

    2004-03-12

    Hepatitis B immunization is provided in many US prison systems. We examined the cost effectiveness of substituting bivalent hepatitis A/B vaccine in this setting, considering regional variation in hepatitis A risks and the potential for disease transmission by former prisoners. Where hepatitis A rates are >200, 100-200, and effectiveness would be US$ Prison-based hepatitis A/B immunization would meet accepted standards of cost effectiveness throughout the US.

  19. COST-EFFECTIVENESS ANALYSIS OF ANTI-DIABETIC THERAPY IN A UNIVERSITY TEACHING HOSPITAL

    OpenAIRE

    Giwa Abdulganiyu; Tayo Fola

    2014-01-01

    Purpose: To conduct cost-effectiveness analysis of anti-diabetic therapy in a University Teaching Hospital in 2010. Methods: A retrospective review of selected case-notes was conducted. World Health Organization Defined Daily Dose Method of evaluating drug use and probability method for potential effectiveness of antidiabetic therapeutic options from literature analysis was employed in determining cost-effectiveness of each anti-diabetic therapeutic option identified from anti-diabetic dru...

  20. A Cost-Effectiveness Analysis of the Swedish Universal Parenting Program All Children in Focus.

    Directory of Open Access Journals (Sweden)

    Malin Ulfsdotter

    Full Text Available There are few health economic evaluations of parenting programs with quality-adjusted life-years (QALYs as the outcome measure. The objective of this study was, therefore, to conduct a cost-effectiveness analysis of the universal parenting program All Children in Focus (ABC. The goals were to estimate the costs of program implementation, investigate the health effects of the program, and examine its cost-effectiveness.A cost-effectiveness analysis was conducted. Costs included setup costs and operating costs. A parent proxy Visual Analog Scale was used to measure QALYs in children, whereas the General Health Questionnaire-12 was used for parents. A societal perspective was adopted, and the incremental cost-effectiveness ratio was calculated. To account for uncertainty in the estimate, the probability of cost-effectiveness was investigated, and sensitivity analyses were used to account for the uncertainty in cost data.The cost was € 326.3 per parent, of which € 53.7 represented setup costs under the assumption that group leaders on average run 10 groups, and € 272.6 was the operating costs. For health effects, the QALY gain was 0.0042 per child and 0.0027 per parent. These gains resulted in an incremental cost-effectiveness ratio for the base case of € 47 290 per gained QALY. The sensitivity analyses resulted in ratios from € 41 739 to € 55 072. With the common Swedish threshold value of € 55 000 per QALY, the probability of the ABC program being cost-effective was 50.8 percent.Our analysis of the ABC program demonstrates cost-effectiveness ratios below or just above the QALY threshold in Sweden. However, due to great uncertainty about the data, the health economic rationale for implementation should be further studied considering a longer time perspective, effects on siblings, and validated measuring techniques, before full scale implementation.

  1. Cost-Effectiveness of Different Diagnostic Strategies in Suspected Stable Coronary Artery Disease in Portugal

    Energy Technology Data Exchange (ETDEWEB)

    Ferreira, António Miguel, E-mail: miguelferreira.md@sapo.pt [Hospital da Luz, Lisboa (Portugal); Hospital Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisboa (Portugal); Marques, Hugo [Hospital da Luz, Lisboa (Portugal); Hospital Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa (Portugal); Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa (Portugal); Gonçalves, Pedro Araújo [Hospital da Luz, Lisboa (Portugal); Hospital Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisboa (Portugal); Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa (Portugal); Cardim, Nuno [Hospital da Luz, Lisboa (Portugal); Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa (Portugal)

    2014-04-15

    Cost-effectiveness is an increasingly important factor in the choice of a test or therapy. To assess the cost-effectiveness of various methods routinely used for the diagnosis of stable coronary disease in Portugal. Seven diagnostic strategies were assessed. The cost-effectiveness of each strategy was defined as the cost per correct diagnosis (inclusion or exclusion of obstructive coronary artery disease) in a symptomatic patient. The cost and effectiveness of each method were assessed using Bayesian inference and decision-making tree analyses, with the pretest likelihood of disease ranging from 10% to 90%. The cost-effectiveness of diagnostic strategies was strongly dependent on the pretest likelihood of disease. In patients with a pretest likelihood of disease of ≤50%, the diagnostic algorithms, which include cardiac computed tomography angiography, were the most cost-effective. In these patients, depending on the pretest likelihood of disease and the willingness to pay for an additional correct diagnosis, computed tomography angiography may be used as a frontline test or reserved for patients with positive/inconclusive ergometric test results or a calcium score of >0. In patients with a pretest likelihood of disease of ≥ 60%, up-front invasive coronary angiography appears to be the most cost-effective strategy. Diagnostic algorithms that include cardiac computed tomography angiography are the most cost-effective in symptomatic patients with suspected stable coronary artery disease and a pretest likelihood of disease of ≤50%. In high-risk patients (pretest likelihood of disease ≥ 60%), up-front invasive coronary angiography appears to be the most cost-effective strategy. In all pretest likelihoods of disease, strategies based on ischemia appear to be more expensive and less effective compared with those based on anatomical tests.

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

    OpenAIRE

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

    2012-01-01

    INTRODUCTION: Since alendronate became available in generic form in the Unites States in 2008, its price has been decreasing. The objective of this study was to investigate the impact of alendronate cost on the cost-effectiveness of osteoporosis screening and treatment in postmenopausal women. METHODS: Microsimulation cost-effectiveness model of osteoporosis screening and treatment for U.S. women age 65 and older. We assumed screening initiation at age 65 with central dual-energy x-ray absorp...

  3. Cost-effectiveness of a hypertension management programme in an elderly population: a Markov model

    Directory of Open Access Journals (Sweden)

    Figar Silvana

    2011-04-01

    Full Text Available Abstract Background Mounting evidence shows that multi-intervention programmes for hypertension treatment are more effective than an isolated pharmacological strategy. Full economic evaluations of hypertension management programmes are scarce and contain methodological limitations. The aim of the study was to evaluate if a hypertension management programme for elderly patients is cost-effective compared to usual care from the perspective of a third-party payer. Methods We built a cost-effectiveness model using published evidence of effectiveness of a comprehensive hypertension programme vs. usual care for patients 65 years or older at a community hospital in Buenos Aires, Argentina. We explored incremental cost-effectiveness between groups. The model used a life-time framework adopting a third-party payer's perspective. Incremental cost-effectiveness ratio (ICER was calculated in International Dollars per life-year gained. We performed a probabilistic sensitivity analysis (PSA to explore variable uncertainty. Results The ICER for the base-case of the "Hypertension Programme" versus the "Usual care" approach was 1,124 International Dollars per life-year gained. PSA did not significantly influence results. The programme had a probability of 43% of being dominant (more effective and less costly and, overall, 95% chance of being cost-effective. Discussion Results showed that "Hypertension Programme" had high probabilities of being cost-effective under a wide range of scenarios. This is the first sound cost-effectiveness study to assess a comprehensive hypertension programme versus usual care. This study measures hard outcomes and explores robustness through a probabilistic sensitivity analysis. Conclusions The comprehensive hypertension programme had high probabilities of being cost-effective versus usual care. This study supports the idea that similar programmes could be the preferred strategy in countries and within health care systems where

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

    OpenAIRE

    Reza Rostamzadeh; Mahdi Sabaghi; Ahmad Esmaili

    2013-01-01

    The aim of this paper is to evaluate and prioritize the proposed cost-effectiveness criteria in supply chain management using fuzzy multiple attribute decision-making (MADM) approach. Over the past few years, the determination of suitable cost-effectiveness criteria in the supply chain has become a key strategic issue. However, the nature of these kinds of decisions is usually complex and unstructured. Many quantitative and qualitative factors must be considered to determine the suitable crit...

  5. Assessing the value of mepolizumab for severe eosinophilic asthma: a cost-effectiveness analysis.

    Science.gov (United States)

    Whittington, Melanie D; McQueen, R Brett; Ollendorf, Daniel A; Tice, Jeffrey A; Chapman, Richard H; Pearson, Steven D; Campbell, Jonathan D

    2017-02-01

    Adding mepolizumab to standard treatment with inhaled corticosteroids and controller medications could decrease asthma exacerbations and use of long-term oral steroids in patients with severe disease and increased eosinophils; however, mepolizumab is costly and its cost effectiveness is unknown. To estimate the cost effectiveness of mepolizumab. A Markov model was used to determine the incremental cost per quality-adjusted life year (QALY) gained for mepolizumab plus standard of care (SoC) and for SoC alone. The population, adults with severe eosinophilic asthma, was modeled for a lifetime time horizon. A responder scenario analysis was conducted to determine the cost effectiveness for a cohort able to achieve and maintain asthma control. Over a lifetime treatment horizon, 23.96 exacerbations were averted per patient receiving mepolizumab plus SoC. Avoidance of exacerbations and decrease in long-term oral steroid use resulted in more than $18,000 in cost offsets among those receiving mepolizumab, but treatment costs increased by more than $600,000. Treatment with mepolizumab plus SoC vs SoC alone resulted in a cost-effectiveness estimate of $386,000 per QALY. To achieve cost effectiveness of approximately $150,000 per QALY, mepolizumab would require a more than 60% price discount. At current pricing, treating a responder cohort yielded cost-effectiveness estimates near $160,000 per QALY. The estimated cost effectiveness of mepolizumab exceeds value thresholds. Achieving these thresholds would require significant discounts from the current list price. Alternatively, treatment limited to responders improves the cost effectiveness toward, but remains still slightly above, these thresholds. Payers interested in improving the efficiency of health care resources should consider negotiations of the mepolizumab price and ways to predict and assess the response to mepolizumab. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All

  6. Cost effectiveness of treatments for wet age-related macular degeneration

    OpenAIRE

    Mitchell, Paul; Annemans, Lieven; White, Richard; Gallagher, Meghan; Thomas, Simu

    2011-01-01

    Age-related macular degeneration (AMD) is a leading cause of blindness in people aged >= 50 years. Wet AMD in particular has a major impact on patient quality of life and imposes substantial burdens on healthcare systems. This systematic review examined the cost-effectiveness data for current therapeutic options for wet AMD. PubMed and EMBASE databases were searched for all articles reporting original cost-effectiveness analyses of wet AMD treatments. The Centre for Reviews and Dissemination ...

  7. Cost Effectiveness of Treatments for Wet Age-Related Macular Degeneration

    OpenAIRE

    Paul Mitchell; Lieven Annemans; Richard White; Meghan Gallagher; Simu Thomas

    2011-01-01

    Age-related macular degeneration (AMD) is a leading cause of blindness in people aged ≥50 years. Wet AMD in particular has a major impact on patient quality of life and imposes substantial burdens on healthcare systems. This systematic review examined the cost-effectiveness data for current therapeutic options for wet AMD. PubMed and EMBASE databases were searched for all articles reporting original cost-effectiveness analyses of wet AMD treatments. The Centre for Reviews and Dissemination an...

  8. The cost-effectiveness of supportive periodontal care: a global perspective.

    OpenAIRE

    2011-01-01

    Abstract Aim: To evaluate the cost-effectiveness of supportive periodontal care (SPC) provided in generalist and periodontal specialist practices under publicly subsidised or private dental care. Material and Methods: SPC cost data and the costs of replacing teeth were synthesised with estimates of the effectiveness of SPC in preventing attachment and tooth loss and adjusted for differences in clinician?s time. Incremental Cost-Effectiveness Ratios were calculated for both outc...

  9. Levee Setbacks: An Innovative, Cost Effective, and Sustainable Solution for Improved Flood Risk management

    Science.gov (United States)

    2017-06-30

    ER D C/ EL S R- 17 -3 Levee Setbacks: An Innovative, Cost-Effective, and Sustainable Solution for Improved Flood Risk Management En vi...EL SR-17-3 June 2017 Levee Setbacks: An Innovative, Cost-Effective, and Sustainable Solution for Improved Flood Risk Management David L. Smith...describes levee setbacks as alternatives to traditional levees for flood risk management and environmental benefits. It is organized into five sections

  10. Cost-effectiveness analysis of combination therapies for visceral leishmaniasis in the Indian subcontinent.

    Directory of Open Access Journals (Sweden)

    Filip Meheus

    Full Text Available BACKGROUND: Visceral leishmaniasis is a systemic parasitic disease that is fatal unless treated. We assessed the cost and cost-effectiveness of alternative strategies for the treatment of visceral leishmaniasis in the Indian subcontinent. In particular we examined whether combination therapies are a cost-effective alternative compared to monotherapies. METHODS AND FINDINGS: We assessed the cost-effectiveness of all possible mono- and combination therapies for the treatment of visceral leishmaniasis in the Indian subcontinent (India, Nepal and Bangladesh from a societal perspective using a decision analytical model based on a decision tree. Primary data collected in each country was combined with data from the literature and an expert poll (Delphi method. The cost per patient treated and average and incremental cost-effectiveness ratios expressed as cost per death averted were calculated. Extensive sensitivity analysis was done to evaluate the robustness of our estimations and conclusions. With a cost of US$92 per death averted, the combination miltefosine-paromomycin was the most cost-effective treatment strategy. The next best alternative was a combination of liposomal amphotericin B with paromomycin with an incremental cost-effectiveness of $652 per death averted. All other strategies were dominated with the exception of a single dose of 10mg per kg of liposomal amphotericin B. While strategies based on liposomal amphotericin B (AmBisome were found to be the most effective, its current drug cost of US$20 per vial resulted in a higher average cost-effectiveness. Sensitivity analysis showed the conclusion to be robust to variations in the input parameters over their plausible range. CONCLUSIONS: Combination treatments are a cost-effective alternative to current monotherapy for VL. Given their expected impact on the emergence of drug resistance, a switch to combination therapy should be considered once final results from clinical trials are

  11. A commentary review of the cost effectiveness of manual therapies for neck and low back pain.

    Science.gov (United States)

    Harper, Brent; Jagger, Kristen; Aron, Adrian; Steinbeck, Larry; Stecco, Antonio

    2017-07-01

    Neck and low back pain (NLBP) are global health problems, which diminish quality of life and consume vast economic resources. Cost effectiveness in healthcare is the minimal amount spent to obtain acceptable outcomes. Studies on manual therapies often fail to identify which manual therapy intervention or combinations with other interventions is the most cost effective. The purpose of this commentary is to sample the dialogue within the literature on the cost effectiveness of evidence-based manual therapies with a particular focus on the neck and low back regions. This commentary identifies and presents the available literature on the cost effectiveness of manual therapies for NLBP. Key words searched were neck and low back pain, cost effectiveness, and manual therapy to select evidence-based articles. Eight articles were identified and presented for discussion. The lack of homogeneity, in the available literature, makes difficult any valid comparison among the various cost effectiveness studies. Potential outcome bias in each study is dependent upon the lens through which it is evaluated. If evaluated from a societal perspective, the conclusion slants toward "adequate" interventions in an effort to decrease costs rather than toward the most efficacious interventions with the best outcomes. When cost data are assessed according to a healthcare (or individual) perspective, greater value is placed on quality of life, the patient's beliefs, and the "willingness to pay." Copyright © 2016 Elsevier Ltd. All rights reserved.

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

    LENUS (Irish Health Repository)

    Bennett, Kathleen

    2009-01-01

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

  13. The augmented representation of the cost-effectiveness acceptability curve for economic evaluation of health technology.

    Science.gov (United States)

    Araki, Daiji; Kamae, Isao

    2015-03-24

    New schemes on the cost-effectiveness acceptability curve (CEAC) were developed, which can make the CEAC augmented to be more informative regarding the types of acceptance and statistical inference. Theoretical approaches have been undertaken to address two questions: 1) how the area under the curve (AUC) can be zoned by different types of acceptance displayed on the incremental cost-effectiveness plane, and 2) how the accepted dataset of incremental cost-effectiveness ratios (ICERs), which are generated by simulation runs, can be statistically associated with a threshold of ICER for acceptance. To address the first question, the AUC of a typically sigmoid-shaped CEAC was divided into three zones according to the three segmentations of the scattered plots accepted at South-east, North-east and South-west quadrants on the incremental cost-effectiveness plane. A solution for the second question was "a new CEAC of the mean" (mCEAC), which is defined by plotting a pair of the mean and its occurrence probability of ICER accepted at North-east quadrant on the incremental cost-effectiveness plane. All those schemes were graphically illustrated based on hypothetical examples using the bootstrapping simulation. Our new schemes on CEAC will provide decision makers with useful information on cost-effectiveness assessment beyond the standard presentation of CEAC.

  14. Cost-effectiveness of novel diagnostic tools for the diagnosis of tuberculosis.

    Science.gov (United States)

    Dowdy, D W; O'Brien, M A; Bishai, D

    2008-09-01

    The potential cost-effectiveness of improved diagnostic tests for tuberculosis (TB) in resource-limited settings is unknown. To estimate the incremental cost-effectiveness of a hypothetical new point-of-care TB diagnostic test in South Africa, Brazil and Kenya. Decision-analysis model, adding four diagnostic interventions (sputum smear microscopy, new test, smear plus new test and smear plus TB culture) to a baseline of existing infrastructure without smear. Adding sputum smear was estimated to be more cost-effective (incremental cost per disability-adjusted life year [DALY] of $86 [South Africa], $131 [Brazil], $38 (Kenya]) than a new TB diagnostic with 70% sensitivity, 95% specificity and price of $20 per test ($198 [South Africa], $275 [Brazil], $84 [Kenya]). However, compared to sputum smear, smear plus new test averted 46-49% more DALYs per 1000 TB suspects (321 vs. 215 [South Africa], 243 vs. 166 [Brazil], 790 vs. 531 [Kenya]), at an incremental cost of $170 (Kenya) to $625 (Brazil) per DALY averted. Cost-effectiveness was most sensitive to the specificity and price of the new test, the baseline TB case detection rate and the discount rate. Novel diagnostic tests for TB are potentially highly cost-effective. Cost-effectiveness is maximized by high-specificity, low-cost tests deployed to regions with poor infrastructure.

  15. Iron fortification and iron supplementation are cost-effective interventions to reduce iron deficiency in four subregions of the world

    NARCIS (Netherlands)

    C. Knai; M. Sharan; R.M.P.M. Baltussen (Rob)

    2004-01-01

    textabstractIron deficiency is the most common and widespread nutritional disorder in the world, affecting millions of people in both nonindustrialized and industrialized countries. We estimated the costs, effects, and cost-effectiveness of iron supplementation and iron

  16. Iron fortification and iron supplementation are cost-effective interventions to reduce iron deficiency in four subregions of the world

    NARCIS (Netherlands)

    C. Knai; M. Sharan; R.M.P.M. Baltussen (Rob)

    2004-01-01

    textabstractIron deficiency is the most common and widespread nutritional disorder in the world, affecting millions of people in both nonindustrialized and industrialized countries. We estimated the costs, effects, and cost-effectiveness of iron supplementation and iron fortificati

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

    Science.gov (United States)

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

    2004-08-01

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

  18. Precision volume measurement system.

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, Erin E.; Shugard, Andrew D.

    2004-11-01

    A new precision volume measurement system based on a Kansas City Plant (KCP) design was built to support the volume measurement needs of the Gas Transfer Systems (GTS) department at Sandia National Labs (SNL) in California. An engineering study was undertaken to verify or refute KCP's claims of 0.5% accuracy. The study assesses the accuracy and precision of the system. The system uses the ideal gas law and precise pressure measurements (of low-pressure helium) in a temperature and computer controlled environment to ratio a known volume to an unknown volume.

  19. Accounting for the drug life cycle and future drug prices in cost-effectiveness analysis.

    Science.gov (United States)

    Hoyle, Martin

    2011-01-01

    Economic evaluations of health technologies typically assume constant real drug prices and model only the cohort of patients currently eligible for treatment. It has recently been suggested that, in the UK, we should assume that real drug prices decrease at 4% per annum and, in New Zealand, that real drug prices decrease at 2% per annum and at patent expiry the drug price falls. It has also recently been suggested that we should model multiple future incident cohorts. In this article, the cost effectiveness of drugs is modelled based on these ideas. Algebraic expressions are developed to capture all costs and benefits over the entire life cycle of a new drug. The lifetime of a new drug in the UK, a key model parameter, is estimated as 33 years, based on the historical lifetime of drugs in England over the last 27 years. Under the proposed methodology, cost effectiveness is calculated for seven new drugs recently appraised in the UK. Cost effectiveness as assessed in the future is also estimated. Whilst the article is framed in mathematics, the findings and recommendations are also explained in non-mathematical language. The 'life-cycle correction factor' is introduced, which is used to convert estimates of cost effectiveness as traditionally calculated into estimates under the proposed methodology. Under the proposed methodology, all seven drugs appear far more cost effective in the UK than published. For example, the incremental cost-effectiveness ratio decreases by 46%, from £61, 900 to £33, 500 per QALY, for cinacalcet versus best supportive care for end-stage renal disease, and by 45%, from £31,100 to £17,000 per QALY, for imatinib versus interferon-α for chronic myeloid leukaemia. Assuming real drug prices decrease over time, the chance that a drug is publicly funded increases over time, and is greater when modelling multiple cohorts than with a single cohort. Using the methodology (compared with traditional methodology) all drugs in the UK and New

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

    NARCIS (Netherlands)

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

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

  1. A model-based cost-effectiveness analysis of osteoporosis screening and treatment strategy for postmenopausal Japanese women.

    Science.gov (United States)

    Yoshimura, M; Moriwaki, K; Noto, S; Takiguchi, T

    2017-02-01

    Although an osteoporosis screening program has been implemented as a health promotion project in Japan, its cost-effectiveness has yet to be elucidated fully. We performed a cost-effectiveness analysis and found that osteoporosis screening and treatment would be cost-effective for Japanese women over 60 years.

  2. Precision Measurement in Biology

    Science.gov (United States)

    Quake, Stephen

    Is biology a quantitative science like physics? I will discuss the role of precision measurement in both physics and biology, and argue that in fact both fields can be tied together by the use and consequences of precision measurement. The elementary quanta of biology are twofold: the macromolecule and the cell. Cells are the fundamental unit of life, and macromolecules are the fundamental elements of the cell. I will describe how precision measurements have been used to explore the basic properties of these quanta, and more generally how the quest for higher precision almost inevitably leads to the development of new technologies, which in turn catalyze further scientific discovery. In the 21st century, there are no remaining experimental barriers to biology becoming a truly quantitative and mathematical science.

  3. Laser precision microfabrication

    CERN Document Server

    Sugioka, Koji; Pique, Alberto

    2010-01-01

    Miniaturization and high precision are rapidly becoming a requirement for many industrial processes and products. As a result, there is greater interest in the use of laser microfabrication technology to achieve these goals. This book composed of 16 chapters covers all the topics of laser precision processing from fundamental aspects to industrial applications to both inorganic and biological materials. It reviews the sate of the art of research and technological development in the area of laser processing.

  4. COST-EFFECTIVENESS ANALYSIS OF ANTI-DIABETIC THERAPY IN A UNIVERSITY TEACHING HOSPITAL

    Directory of Open Access Journals (Sweden)

    Giwa Abdulganiyu

    2014-03-01

    Full Text Available Purpose: To conduct cost-effectiveness analysis of anti-diabetic therapy in a University Teaching Hospital in 2010. Methods: A retrospective review of selected case-notes was conducted. World Health Organization Defined Daily Dose Method of evaluating drug use and probability method for potential effectiveness of antidiabetic therapeutic options from literature analysis was employed in determining cost-effectiveness of each anti-diabetic therapeutic option identified from anti-diabetic drug utilization studies. Sample Size, n=1200. Subjects’ case-notes were selected by systematic random sampling (Sampling Interval = 1. Results: Glibenclamide (N1.76/unit of effectiveness which was more cost-effective than chlopropamide (N2.97/unit of effectiveness in the management of moderate hyperglycemia in non-obese Type II Diabetes Mellitus was more frequently prescribed (81.5%. Glibenclamide + Metformin (N7.63/unit of effectiveness which was more frequently prescribed (92.5% was not necessarily more cost-effective than Chlopropamide + Metformin (N9.76/unit of effectiveness in the management of moderate hyperglycemia in obese Type II Diabetes- Mellitus. Biphasic Isophane Insulin (N12.65/unit of effectiveness which was more cost-effective than soluble insulin + insulin zinc (N30.37/unit of effectiveness in the management of serve hyperglycemia in non-obese Type II Diabetes Mellitus was less frequently prescribed (42.3%. Biphasic Isophane Insulin + Metformin (N15.91/unit of effectiveness which was more cost-effective than soluble insulin + insulin zinc + metformin (N34.45/ unit of effectiveness in the management of severe hyperglycemia in obese Type II Diabetes Mellitus patients was less frequently prescribed (25%. Conclusions: Prescription of lees cost-effective anti-diabetic drugs was rampant in Hospitals.

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

    Directory of Open Access Journals (Sweden)

    Michelle Remme

    2014-11-01

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

  6. Cost-effectiveness of Total Knee Arthroplasty in the United States

    Science.gov (United States)

    Losina, Elena; Walensky, Rochelle P.; Kessler, Courtenay L.; Emrani, Parastu S.; Reichmann, William M.; Wright, Elizabeth A.; Holt, Holly L.; Solomon, Daniel H.; Yelin, Edward; Paltiel, A. David; Katz, Jeffrey N.

    2009-01-01

    Background Total knee arthroplasty (TKA) relieves pain and improves quality of life for persons with advanced knee osteoarthritis. However, to our knowledge, the cost-effectiveness of TKA and the influences of hospital volume and patient risk on TKA cost-effectiveness have not been investigated in the United States. Methods We developed a Markov, state-transition, computer simulation model and populated it with Medicare claims data and cost and outcomes data from national and multinational sources. We projected lifetime costs and quality-adjusted life expectancy (QALE) for different risk populations and varied TKA intervention and hospital volume. Cost-effectiveness of TKA was estimated across all patient risk and hospital volume permutations. Finally, we conducted sensitivity analyses to determine various parameters’ influences on cost-effectiveness. Results Overall, TKA increased QALE from 6.822 to 7.957 quality-adjusted life years (QALYs). Lifetime costs rose from $37 100 (no TKA) to $57 900 after TKA, resulting in an incremental cost-effectiveness ratio of $18 300 per QALY. For high-risk patients, TKA increased QALE from 5.713 to 6.594 QALY, yielding a cost-effectiveness ratio of $28 100 per QALY. At all risk levels, TKA was more costly and less effective in low-volume centers than in high-volume centers. Results were insensitive to variations of key input parameters within policy-relevant, clinically plausible ranges. The greatest variations were seen for the quality of life gain after TKA and the cost of TKA. Conclusions Total knee arthroplasty appears to be cost-effective in the US Medicare-aged population, as currently practiced across all risk groups. Policy decisions should be made on the basis of available local options for TKA. However, when a high-volume hospital is available, TKAs performed in a high-volume hospital confer even greater value per dollar spent than TKAs performed in low-volume centers. PMID:19546411

  7. Antihypertensive drugs: a perspective on pharmaceutical price erosion and its impact on cost-effectiveness.

    Science.gov (United States)

    Refoios Camejo, Rodrigo; McGrath, Clare; Herings, Ron; Meerding, Willem-Jan; Rutten, Frans

    2012-01-01

    When comparators' prices decrease due to market competition and loss of exclusivity, the incremental clinical effectiveness required for a new technology to be cost-effective is expected to increase; and/or the minimum price at which it will be funded will tend to decrease. This may be, however, either unattainable physiologically or financially unviable for drug development. The objective of this study is to provide an empirical basis for this discussion by estimating the potential for price decreases to impact on the cost-effectiveness of new therapies in hypertension. Cost-effectiveness at launch was estimated for all antihypertensive drugs launched between 1998 and 2008 in the United Kingdom using hypothetical degrees of incremental clinical effectiveness within the methodologic framework applied by the UK National Institute for Health and Clinical Excellence. Incremental cost-effectiveness ratios were computed and compared with funding thresholds. In addition, the levels of incremental clinical effectiveness required to achieve specific cost-effectiveness thresholds at given prices were estimated. Significant price decreases were observed for existing drugs. This was shown to markedly affect cost-effectiveness of technologies entering the market. The required incremental clinical effectiveness was in many cases greater than physiologically possible so, as a consequence, a number of products might not be available today if current methods of economic appraisal had been applied. We conclude that the definition of cost-effectiveness thresholds is fundamental in promoting efficient innovation. Our findings demonstrate that comparator price attrition has the potential to put pressure in the pharmaceutical research model and presents a challenge to new therapies being accepted for funding. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  8. Cost-effectiveness of Barostim therapy for the treatment of resistant hypertension in European settings.

    Science.gov (United States)

    Borisenko, Oleg; Beige, Joachim; Lovett, Eric G; Hoppe, Uta C; Bjessmo, Staffan

    2014-03-01

    The purpose of this study is to simulate the cost-effectiveness and the long-term clinical performance of the Barostim neo System for the treatment of resistant hypertension when compared to optimal medical treatment. A decision analytic model with a combination of a decision tree and Markov process was used to evaluate the cost-effectiveness of Barostim. The clinical effectiveness of Barostim was based on the results of the randomized, placebo-controlled Rheos trial and the follow-up substudy of the DEBuT-HT trial. The cost-effectiveness was modelled from a German societal perspective over a lifetime horizon. Patients with high SBP levels have an increased risk of myocardial infarction, stroke, heart failure and end-stage renal disease. In a simulated cohort of 50-year-old patients at high risk of end-organ damage, Barostim therapy generated 1.66 additional life-years and 2.17 additional quality-adjusted life years with an incremental cost of &OV0556;16 891 when compared with continuation of medical management. Barostim was estimated to be cost-effective compared with optimal medical treatment with an incremental cost-effectiveness ratio of &OV0556;7 797/QALY. In the model, Barostim reduced over a lifetime the rates of myocardial infarction by 19%, stroke by 35%, heart failure by 12% and end-stage renal disease by 23%. The cost-effectiveness of Barostim can be greater in younger patients with resistant hypertension and in patients with significant risk factors for end-organ damage. Barostim may be a cost-effective treatment when compared with optimal medical management in patients with resistant hypertension.

  9. Bayesian comparison of cost-effectiveness of different clinical approaches to diagnose coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Patterson, R.E.; Eng, C.; Horowitz, S.F.; Gorlin, R.; Goldstein, S.R.

    1984-08-01

    The objective of this study was to compare the cost-effectiveness of four clinical policies (policies I to IV) in the diagnosis of the presence or absence of coronary artery disease. A model based on Bayes theorem and published clinical data was constructed to make these comparisons. Effectiveness was defined as either the number of patients with coronary disease diagnosed or as the number of quality-adjusted life years extended by therapy after the diagnosis of coronary disease. The following conclusions arise strictly from analysis of the model and may not necessarily be applicable to all situations. As prevalence of coronary disease in the population increased, it caused a linear increase in cost per patient tested, but a hyperbolic decrease in cost per effect, that is, increased cost-effectiveness. Thus, cost-effectiveness of all policies (I to IV) was poor in populations with a prevalence of disease below 10%. Analysis of the model also indicates that at prevalences less than 80%, exercise thallium scintigraphy alone as a first test (policy II) is a more cost-effective initial test than is exercise electrocardiography alone as a first test (policy I) or exercise electrocardiography first combined with thallium imaging as a second test (policy IV). Exercise electrocardiography before thallium imaging (policy IV) is more cost-effective than exercise electrocardiography alone (policy I) at prevalences less than 80%. 4) Noninvasive exercise testing before angiography (policies I, II and IV) is more cost-effective than using coronary angiography as the first and only test (policy III) at prevalences less than 80%. 5) Above a threshold value of prevalence of 80% (for example patients with typical angina), proceeding to angiography as the first test (policy III) was more cost-effective than initial noninvasive exercise tests (policies I, II and IV).

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

    Science.gov (United States)

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

    2013-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Joakim Ramsberg

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

  12. Guidelines for pharmacoeconomic studies. Recommendations from the panel on cost effectiveness in health and medicine. Panel on cost Effectiveness in Health and Medicine.

    Science.gov (United States)

    Siegel, J E; Torrance, G W; Russell, L B; Luce, B R; Weinstein, M C; Gold, M R

    1997-02-01

    This article reports the recommendations of the Panel on Cost Effectiveness in Health and Medicine, sponsored by the US Public Health Service, on standardised methods for conducting cost-effectiveness analyses. Although not expressly directed at analyses of pharmaceutical agents, the Panel's recommendations are relevant to pharmacoeconomic studies. The Panel outlines a 'Reference Case' set of methodological practices to improve quality and comparability of analyses. Designed for studies that inform resource-allocation decisions, the Reference Case includes recommendations for study framing and scope, components of the numerator and denominator of cost-effectiveness ratios, discounting, handling uncertainty and reporting. The Reference Case analysis is conducted from the societal perspective, and includes all effects of interventions on resource use and health. Resource use includes 'time' resources, such as for caregiving or undergoing an intervention. The quality-adjusted life-year (QALY) is the common measure of health effect across Reference Case studies. Although the Panel does not endorse a measure for obtaining quality-of-life weights, several recommendations address the QALY. The Panel recommends a 3% discount rate for costs and health effects. Pharmacoeconomic studies have burgeoned in recent years. The Reference Case analysis will improve study quality and usability, and permit comparison of pharmaceuticals with other health interventions.

  13. Prevention and treatment of cardiovascular disease in Ethiopia: a cost-effectiveness analysis.

    Science.gov (United States)

    Tolla, Mieraf Taddesse; Norheim, Ole Frithjof; Memirie, Solomon Tessema; Abdisa, Senbeta Guteta; Ababulgu, Awel; Jerene, Degu; Bertram, Melanie; Strand, Kirsten; Verguet, Stéphane; Johansson, Kjell Arne

    2016-01-01

    The coverage of prevention and treatment strategies for ischemic heart disease and stroke is very low in Ethiopia. In view of Ethiopia's meager healthcare budget, it is important to identify the most cost-effective interventions for further scale-up. This paper's objective is to assess cost-effectiveness of prevention and treatment of ischemic heart disease (IHD) and stroke in an Ethiopian setting. Fifteen single interventions and sixteen intervention packages were assessed from a healthcare provider perspective. The World Health Organization's Choosing Interventions that are Cost-Effective model for cardiovascular disease was updated with available country-specific inputs, including demography, mortality and price of traded and non-traded goods. Costs and health benefits were discounted at 3 % per year. Incremental cost-effectiveness ratios are reported in US$ per disability adjusted life year (DALY) averted. Sensitivity analysis was undertaken to assess robustness of our results. Combination drug treatment for individuals having >35 % absolute risk of a CVD event in the next 10 years is the most cost-effective intervention. This intervention costs US$67 per DALY averted and about US$7 million annually. Treatment of acute myocardial infarction (AMI) (costing US$1000-US$7530 per DALY averted) and secondary prevention of IHD and stroke (costing US$1060-US$10,340 per DALY averted) become more efficient when delivered in integrated packages. At an annual willingness-to-pay (WTP) level of about US$3 million, a package consisting of aspirin, streptokinase, ACE-inhibitor and beta-blocker for AMI has the highest probability of being most cost-effective, whereas as WTP increases to > US$7 million, combination drug treatment to individuals having >35 % absolute risk stands out as the most cost-effective strategy. Cost-effectiveness ratios were relatively more sensitive to halving the effectiveness estimates as compared with doubling the price of drugs and laboratory

  14. 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

  15. Cost-effectiveness of diagnostic for malaria in Extra-Amazon Region, Brazil

    Directory of Open Access Journals (Sweden)

    de Oliveira Maria Regina F

    2012-11-01

    Full Text Available Abstract Background Rapid diagnostic tests (RDT for malaria have been demonstrated to be effective and they should replace microscopy in certain areas. Method The cost-effectiveness of five RDT and thick smear microscopy was estimated and compared. Data were collected on Brazilian Extra-Amazon Region. Data sources included the National Malaria Control Programme of the Ministry of Health, the National Healthcare System reimbursement table, laboratory suppliers and scientific literature. The perspective was that of the Brazilian public health system, the analytical horizon was from the start of fever until the diagnostic results provided to patient and the temporal reference was that of year 2010. Two costing methods were produced, based on exclusive-use microscopy or shared-use microscopy. The results were expressed in costs per adequately diagnosed cases in 2010 U.S. dollars. One-way sensitivity analysis was performed considering key model parameters. Results In the cost-effectiveness analysis with exclusive-use microscopy, the RDT CareStart™ was the most cost-effective diagnostic strategy. Microscopy was the most expensive and most effective, with an additional case adequately diagnosed by microscopy costing US$ 35,550.00 in relation to CareStart™. In opposite, in the cost-effectiveness analysis with shared-use microscopy, the thick smear was extremely cost-effective. Introducing into the analytic model with shared-use microscopy a probability for individual access to the diagnosis, assuming a probability of 100% of access for a public health system user to any RDT and, hypothetically, of 85% of access to microscopy, this test saw its effectiveness reduced and was dominated by the RDT CareStart™. Conclusion The analysis of cost-effectiveness of malaria diagnosis technologies in the Brazilian Extra-Amazon Region depends on the exclusive or shared use of the microscopy. Following the assumptions of this study, shared-use microscopy would be

  16. Cost Effectiveness of Screening Colonoscopy Depends on Adequate Bowel Preparation Rates – A Modeling Study

    Science.gov (United States)

    Kingsley, James; Karanth, Siddharth; Revere, Frances Lee

    2016-01-01

    Background Inadequate bowel preparation during screening colonoscopy necessitates repeating colonoscopy. Studies suggest inadequate bowel preparation rates of 20–60%. This increases the cost of colonoscopy for our society. Aim The aim of this study is to determine the impact of inadequate bowel preparation rate on the cost effectiveness of colonoscopy compared to other screening strategies for colorectal cancer (CRC). Methods A microsimulation model of CRC screening strategies for the general population at average risk for CRC. The strategies include fecal immunochemistry test (FIT) every year, colonoscopy every ten years, sigmoidoscopy every five years, or stool DNA test every 3 years. The screening could be performed at private practice offices, outpatient hospitals, and ambulatory surgical centers. Results At the current assumed inadequate bowel preparation rate of 25%, the cost of colonoscopy as a screening strategy is above society’s willingness to pay (<$50,000/QALY). Threshold analysis demonstrated that an inadequate bowel preparation rate of 13% or less is necessary before colonoscopy is considered more cost effective than FIT. At inadequate bowel preparation rates of 25%, colonoscopy is still more cost effective compared to sigmoidoscopy and stool DNA test. Sensitivity analysis of all inputs adjusted by ±10% showed incremental cost effectiveness ratio values were influenced most by the specificity, adherence, and sensitivity of FIT and colonoscopy. Conclusions Screening colonoscopy is not a cost effective strategy when compared with fecal immunochemical test, as long as the inadequate bowel preparation rate is greater than 13%. PMID:27936028

  17. Cost-effectiveness of interferon-gamma release assay for entry tuberculosis screening in prisons.

    Science.gov (United States)

    Kowada, A

    2013-10-01

    The incidence of active tuberculosis (TB) and latent tuberculosis infection (LTBI) in inmates and prison staff is higher than that in the general population. Mycobacterium tuberculosis-specific interferon-gamma release assays (IGRAs) provide more accurate diagnosis of M. tuberculosis infection with higher specificity than the tuberculin skin test (TST). To assess the cost effectiveness of QuantiFERON®-TB Gold In-Tube (QFT) compared to TST, TST followed by QFT and chest X-ray, we constructed Markov models using a societal perspective on the lifetime horizon. The main outcome measure of effectiveness was quality-adjusted life-years (QALYs) gained. The incremental cost-effectiveness was compared. The QFT-alone strategy was the most cost-effective for entry TB screening in prisons in developed countries. Cost-effectiveness was not sensitive to the rates of BCG vaccination, LTBI, TB, HIV infection and multidrug-resistant TB. Entry TB screening using an IGRA in prisons should be considered on the basis of its cost-effectiveness by public health intervention.

  18. 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.

  19. Cost effectiveness of therapeutic interventions in ankylosing spondylitis: a critical and systematic review.

    Science.gov (United States)

    Gaujoux-Viala, Cécile; Fautrel, Bruno

    2012-12-01

    This report reviews the cost effectiveness of different therapeutic interventions used in the treatment of ankylosing spondylitis (AS). We performed a systematic search of the databases MEDLINE via PubMed, EMBASE and the Cochrane Library and used hand-searching to identify articles on cost effectiveness of therapies for adult patients with AS published up to November 2010. Of 135 articles, 13 studies were analysed. Two articles were on physical therapies, one article was on NSAIDs and ten articles were on tumour necrosis factor (TNF) inhibitors (infliximab = 6, etanercept = 2, infliximab and etanercept = 1 and adalimumab = 1). Of the latter, no article directly compared TNF inhibitors. Articles showed substantial heterogeneity in methodological approaches and thus results, which prevented us from any extensive comparison, data pooling or meta-analysis. The incremental cost-effectiveness ratio (ICER) for spa-exercise treatment was &U20AC;7465 (95% CI 3294, 14 686) per QALY. The ICERs for infliximab, etanercept and adalimumab were &U20AC;5307-237 010, &U20AC;29 815-123 761 and &U20AC;7344-33 303 per QALY, respectively. Modelling treatment strategies in chronic relapsing diseases such as AS presents specific challenges, as reflected in the variation in the cost-effectiveness results reported. Although quite variable, the cost-effectiveness ratios for AS therapies remain within an acceptable range.

  20. Cost-effectiveness of escitalopram vs. citalopram in major depressive disorder.

    Science.gov (United States)

    Fantino, Bruno; Moore, Nicholas; Verdoux, Hélène; Auray, Jean-Paul

    2007-03-01

    Clinical trials have shown better efficacy of escitalopram over citalopram, and review-based economic models the cost-effectiveness of escitalopram vs. citalopram (brand and generic). No head-to-head clinical trial has, however, evaluated the cost-effectiveness of both drugs so far. The aim of this study was to assess the relative cost-effectiveness of escitalopram compared with citalopram in patients with major depressive disorder. An economic evaluation was conducted alongside a double-blind randomized clinical trial conducted by general practitioners and psychiatrists comparing fixed doses of escitalopram (20 mg/day) or citalopram (40 mg/day) over 8 weeks in ambulatory care patients with major depressive disorder (baseline Montgomery-Asberg Depression Rating Scale score > or =30). Resources use was recorded using a standardized form recording use of healthcare services and days of sick leave for the 2-month prestudy period and for the 8-week study period. Statistically significant improvements were observed in patients treated with escitalopram. Mean per-patient costs for the escitalopram group, compared with the citalopram group, were 41% lower (96 euro vs. 163 euro; Pescitalopram compared with citalopram recipients, assuming a parity price between escitalopram and citalopram. Bootstrapped distributions of the cost-effectiveness ratios also showed better effectiveness and lower costs for escitalopram compared with citalopram. Escitalopram is significantly more effective than citalopram, and is associated with lower healthcare costs. This prospective economic analysis demonstrated that escitalopram is a cost-effective first-line treatment option for major depressive disorder.

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

    Science.gov (United States)

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

    2009-11-01

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

  2. Cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry meat food supply.

    Science.gov (United States)

    Lake, Robin J; Horn, Beverley J; Dunn, Alex H; Parris, Ruth; Green, F Terri; McNickle, Don C

    2013-07-01

    An analysis of the cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry supply examined a series of interventions. Effectiveness was evaluated in terms of reduced health burden measured by disability-adjusted life years (DALYs). Costs of implementation were estimated from the value of cost elements, determined by discussions with industry. Benefits were estimated by changing the inputs to a poultry food chain quantitative risk model. Proportional reductions in the number of predicted Campylobacter infections were converted into reductions in the burden of disease measured in DALYs. Cost-effectiveness ratios were calculated for each intervention, as cost per DALY reduction and the ratios compared. The results suggest that the most cost-effective interventions (lowest ratios) are at the primary processing stage. Potential phage-based controls in broiler houses were also highly cost-effective. This study is limited by the ability to quantify costs of implementation and assumptions required to estimate health benefits, but it supports the implementation of interventions at the primary processing stage as providing the greatest quantum of benefit and lowest cost-effectiveness ratios.

  3. Cost-effectiveness of bedaquiline in MDR and XDR tuberculosis in Italy

    Science.gov (United States)

    Codecasa, Luigi R.; Toumi, Mondher; D’Ausilio, Anna; Aiello, Andrea; Damele, Francesco; Termini, Roberta; Uglietti, Alessia; Hettle, Robert; Graziano, Giorgio; De Lorenzo, Saverio

    2017-01-01

    ABSTRACT Objective: To evaluate the cost-effectiveness of bedaquiline plus background drug regimens (BR) for multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in Italy. Methods: A Markov model was adapted to the Italian setting to estimate the incremental cost-effectiveness ratio (ICER) of bedaquiline plus BR (BBR) versus BR in the treatment of MDR-TB and XDR-TB over 10 years, from both the National Health Service (NHS) and societal perspective. Cost-effectiveness was evaluated in terms of life-years gained (LYG). Clinical data were sourced from trials; resource consumption for compared treatments was modelled according to advice from an expert clinicians panel. NHS tariffs for inpatient and outpatient resource consumption were retrieved from published Italian sources. Drug costs were provided by reference centres for disease treatment in Italy. A 3% annual discount was applied to both cost and effectiveness. Deterministic and probabilistic sensitivity analyses were conducted. Results: Over 10 years, BBR vs. BR alone is cost-effective, with ICERs of €16,639/LYG and €4081/LYG for the NHS and society, respectively. The sensitivity analyses confirmed the robustness of the results from both considered perspectives. Conclusion: In Italy, BBR vs. BR alone has proven to be cost-effective in the treatment of MDR-TB and XDR-TB under a range of scenarios. PMID:28265350

  4. Cost-effectiveness analysis of therapeutic options for chronic hepatitis C genotype 3 infected patients.

    Science.gov (United States)

    Gimeno-Ballester, Vicente; Mar, Javier; O'Leary, Aisling; Adams, Róisín; San Miguel, Ramón

    2017-01-01

    This study provides a cost-effectiveness analysis of therapeutic strategies for chronic hepatitis C genotype 3 infected patients in Spain. A Markov model was designed to simulate the progression in a cohort of patients aged 50 years over a lifetime horizon. Sofosbuvir (SOF) plus peginterferon and ribavirin for 12 weeks was a cost-effective option when compared to standard of care (SoC) in the treatment of both 'moderate fibrosis' and 'cirrhotic' patients. Incremental cost-effectiveness ratios were €35,276/QALY and €18,374/QALY respectively. ICERs for SOF plus daclatasvir (DCV) regimens versus SoC were over the threshold limit considered, at €56,178/QALY and €77,378/QALY for 'moderate fibrosis' and 'cirrhotic' patients respectively. Addition of SOF to IFN-based regimens for genotype 3 was cost-effective for both 'moderate fibrosis' and 'cirrhotic' patients. IFN-free options including SOF and DCV association required price reductions lower than the list prices to be considered cost-effective.

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

    Science.gov (United States)

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

    2014-03-26

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

  6. Projected cost-effectiveness of new vaccines for adolescents in the United States.

    Science.gov (United States)

    Ortega-Sanchez, Ismael R; Lee, Grace M; Jacobs, R Jake; Prosser, Lisa A; Molinari, Noelle-Angelique; Zhang, Xinzhi; Baine, William B; McCauley, Mary M; Miller, Ted

    2008-01-01

    Economic assessments that guide policy making on immunizations are becoming increasingly important in light of new and anticipated vaccines for adolescents. However, important considerations that limit the utility of these assessments, such as the diversity of approaches used, are often overlooked and should be better understood. Our goal was to examine economic studies of adolescent vaccines and compare cost-effectiveness outcomes among studies on a particular vaccine, across adolescent vaccines, and between new adolescent vaccines versus vaccines that are recommended for young children. A systematic review of economic studies on immunizations for adolescents was conducted. Studies were identified by searching the Medline, Embase, and EconLit databases. Each study was reviewed for appropriateness of model design, baseline setup, sensitivity analyses, and input variables (ie, epidemiologic, clinical, cost, and quality-of-life impact). For comparison, the cost-effectiveness outcomes reported in key studies on vaccines for younger children were selected. Vaccines for healthy adolescents were consistently found to be more costly than the health care or societal cost savings they produced and, in general, were less cost-effective than vaccines for younger children. Among the new vaccines, pertussis and human papillomavirus vaccines were more cost-effective than meningococcal vaccines. Including herd-immunity benefits in studies significantly improved the cost-effectiveness estimates for new vaccines. Differences in measurements or assumptions limited further comparisons. Although using the new adolescent vaccines is unlikely to be cost-saving, vaccination programs will result in sizable health benefits.

  7. [Cost-effectiveness analysis and diet quality index applied to the WHO Global Strategy].

    Science.gov (United States)

    Machado, Flávia Mori Sarti; Simões, Arlete Naresse

    2008-02-01

    To test the use of cost-effectiveness analysis as a decision making tool in the production of meals for the inclusion of the recommendations published in the World Health Organization's Global Strategy. Five alternative options for breakfast menu were assessed previously to their adoption in a food service at a university in the state of Sao Paulo, Southeastern Brazil, in 2006. Costs of the different options were based on market prices of food items (direct cost). Health benefits were estimated based on adaptation of the Diet Quality Index (DQI). Cost-effectiveness ratios were estimated by dividing benefits by costs and incremental cost-effectiveness ratios were estimated as cost differential per unit of additional benefit. The meal choice was based on health benefit units associated to direct production cost as well as incremental effectiveness per unit of differential cost. The analysis showed the most simple option with the addition of a fruit (DQI = 64 / cost = R$ 1.58) as the best alternative. Higher effectiveness was seen in the options with a fruit portion (DQI1=64 / DQI3=58 / DQI5=72) compared to the others (DQI2=48 / DQI4=58). The estimate of cost-effectiveness ratio allowed to identifying the best breakfast option based on cost-effectiveness analysis and Diet Quality Index. These instruments allow easy application easiness and objective evaluation which are key to the process of inclusion of public or private institutions under the Global Strategy directives.

  8. Challenges from variation across regions in cost effectiveness analysis in multi-regional clinical trials

    Directory of Open Access Journals (Sweden)

    Yunbo Chu

    2016-10-01

    Full Text Available Economic evaluation in the form of cost-effectiveness analysis has become a popular means to inform decisions in healthcare. With multi-regional clinical trials in a global development program becoming a new venue for drug efficacy testing in recent decades, questions in methods for cost-effectiveness analysis in the multi-regional clinical trials setting also emerge. This paper addresses some challenges from variation across regions in cost effectiveness analysis in multi-regional clinical trials. Several discussion points are raised for further attention and a multi-regional clinical trial example is presented to illustrate the implications in industrial application. A general message is delivered to call for a depth discussion by all stakeholders to reach an agreement on a good practice in cost-effectiveness analysis in the multi-regional clinical trials. Meanwhile, we recommend an additional consideration of cost-effectiveness analysis results based on the clinical evidence from a certain homogeneous population as sensitivity or scenario analysis upon data availability.

  9. Calculation of the performance of magnetic lenses with limited machining precision.

    Science.gov (United States)

    Sháněl, O; Zlámal, J; Oral, M

    2014-02-01

    To meet a required STEM resolution, the mechanical precision of the pole pieces of a magnetic lens needs to be determined. A tolerancing plugin in the EOD software is used to determine a configuration which both meets the optical specifications and is cost effective under the constraints of current manufacturing technologies together with a suitable combination of correction elements.

  10. Estimating sparse precision matrices

    Science.gov (United States)

    Padmanabhan, Nikhil; White, Martin; Zhou, Harrison H.; O'Connell, Ross

    2016-08-01

    We apply a method recently introduced to the statistical literature to directly estimate the precision matrix from an ensemble of samples drawn from a corresponding Gaussian distribution. Motivated by the observation that cosmological precision matrices are often approximately sparse, the method allows one to exploit this sparsity of the precision matrix to more quickly converge to an asymptotic 1/sqrt{N_sim} rate while simultaneously providing an error model for all of the terms. Such an estimate can be used as the starting point for further regularization efforts which can improve upon the 1/sqrt{N_sim} limit above, and incorporating such additional steps is straightforward within this framework. We demonstrate the technique with toy models and with an example motivated by large-scale structure two-point analysis, showing significant improvements in the rate of convergence. For the large-scale structure example, we find errors on the precision matrix which are factors of 5 smaller than for the sample precision matrix for thousands of simulations or, alternatively, convergence to the same error level with more than an order of magnitude fewer simulations.

  11. Cost Effectiveness Analysis of Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis. A Systematic Review Literature

    Directory of Open Access Journals (Sweden)

    Maurizio Benucci

    2011-01-01

    Full Text Available The cost effectiveness of treatments that have changed the “natural history” of a chronic progressive disease needs to be evaluated over the long term. Disease-modifying antirheumatic drugs (DMARDs are the standard treatment of rheumatoid arthritis (RA and should be started as early as possible. A number of studies have shown that they are effective in improving disease activity and function, and in joint damage. Our review was focused on revision and critical evaluation of the studies including the literature on cost effectiveness of DMARDs (cyclosporine A, sulphasalazine, leflunomide, and methotrexate. The European League Against Rheumatism (EULAR recommendations showed that traditional DMARDs are cost effective at the time of disease onset. They are less expensive than biological DMARDs and can be useful in controlling disease activity in early RA.

  12. Cost-effectiveness of integrated care for elderly depressed patients in the PRISM-E study.

    Science.gov (United States)

    Wiley-Exley, Elizabeth; Domino, Marisa Elena; Maxwell, James; Levkoff, Sue Ellen

    2009-12-01

    One proposed strategy to improve outcomes associated with depression and other behavioral health disorders in primary care settings is to strengthen collaboration between primary care and specialty mental health care through integrated care (IC). We compare the cost-effectiveness of IC in primary care to enhanced specialty referral (ESR) for elders with behavioral health disorders from the Primary Care Research in Substance Abuse and Mental Health study, which was a randomized trial conducted between 2000 and 2002, using a societal perspective. The IC model had a behavioral health professional co-located in the primary care setting, and the primary care provider continued involvement in the mental health/substance abuse care of the patient. The comparison model, enhanced specialty referral (ESR), required referral to a behavioral health provider outside the primary care setting, and the behavioral health provider had primary responsibility for the mental health/substance abuse needs of the patient. Costs and clinical outcomes for 840 elders with depression were analyzed using incremental cost-effectiveness ratios, the net benefits framework, cost-effectiveness planes, and acceptability curves. Outcomes were measured by the Center for Epidemiologic Studies Depression Scale (CES-D) and converted to depression-free days and Quality Adjusted Life Years (QALY). A variation on depression free days was proposed as an improvement on current methods. Separate analyses were conducted for Veteran's Affairs (n=365; n=175 in IC and n=190 in ESR) and non-Veteran's Affairs (n=475; n=242 in IC and n=233 in ESR) settings. ESR participants in the non-VA sample exhibited lower average CES-D scores (i.e., an improvement in depressive symptoms) than did IC participants (beta = 2.8, p 0.05). Mean costs were $D6,338 for VA IC participants; $7,007 for VA ESR participants; $3,657 for non-VA IC participants; and $3,673 for non-VA ESR participants. Although the cost-effectiveness planes

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-11-01

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

  14. Cost-effectiveness of alternative outpatient pelvic inflammatory disease treatment strategies.

    Science.gov (United States)

    Smith, Kenneth J; Ness, Roberta B; Wiesenfeld, Harold C; Roberts, Mark S

    2007-12-01

    Effectiveness differences between outpatient pelvic inflammatory disease (PID) treatment regimens are uncertain, but significant differences in cost exist. To examine the influence of antibiotic costs on PID therapy cost-effectiveness. The authors used a Markov decision model to estimate the cost-effectiveness of recommended antibiotic regimens for PID and performed a value of information analysis to guide future research. Antibiotic costs vary between USD 43 and USD188. Pairwise comparisons, assuming a hypothetical 1% relative risk reduction in PID complications with the more expensive regimen, showed economically reasonable cost-effectiveness ratios. Value of information and sample size considerations support further investigation to detect 10% PID complication rate differences between regimens with >or=USD 50 cost differences. Within the cost range of recommended regimens, use of more expensive antibiotics would be economically reasonable if relatively small decreases in PID complication rates exist. Further investigation of effectiveness differences between regimens is needed.

  15. Cost-effectiveness analysis of a statewide media campaign to promote adolescent physical activity.

    Science.gov (United States)

    Peterson, Michael; Chandlee, Margaret; Abraham, Avron

    2008-10-01

    A cost-effectiveness analysis of a statewide social marketing campaign was performed using a statewide surveillance survey distributed to 6th through 12th graders, media production and placement costs, and 2000 census data. Exposure to all three advertisements had the highest impact on both intent and behavior with 65.6% of the respondents considering becoming more active and 58.3% reporting becoming more active. Average cost of the entire campaign was $4.01 per person to see an ad, $7.35 per person to consider being more active, and $8.87 per person to actually become more active, with billboards yielding the most positive cost-effectiveness. Findings highlight market research as an essential part of social marketing campaigns and the importance of using multiple marketing modalities to enhance cost-effectiveness and impact.

  16. An Efficient, Noniterative Method of Identifying the Cost-Effectiveness Frontier.

    Science.gov (United States)

    Suen, Sze-chuan; Goldhaber-Fiebert, Jeremy D

    2016-01-01

    Cost-effectiveness analysis aims to identify treatments and policies that maximize benefits subject to resource constraints. However, the conventional process of identifying the efficient frontier (i.e., the set of potentially cost-effective options) can be algorithmically inefficient, especially when considering a policy problem with many alternative options or when performing an extensive suite of sensitivity analyses for which the efficient frontier must be found for each. Here, we describe an alternative one-pass algorithm that is conceptually simple, easier to implement, and potentially faster for situations that challenge the conventional approach. Our algorithm accomplishes this by exploiting the relationship between the net monetary benefit and the cost-effectiveness plane. To facilitate further evaluation and use of this approach, we also provide scripts in R and Matlab that implement our method and can be used to identify efficient frontiers for any decision problem.

  17. Cost effectiveness of conventional versus LANDSAT use data for hydrologic modeling

    Science.gov (United States)

    George, T. S.; Taylor, R. S.

    1982-01-01

    Six case studies were analyzed to investigate the cost effectiveness of using land use data obtained from LANDSAT as opposed to conventionally obtained data. A procedure was developed to determine the relative effectiveness of the two alternative means of acquiring data for hydrological modelling. The cost of conventionally acquired data ranged between $3,000 and $16,000 for the six test basins. Information based on LANDSAT imagery cost between $2,000 and $5,000. Results of the effectiveness analysis shows the differences between the two methods are insignificant. From the cost comparison and the act that each method, conventional and LANDSAT, is shown to be equally effective in developing land use data for hydrologic studies, the cost effectiveness of the conventional or LANDSAT method is found to be a function of basin size for the six test watersheds analyzed. The LANDSAT approach is cost effective for areas containing more than 10 square miles.

  18. Cost effectiveness of day stay versus inpatient radiofrequency (RF) ablation for the treatment of supraventricular tachyarrhythmias

    Energy Technology Data Exchange (ETDEWEB)

    Weerasooriya, H.R. [Royal Perth Hospital, WA (Australia); Harris, A.H. [Monash Univ., Clayton, VIC (Australia); Davis, M.J.E. [Western Australia Univ., Nedlands, WA (Australia)

    1996-04-01

    It is well established that radiofrequency (RF) ablation is the most cost effective treatment strategy for patients with supraventricular tachycardia. Previous cost estimates assumed at least an overnight stay following RF ablation. Day stay RF ablation however appears to be a safe alternative. The aim of this study was to compare day stay and inpatient catheter ablation in terms of cost, efficacy and safety. This was a retrospective cost effectiveness analysis. The study population consisted of 25 consecutive patients who underwent impatient RF ablation (historical controls). Economic analysis was based upon a detailed clinical costing. The mean overall cost per patient of inpatient RF ablation in 1994 Australian dollar values is $2354 (SD, $642) compared with $1876 (SD, $595) for day stay RF ablation (p<0.01). Day stay RF ablation is a cost effective alternative to inpatient RF ablation. 16 refs., 2 tabs.

  19. 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.

  20. [Cost-effectiveness of a TLC-NOSF polyurethane foam dressing].

    Science.gov (United States)

    Arroyo Ana, Abejón; Alvarez Vázquez, Juan Carlos; Blasco García, Carmen; Bermejo Martínez, Mariano; López Casanova, Pablo; Cuesta Cuesta, Juan José; De Haro Fernández, Francisco; Mateo Marín, Emilia; Segovia Gómez, Teresa; Villar Rojas, Antonio Erasto

    2012-11-01

    Chronic wounds represent a drain on the Spanish health system, nowdays is necessary an optimization of the resources used and that is for this that is necessary justify the use of the products over others through cost-effective studies for to show the economic benefit to professionals and the life quality of patient. This article compares the use of a new technology for format polyurethane foam, TLC-NOSF, with the most commonly used products for treating wounds. This comparison is made using a cost-effectiveness model (Markov Model). The results demonstrate that treatment with polyurethane foam dressing with TLC-NOSF are cost-effective versus treatments with polyurethane foams most commonly used in Spain.

  1. An Efficient, Non-iterative Method of Identifying the Cost-Effectiveness Frontier

    Science.gov (United States)

    Suen, Sze-chuan; Goldhaber-Fiebert, Jeremy D.

    2015-01-01

    Cost-effectiveness analysis aims to identify treatments and policies that maximize benefits subject to resource constraints. However, the conventional process of identifying the efficient frontier (i.e., the set of potentially cost-effective options) can be algorithmically inefficient, especially when considering a policy problem with many alternative options or when performing an extensive suite of sensitivity analyses for which the efficient frontier must be found for each. Here, we describe an alternative one-pass algorithm that is conceptually simple, easier to implement, and potentially faster for situations that challenge the conventional approach. Our algorithm accomplishes this by exploiting the relationship between the net monetary benefit and the cost-effectiveness plane. To facilitate further evaluation and use of this approach, we additionally provide scripts in R and Matlab that implement our method and can be used to identify efficient frontiers for any decision problem. PMID:25926282

  2. Cost Effectiveness Analysis of Antibiotic Used among Sepsis Patients in Hospital in Bandung

    Directory of Open Access Journals (Sweden)

    Cherry Rahayu

    2013-06-01

    Full Text Available The aim of this study was to determine the antibiotic combination group that were the most effective in cost (cost effectiveness used as sepsis with respiratory infections treatment at one of hospital in Bandung. Observational study was conducted by retrospective data. Data were collected from medical record from inpatients sepsis with respiratory infection and received empirical therapy cefotaxime-metronidazole or cefotaxime-erythromycin. Direct medical cost is collected from empirical antibiotic costs, costs of medical treatment, medical expenses, hospitalization costs, and administrative costs. The results of Incremental Cost Effectiveness Ratio (ICER showed that ratio of direct medical cost and survived patients is 3.301.090,00 IDR for cefotaxime-metronidazole that compared to other empirical antibiotic, and 2.227.366,89 IDR for cefotaxime-erythromycin. It can be conclude that the combination of cefotaxime-erythromycin is more cost effective than cefotaxime-metronidazole.

  3. Cost-effectiveness of different diagnostic strategies in patients with nonresectable upper gastrointestinal tract malignancies

    DEFF Research Database (Denmark)

    Mortensen, M B; Ainsworth, A P; Scheel-Hincke, J D

    2000-01-01

    cost, but a diagnostic strategy based on CT with US or CT with US and laparoscopy was not cost-effective. The inclusion of endoscopic or laparoscopic ultrasonography seemed necessary to the provision of a cost-effective strategy because both techniques had a high diagnostic accuracy combined with a low......BACKGROUND AND METHODS: Using a simple model, this retrospective study evaluated the cost-effectiveness of different diagnostic strategies used for pretherapeutic detection of patients with disseminated or locally nonresectable upper gastrointestinal tract malignancies (UGIM). Of 162 consecutive...... UGIM patients referred for treatment, 73 (45%) had disseminated or locally nonresectable disease, and these patients were eligible for evaluation. RESULTS: The noninvasive diagnostic strategies (computed tomography [CT] with ultrasonography [US] and endoscopic ultrasonography [EUS]) had a low procedure...

  4. Cost-Effective Control of Ground-Level Ozone Pollution in and around Beijing

    Institute of Scientific and Technical Information of China (English)

    Xie Xuxuan; Zhang Shiqiu; Xu Jianhua; Wu Dan; Zhu Tong

    2012-01-01

    Ground level ozone pollution has become a significant air pollution problem in Beijing. Because of the complex way in which ozone is formed, it is difficult for policy makers to identify optimal control options on a cost-effective basis. This paper identi- fies and assesses a range of options for addressing this problem. We apply the Ambient Least Cost Model and compare the eco- nomic costs of control options, then recommend the most effective sequence to realize pollution control at the lowest cost. The study finds that installing of Stage II gasoline vapor recovery system at Beijing's 1446 gasoline stations would be the most cost-effective option. Overall, options to reduce ozone pollution by cutting ve- hicular emissions are much more cost-effective than options to "clean up" coal-fired power plants.

  5. GIS to support cost-effective decisions on renewable sources applications for low temperature geothermal energy

    CERN Document Server

    Gemelli, Alberto; Diamantini, Claudia; Longhi, Sauro

    2013-01-01

    Through the results of a developed case study of information system for low temperature geothermal energy, GIS to Support Cost-effective Decisions on Renewable Sources addresses the issue of the use of Geographic Information Systems (GIS) in evaluating cost-effectiveness of renewable resource exploitation regional scale. Focusing on the design of a Decision Support System, a process is presented aimed to transform geographic data into knowledge useful for analysis and decision-making on the economic exploitation of geothermal energy. This detailed description includes a literature review and technical issues related to data collection, data mining, decision analysis for the informative system developed for the case study. A multi-disciplinary approach to GIS design is presented which is also an innovative example of fusion of georeferenced data acquired from multiple sources including remote sensing, networks of sensors and socio-economic censuses. GIS to Support Cost-effective Decisions on Renewable Sources ...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-01-31

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

  7. Improving Precision of Types

    DEFF Research Database (Denmark)

    Winther, Johnni

    Types in programming languages provide a powerful tool for the programmer to document the code so that a large aspect of the intent can not only be presented to fellow programmers but also be checked automatically by compilers. The precision with which types model the behavior of programs...... is crucial to the quality of these automated checks, and in this thesis we present three different improvements to the precision of types in three different aspects of the Java programming language. First we show how to extend the type system in Java with a new type which enables the detection of unintended...... mixing of unrelated types. Secondly, we present an improvement of the type checking algorithm in Java which enables the compiler to detect and ease the use of a common programming idiom called guarded casts. Thirdly, we present an improvement of the precision with which classes generated by a parser...

  8. Precision Experiments at LEP

    CERN Document Server

    de Boer, Wim

    2015-01-01

    The Large Electron Positron Collider (LEP) established the Standard Model (SM) of particle physics with unprecedented precision, including all its radiative corrections. These led to predictions for the masses of the top quark and Higgs boson, which were beautifully confirmed later on. After these precision measurements the Nobel Prize in Physics was awarded in 1999 jointly to 't Hooft and Veltman "for elucidating the quantum structure of electroweak interactions in physics". Another hallmark of the LEP results were the precise measurements of the gauge coupling constants, which excluded unification of the forces within the SM, but allowed unification within the supersymmetric extension of the SM. This increased the interest in Supersymmetry (SUSY) and Grand Unified Theories, especially since the SM has no candidate for the elusive dark matter, while Supersymmetry provides an excellent candidate for dark matter. In addition, Supersymmetry removes the quadratic divergencies of the SM and {\\it predicts} the Hig...

  9. Precision Muonium Spectroscopy

    CERN Document Server

    Jungmann, Klaus P

    2016-01-01

    The muonium atom is the purely leptonic bound state of a positive muon and an electron. It has a lifetime of 2.2 $\\mu$s. The absence of any known internal structure provides for precision experiments to test fundamental physics theories and to determine accurate values of fundamental constants. In particular groun dstate hyperfine structure transitions can be measured by microwave spectroscopy to deliver the muon magnetic moment. The frequency of the 1s-2s transition in the hydrogen-like atom can be determined with laser spectroscopy to obtain the muon mass. With such measurements fundamental physical interactions, in particular Quantum Electrodynamics, can also be tested at highest precision. The results are important input parameters for experiments on the muon magnetic anomaly. The simplicity of the atom enables further precise experiments, such as a search for muonium-antimuonium conversion for testing charged lepton number conservation and searches for possible antigravity of muons and dark matter.

  10. Precision Muonium Spectroscopy

    Science.gov (United States)

    Jungmann, Klaus P.

    2016-09-01

    The muonium atom is the purely leptonic bound state of a positive muon and an electron. It has a lifetime of 2.2 µs. The absence of any known internal structure provides for precision experiments to test fundamental physics theories and to determine accurate values of fundamental constants. In particular ground state hyperfine structure transitions can be measured by microwave spectroscopy to deliver the muon magnetic moment. The frequency of the 1s-2s transition in the hydrogen-like atom can be determined with laser spectroscopy to obtain the muon mass. With such measurements fundamental physical interactions, in particular quantum electrodynamics, can also be tested at highest precision. The results are important input parameters for experiments on the muon magnetic anomaly. The simplicity of the atom enables further precise experiments, such as a search for muonium-antimuonium conversion for testing charged lepton number conservation and searches for possible antigravity of muons and dark matter.

  11. Cost-effectiveness analysis of Belimumab in patients with systemic lupus erythematosus in Spain

    Directory of Open Access Journals (Sweden)

    Silvia Díaz-Cerezo

    2015-02-01

    Full Text Available Objective: To estimate the cost-effectiveness of belimumab in patients with systemic lupus erythematosus (SLE presenting positive biomarkers and active disease despite standard treatment (ST, from the Spanish social perspective. Methods: A microsimulation model was used to estimate the cost-effectiveness of belimumab plus ST versus ST alone. A treatment duration of two years with a life-time horizon were considered. Efficacy data were obtained from belimumab clinical trials and the evolution of the disease was simulated from John Hopkins ´patient cohort data in the United States. Utility data were obtained from literature review. Direct and indirect costs were calculated based on Spanish published data (€, 2014, applying a discount rate (DR of 3% to both costs and effects. Results were expressed as incremental cost-effectiveness ratio (ICER in terms of gained life years (LY and quality of life adjusted life years (QALYs. Probabilistic (PSA and deterministic sensitivity analyses (DR of 0% and 5%, 5-years treatment duration and excluding indirect costs were performed to determine the robustness of the model. Results: The incremental cost-effectiveness ratio (ICER was 16,647€ per life year gained, with an incremental cost-utility ratio (ICUR of 23,158€ per additional QALY gained. In 68% of the scenarios simulated in the PSA, belimumab was found to be a cost-effective alternative, considering a threshold of 30,000€/ QALY. Conclusion: Belimumab can be regarded as a cost-effective alternative from the Spanish social perspective

  12. Users′ guide to the orthopaedic literature: What is a cost-effectiveness analysis?

    Directory of Open Access Journals (Sweden)

    Tanner Stephanie

    2008-01-01

    Full Text Available As the cost of healthcare continue to rise, orthopaedic surgeons are being pressured to practice cost-effective healthcare. Consequently, economic evaluation of treatment options are being reported more commonly in medical and surgical literature. As new orthopaedic procedures and treatments may improve patient outcome and function over traditional treatment options, the effect of the potentially higher costs of new treatments should be formally evaluated. Unfortunately, the resources available for healthcare spending are typically limited. Therefore, cost-effectiveness analyses have become an important and useful tool in informing which procedure or treatment to implement into practice. Cost-effectiveness analysis is a type of economic analysis that compares both the clinical outcomes and the costs of new treatment options to current treatment options or standards of care. For a clinician to be able to apply the results of a cost-effectiveness analysis to their practice, they must be able to critically review the available literature. Conducting an economic analysis is a challenging process, which has resulted in a number of published economic analyses that are of lower quality and may be fraught with bias. It is important that the reader of an economic analysis or cost-effectiveness analysis have the skills required to properly evaluate and critically appraise the methodology used before applying the recommendations to their practice. Using the principles of evidence-based medicine and the questions outlined in the Journal of the American Medical Association′s Users′ Guide to the Medical Literature, this article attempts to illustrate how to critically appraise a cost-effectiveness analysis in the orthopaedic surgery literature.

  13. Cost-effectiveness of a smokeless tobacco control mass media campaign in India.

    Science.gov (United States)

    Murukutla, Nandita; Yan, Hongjin; Wang, Shuo; Negi, Nalin Singh; Kotov, Alexey; Mullin, Sandra; Goodchild, Mark

    2017-08-10

    Tobacco control mass media campaigns are cost-effective in reducing tobacco consumption in high-income countries, but similar evidence from low-income countries is limited. An evaluation of a 2009 smokeless tobacco control mass media campaign in India provided an opportunity to test its cost-effectiveness. Campaign evaluation data from a nationally representative household survey of 2898 smokeless tobacco users were compared with campaign costs in a standard cost-effectiveness methodology. Costs and effects of the Surgeon campaign were compared with the status quo to calculate the cost per campaign-attributable benefit, including quit attempts, permanent quits and tobacco-related deaths averted. Sensitivity analyses at varied CIs and tobacco-related mortality risk were conducted. The Surgeon campaign was found to be highly cost-effective. It successfully generated 17 259 148 additional quit attempts, 431 479 permanent quits and 120 814 deaths averted. The cost per benefit was US$0.06 per quit attempt, US$2.6 per permanent quit and US$9.2 per death averted. The campaign continued to be cost-effective in sensitivity analyses. This study suggests that tobacco control mass media campaigns can be cost-effective and economically justified in low-income and middle-income countries. It holds significant policy implications, calling for sustained investment in evidence-based mass media campaigns as part of a comprehensive tobacco control strategy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Cost-effectiveness of interventions to promote fruit and vegetable consumption.

    Directory of Open Access Journals (Sweden)

    Linda J Cobiac

    Full Text Available BACKGROUND: Fruits and vegetables are an essential part of the human diet, but many people do not consume the recommended serves to prevent cardiovascular disease and cancer. In this research, we evaluate the cost-effectiveness of interventions to promote fruit and vegetable consumption to determine which interventions are good value for money, and by how much current strategies can reduce the population disease burden. METHODS/PRINCIPAL FINDINGS: In a review of published literature, we identified 23 interventions for promoting fruit and vegetable intake in the healthy adult population that have sufficient evidence for cost-effectiveness analysis. For each intervention, we model the health impacts in disability-adjusted life years (DALYs, the costs of intervention and the potential cost-savings from averting disease treatment, to determine cost-effectiveness of each intervention over the lifetime of the population, from an Australian health sector perspective. Interventions that rely on dietary counselling, telephone contact, worksite promotion or other methods to encourage change in dietary behaviour are not highly effective or cost-effective. Only five out of 23 interventions are less than an A$50,000 per disability-adjusted life year cost-effectiveness threshold, and even the most effective intervention can avert only 5% of the disease burden attributed to insufficient fruit and vegetable intake. CONCLUSIONS/SIGNIFICANCE: We recommend more investment in evaluating interventions that address the whole population, such as changing policies influencing price or availability of fruits and vegetables, to see if these approaches can provide more effective and cost-effective incentives for improving fruit and vegetable intake.

  15. Cost-effectiveness of thrombolysis within 4.5 hours of acute ischemic stroke in China.

    Directory of Open Access Journals (Sweden)

    Yuesong Pan

    Full Text Available BACKGROUND: Previous economic studies conducted in developed countries showed intravenous tissue-type plasminogen activator (tPA is cost-effective for acute ischemic stroke. The present study aimed to determine the cost-effectiveness of tPA treatment in China, the largest developing country. METHODS: A combination of decision tree and Markov model was developed to determine the cost-effectiveness of tPA treatment versus non-tPA treatment within 4.5 hours after stroke onset. Outcomes and costs data were derived from the database of Thrombolysis Implementation and Monitor of acute ischemic Stroke in China (TIMS-China study. Efficacy data were derived from a pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Costs and quality-adjusted life-years (QALYs were compared in both short term (2 years and long term (30 years. One-way and probabilistic sensitivity analyses were performed to test the robustness of the results. RESULTS: Comparing to non-tPA treatment, tPA treatment within 4.5 hours led to a short-term gain of 0.101 QALYs at an additional cost of CNY 9,520 (US$ 1,460, yielding an incremental cost-effectiveness ratio (ICER of CNY 94,300 (US$ 14,500 per QALY gained in 2 years; and to a long-term gain of 0.422 QALYs at an additional cost of CNY 6,530 (US$ 1,000, yielding an ICER of CNY 15,500 (US$ 2,380 per QALY gained in 30 years. Probabilistic sensitivity analysis showed that tPA treatment is cost-effective in 98.7% of the simulations at a willingness-to-pay threshold of CNY 105,000 (US$ 16,200 per QALY. CONCLUSIONS: Intravenous tPA treatment within 4.5 hours is highly cost-effective for acute ischemic strokes in China.

  16. Cost Effectiveness of Lenvatinib, Sorafenib and Placebo in Treatment of Radioiodine-Refractory Differentiated Thyroid Cancer.

    Science.gov (United States)

    Wilson, Leslie; Huang, Wei; Chen, Linda; Ting, Jie; Cao, Vicky

    2017-08-01

    Lenvatinib (Lenvima(®)) and sorafenib (Nexavar(®)) are the two most recently Food and Drug Administration-approved drugs for treating radioiodine-refractory differentiated thyroid cancer (RR-DTC). Both demonstrated superior progression-free survival over placebo in their respective Phase III clinical trials. This study compared the cost-effectiveness of the two treatments with placebo from a limited societal perspective. A Markov model was developed to estimate the costs and health benefits for treatment of RR-DTC. The probabilities and survival rates were obtained from two Phase III trials: the SELECT trial comparing lenvatinib to placebo, and the DECISION trial comparing sorafenib to placebo. A bimonthly cycle length and half-cycle correction were used for a lifetime time horizon. Medical costs and utility data were obtained from RedBook, Healthcare Cost and Utilization Project, and the published literature. All costs were adjusted to US$2015, discounted at 3% annually. Then second-order Monte Carlo simulation with distributions was conducted to obtain the acceptability curve to address the uncertainty around model inputs. In the base case, lenvatinib was the most cost-effective treatment compared to sorafenib (incremental cost-effectiveness ratio [ICER] = $25,275/quality-adjusted life year [QALY]) and placebo (ICER = $40,869). Sorafenib is also cost-effective compared to placebo (ICER = $64,067/QALY). The treatment decisions were found to be sensitive to the treatment costs and the health utility associated with lenvatinib and its side effects. The acceptability curve showed lenvatinib optimal 80% of time at WTP of $100,000/QALY. This study suggests that lenvatinib is the optimally cost-effective treatment for RR-DTC, although both lenvatinib and sorafenib are cost-effective compared to placebo.

  17. Cost-effective alternatives for mitigating Cryptosporidium risk in drinking water and enhancing ecosystem services

    Science.gov (United States)

    Bryan, B. A.; Kandulu, J. M.

    2009-08-01

    Under the multibarrier paradigm, water quality management barriers that mitigate risk to consumers are required at multiple points from the catchment to the tap. We present a cost-effectiveness analysis of 13 catchment- and treatment-based management alternatives for mitigating Cryptosporidium risk in the Myponga water supply catchment, South Australia. A broad range of costs and benefits are identified and valued, including setup, operation and maintenance, and opportunity costs, and benefits for ecosystem services including water quality, biodiversity, carbon sequestration, and farm production services. The results suggest that the cost-effectiveness of investment in water quality management can be substantially enhanced by considering the costs of management and the benefits for ecosystem services, in addition to Cryptosporidium removal effectiveness. Cost-effectiveness of investment in management alternatives is dependent upon the desired level of Cryptosporidium removal effectiveness by both the catchment and treatment barriers. The combination of a spatially targeted 25% restriction in water course access of nondairy cattle and treatment by enhanced coagulation provides the most (net) cost-effective Cryptosporidium risk mitigation strategy. This combination may achieve 0.614 log removal at a net cost of A0.7 million and (net) cost-effectiveness of A1.14 million per log removal. Additional risk mitigation can be achieved through the addition of ultraviolet irradiation treatment, higher levels of water course access restriction for cattle, and the adoption of dung beetles in the catchment. Economic valuation of a range of costs and benefits of management priorities can support cost-effective water quality management investment decisions and inform elements of policy design such as cost-sharing arrangements and spatial targeting.

  18. Cost-effectiveness analysis of diagnostic options for pneumocystis pneumonia (PCP.

    Directory of Open Access Journals (Sweden)

    Julie R Harris

    Full Text Available BACKGROUND: Diagnosis of Pneumocystis jirovecii pneumonia (PCP is challenging, particularly in developing countries. Highly sensitive diagnostic methods are costly, while less expensive methods often lack sensitivity or specificity. Cost-effectiveness comparisons of the various diagnostic options have not been presented. METHODS AND FINDINGS: We compared cost-effectiveness, as measured by cost per life-years gained and proportion of patients successfully diagnosed and treated, of 33 PCP diagnostic options, involving combinations of specimen collection methods [oral washes, induced and expectorated sputum, and bronchoalveolar lavage (BAL] and laboratory diagnostic procedures [various staining procedures or polymerase chain reactions (PCR], or clinical diagnosis with chest x-ray alone. Our analyses were conducted from the perspective of the government payer among ambulatory, HIV-infected patients with symptoms of pneumonia presenting to HIV clinics and hospitals in South Africa. Costing data were obtained from the National Institutes of Communicable Diseases in South Africa. At 50% disease prevalence, diagnostic procedures involving expectorated sputum with any PCR method, or induced sputum with nested or real-time PCR, were all highly cost-effective, successfully treating 77-90% of patients at $26-51 per life-year gained. Procedures using BAL specimens were significantly more expensive without added benefit, successfully treating 68-90% of patients at costs of $189-232 per life-year gained. A relatively cost-effective diagnostic procedure that did not require PCR was Toluidine Blue O staining of induced sputum ($25 per life-year gained, successfully treating 68% of patients. Diagnosis using chest x-rays alone resulted in successful treatment of 77% of patients, though cost-effectiveness was reduced ($109 per life-year gained compared with several molecular diagnostic options. CONCLUSIONS: For diagnosis of PCP, use of PCR technologies, when

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1993-09-01

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

  20. Cost effectiveness of tobacco control policies in Vietnam: the case of population-level interventions.

    Science.gov (United States)

    Higashi, Hideki; Truong, Khoa D; Barendregt, Jan J; Nguyen, Phuong K; Vuong, Mai L; Nguyen, Thuy T; Hoang, Phuong T; Wallace, Angela L; Tran, Tien V; Le, Cuong Q; Doran, Christopher M

    2011-05-01

    Tobacco smoking is one of the leading public health problems in the world. It is also possible to prevent and/or reduce the harm from tobacco use through the use of cost-effective tobacco control measures. However, most of this evidence comes from developed countries and little research has been conducted on this issue in developing countries. The objective of this study was to analyse the cost effectiveness of four population-level tobacco control interventions in Vietnam. Four tobacco control interventions were evaluated: excise tax increase; graphic warning labels on cigarette packs; mass media campaigns; and smoking bans (in public or in work places). A multi-state life table model was constructed in Microsoft® Excel to examine the cost effectiveness of the tobacco control intervention options. A government perspective was adopted, with costing conducted using a bottom-up approach. Health improvement was considered in terms of disability-adjusted life-years (DALYs) averted. All assumptions were subject to sensitivity and uncertainty analysis. All the interventions fell within the definition of being very cost effective according to the threshold level suggested by the WHO (i.e. GDP per capita). Graphic warning labels on cigarette packs was the most cost-effective option, followed by excise tax increases, mass media campaigns, public smoking bans and work place smoking bans. If the cost offset was included in the analysis, all interventions would provide cost savings to the government health sector. All four interventions to reduce the harm from tobacco use appear to be highly cost effective and should be considered as priorities in the context of Vietnam. The government may initially consider graphic warning labels and tax increase, followed by other interventions.

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

    Science.gov (United States)

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

    2014-12-22

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

  2. Cost-Effectiveness of Contralateral Prophylactic Mastectomy Versus Routine Surveillance in Patients With Unilateral Breast Cancer

    Science.gov (United States)

    Zendejas, Benjamin; Moriarty, James P.; O'Byrne, Jamie; Degnim, Amy C.; Farley, David R.; Boughey, Judy C.

    2011-01-01

    Purpose Contralateral prophylactic mastectomy (CPM) rates in women with unilateral breast cancer are increasing despite controversy regarding survival advantage. Current scrutiny of the medical costs led us to evaluate the cost-effectiveness of CPM versus routine surveillance as an alternative contralateral breast cancer (CBC) risk management strategy. Methods Using a Markov model, we simulated patients with breast cancer from mastectomy to death. Model parameters were gathered from published literature or national databases. Base-case analysis focused on patients with average-risk breast cancer, 45 years of age at treatment. Outcomes were valued in quality-adjusted life-years (QALYs). Patients' age, risk level of breast cancer, and quality of life (QOL) were varied to assess their impact on results. Results Mean costs of treatment for women age 45 years are comparable: $36,594 for the CPM and $35,182 for surveillance. CPM provides 21.22 mean QALYs compared with 20.93 for surveillance, resulting in an incremental cost-effectiveness ratio (ICER) of $4,869/QALY gained for CPM. To prevent one CBC, six CPMs would be needed. CPM is no longer cost-effective for patients older than 70 years (ICER $62,750/QALY). For BRCA-positive patients, CPM is clearly cost-effective, providing more QALYs while being less costly. In non-BRCA patients, cost-effectiveness of CPM is highly dependent on assumptions regarding QOL for CPM versus surveillance strategy. Conclusion CPM is cost-effective compared with surveillance for patients with breast cancer who are younger than 70 years. Results are sensitive to BRCA-positive status and assumptions of QOL differences between CPM and surveillance patients. This highlights the importance of tailoring treatment for individual patients. PMID:21690472

  3. Precision electron polarimetry

    Energy Technology Data Exchange (ETDEWEB)

    Chudakov, E. [Jefferson Lab 12000 Jefferson Ave, STE 16, Newport News, VA 23606 (United States)

    2013-11-07

    A new generation of precise Parity-Violating experiments will require a sub-percent accuracy of electron beam polarimetry. Compton polarimetry can provide such accuracy at high energies, but at a few hundred MeV the small analyzing power limits the sensitivity. Mo/ller polarimetry provides a high analyzing power independent on the beam energy, but is limited by the properties of the polarized targets commonly used. Options for precision polarimetry at 300 MeV will be discussed, in particular a proposal to use ultra-cold atomic hydrogen traps to provide a 100%-polarized electron target for Mo/ller polarimetry.

  4. Precision genome editing

    DEFF Research Database (Denmark)

    Steentoft, Catharina; Bennett, Eric P; Schjoldager, Katrine Ter-Borch Gram

    2014-01-01

    of glycobiology, primarily due to their low efficiencies, with resultant failure to impose substantial phenotypic consequences upon the final glycosylation products. Here, we review novel nuclease-based precision genome editing techniques enabling efficient and stable gene editing, including gene disruption...... by introducing single or double-stranded breaks at a defined genomic sequence. We here compare and contrast the different techniques and summarize their current applications, highlighting cases from the field of glycobiology as well as pointing to future opportunities. The emerging potential of precision gene...

  5. Precision machine design

    CERN Document Server

    Slocum, Alexander H

    1992-01-01

    This book is a comprehensive engineering exploration of all the aspects of precision machine design - both component and system design considerations for precision machines. It addresses both theoretical analysis and practical implementation providing many real-world design case studies as well as numerous examples of existing components and their characteristics. Fast becoming a classic, this book includes examples of analysis techniques, along with the philosophy of the solution method. It explores the physics of errors in machines and how such knowledge can be used to build an error budget for a machine, how error budgets can be used to design more accurate machines.

  6. Precision electron polarimetry

    Energy Technology Data Exchange (ETDEWEB)

    Chudakov, Eugene A. [JLAB

    2013-11-01

    A new generation of precise Parity-Violating experiments will require a sub-percent accuracy of electron beam polarimetry. Compton polarimetry can provide such accuracy at high energies, but at a few hundred MeV the small analyzing power limits the sensitivity. M{\\o}ller polarimetry provides a high analyzing power independent on the beam energy, but is limited by the properties of the polarized targets commonly used. Options for precision polarimetry at ~300 MeV will be discussed, in particular a proposal to use ultra-cold atomic hydrogen traps to provide a 100\\%-polarized electron target for M{\\o}ller polarimetry.

  7. Standard practice: Estimating the cost-effectiveness of coordinated DSM programs

    Energy Technology Data Exchange (ETDEWEB)

    Hill, L.J.; Brown, M.A.

    1994-12-01

    The purpose of this document is to describe and illustrate a methodology for estimating the cost-effectiveness of coordinated demand-side management (DSM) programs, extending California {open_quotes}standard practice{close_quotes} to address the special evaluation challenges arising from these programs. A coordinated DSM program is one that is co-administered by a state or local government agency and a gas or electric utility. Although the primary subject of this document is coordinated low-income programs, the principles are easily extended to estimating the cost-effectiveness of all coordinated programs.

  8. Cost-Effectiveness Comparison of Coupler Designs of Wireless Power Transfer for Electric Vehicle Dynamic Charging

    Directory of Open Access Journals (Sweden)

    Weitong Chen

    2016-11-01

    Full Text Available This paper presents a cost-effectiveness comparison of coupler designs for wireless power transfer (WPT, meant for electric vehicle (EV dynamic charging. The design comparison of three common types of couplers is first based on the raw material cost, output power, transfer efficiency, tolerance of horizontal offset, and flux density. Then, the optimal cost-effectiveness combination is selected for EV dynamic charging. The corresponding performances of the proposed charging system are compared and analyzed by both simulation and experimentation. The results verify the validity of the proposed dynamic charging system for EVs.

  9. Cost-Effectiveness Analysis of Different Genetic Testing Strategies for Lynch Syndrome in Taiwan.

    Science.gov (United States)

    Chen, Ying-Erh; Kao, Sung-Shuo; Chung, Ren-Hua

    2016-01-01

    Patients with Lynch syndrome (LS) have a significantly increased risk of developing colorectal cancer (CRC) and other cancers. Genetic screening for LS among patients with newly diagnosed CRC aims to identify mutations in the disease-causing genes (i.e., the DNA mismatch repair genes) in the patients, to offer genetic testing for relatives of the patients with the mutations, and then to provide early prevention for the relatives with the mutations. Several genetic tests are available for LS, such as DNA sequencing for MMR genes and tumor testing using microsatellite instability and immunohistochemical analyses. Cost-effectiveness analyses of different genetic testing strategies for LS have been performed in several studies from different countries such as the US and Germany. However, a cost-effectiveness analysis for the testing has not yet been performed in Taiwan. In this study, we evaluated the cost-effectiveness of four genetic testing strategies for LS described in previous studies, while population-specific parameters, such as the mutation rates of the DNA mismatch repair genes and treatment costs for CRC in Taiwan, were used. The incremental cost-effectiveness ratios based on discounted life years gained due to genetic screening were calculated for the strategies relative to no screening and to the previous strategy. Using the World Health Organization standard, which was defined based on Taiwan's Gross Domestic Product per capita, the strategy based on immunohistochemistry as a genetic test followed by BRAF mutation testing was considered to be highly cost-effective relative to no screening. Our probabilistic sensitivity analysis results also suggest that the strategy has a probability of 0.939 of being cost-effective relative to no screening based on the commonly used threshold of $50,000 to determine cost-effectiveness. To the best of our knowledge, this is the first cost-effectiveness analysis for evaluating different genetic testing strategies for LS in

  10. Cost-effectiveness analyses of elective orthopaedic surgical procedures in patients with inflammatory arthropathies

    DEFF Research Database (Denmark)

    Osnes-Ringen, H.; Kvamme, M. K.; Sønbø Kristiansen, Ivar

    2011-01-01

    (SD 13) years, 77% female] with inflammatory arthropathies underwent orthopaedic surgical treatment and responded to mail surveys at baseline and during follow-up (3, 6, 9, and 12 months). Questionnaires included the quality-of-life EuroQol-5D (EQ-5D) and Short Form-6D (SF-6D) utility scores...... 800 for non-replacement surgical procedures measured by EQ-5D (SF-6D: EUR 67 500). Conclusions: Elective orthopaedic surgery in patients with inflammatory arthropathies was cost-effective when measured with EQ-5D, and some procedures were also cost-effective when SF-6D was used in the economic...

  11. Cost-Effective Strategies for Developing Formative Assessments in Online Workplace Training

    Directory of Open Access Journals (Sweden)

    Terry Mackey

    2009-11-01

    Full Text Available In the context of asynchronous online learning, formative assessments can offer amazing flexibility and support a wide range of learning strategies. While some versions do involve a considerable investment in time and cost, effective formative assessments need not be expensive. Many cost-effective strategies for developing formative assessments exist, and these can be employed quickly and effectively in online workplace training. These strategies allow learners to assess their progress and accomplishments before the risks of decreased motivation, confidence and understanding become unfortunate realities that negatively impact instructional outcomes, on-the-job performance and online learning ROI.

  12. Innovative grinding wheel design for cost-effective machining of advanced ceramics

    Energy Technology Data Exchange (ETDEWEB)

    Licht, R.H.; Kuo, P.; Liu, S.; Murphy, D.; Picone, J.W.; Ramanath, S.

    2000-05-01

    This Final Report covers the Phase II Innovative Grinding Wheel (IGW) program in which Norton Company successfully developed a novel grinding wheel for cost-effective cylindrical grinding of advanced ceramics. In 1995, Norton Company successfully completed the 16-month Phase I technical effort to define requirements, design, develop, and evaluate a next-generation grinding wheel for cost-effective cylindrical grinding of advanced ceramics using small prototype wheels. The Phase II program was initiated to scale-up the new superabrasive wheel specification to larger diameters, 305-mm to 406-mm, required for most production grinding of cylindrical ceramic parts, and to perform in-house and independent validation grinding tests.

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

    Energy Technology Data Exchange (ETDEWEB)

    Wyckoff, D.J.

    1993-11-01

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

  14. A generalized concept for cost-effective structural design. [Statistical Decision Theory applied to aerospace systems

    Science.gov (United States)

    Thomas, J. M.; Hawk, J. D.

    1975-01-01

    A generalized concept for cost-effective structural design is introduced. It is assumed that decisions affecting the cost effectiveness of aerospace structures fall into three basic categories: design, verification, and operation. Within these basic categories, certain decisions concerning items such as design configuration, safety factors, testing methods, and operational constraints are to be made. All or some of the variables affecting these decisions may be treated probabilistically. Bayesian statistical decision theory is used as the tool for determining the cost optimum decisions. A special case of the general problem is derived herein, and some very useful parametric curves are developed and applied to several sample structures.

  15. Stool DNA Analysis is Cost-Effective for Colorectal Cancer Surveillance in Patients With Ulcerative Colitis.

    Science.gov (United States)

    Kisiel, John B; Konijeti, Gauree G; Piscitello, Andrew J; Chandra, Tarun; Goss, Thomas F; Ahlquist, David A; Farraye, Francis A; Ananthakrishnan, Ashwin N

    2016-12-01

    Patients with chronic ulcerative colitis are at increased risk for colorectal neoplasia (CRN). Surveillance by white-light endoscopy (WLE) or chromoendoscopy may reduce risk of CRN, but these strategies are underused. Analysis of DNA from stool samples (sDNA) can detect CRN with high levels of sensitivity, but it is not clear if this approach is cost-effective. We simulated these strategies for CRN detection to determine which approach is most cost-effective. We adapted a previously published Markov model to simulate the clinical course of chronic ulcerative colitis, the incidence of cancer or dysplasia, and costs and benefits of care with 4 surveillance strategies: (1) analysis of sDNA and diagnostic chromoendoscopy for patients with positive results, (2) analysis of sDNA with diagnostic WLE for patients with positive results, (3) chromoendoscopy with targeted collection of biopsies, or (4) WLE with random collection of biopsies. Costs were based on 2014 Medicare reimbursement. The primary outcome was the incremental cost-effectiveness ratio (incremental cost/incremental difference in quality-adjusted life-years) compared with no surveillance and a willingness-to-pay threshold of $50,000. All strategies fell below the willingness-to-pay threshold at 2-year intervals. Incremental cost-effectiveness ratios were $16,362 per quality-adjusted life-year for sDNA analysis with diagnostic chromoendoscopy; $18,643 per quality-adjusted life-year for sDNA analysis with diagnostic WLE; $23,830 per quality-adjusted life-year for chromoendoscopy alone; and $27,907 per quality-adjusted life-year for WLE alone. In sensitivity analyses, sDNA analysis with diagnostic chromoendoscopy was more cost-effective than chromoendoscopy alone, up to a cost of $1135 per sDNA test. sDNA analysis remained cost-effective at all rates of compliance; when combined with diagnostic chromoendoscopy, this approach was preferred over chromoendoscopy alone, when the specificity of the sDNA test for CRN

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

    Directory of Open Access Journals (Sweden)

    Costa José

    2011-09-01

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

  17. A cost/effective screening method for assessing the toxicity of nutrient rich effluents to algae.

    Science.gov (United States)

    Carbonell, G; Fernández, C; Tarazona, J V

    2010-07-01

    Screening whole effluent toxicity tests are cost/effective methods for detecting the presence of toxic concentrations of unknown pollutants, but the application must solve the problem associated with the effect of high and variable concentrations of nutrients in the effluent on the results of algal toxicity tests. This work proposes a cost/effective test, based on three dilution levels measured at a single point time and a discriminant model for establishing if this kind of complex samples, with difficult interpretation of dilution-response curves, should be considered toxic to algae. This procedure identified properly around 85% of the samples considered toxic by expert judgement.

  18. Preventing the Wernicke-Korsakoff syndrome in Australia: cost-effectiveness of thiamin-supplementation alternatives.

    Science.gov (United States)

    Connelly, L; Price, J

    1996-04-01

    Alcoholic Wernicke's encephalopathy has been commonplace in Australia for many years and, as this syndrome is attributed to a deficiency in the diet, it should be preventable. This study employs conventional cost-effectiveness methodology to compare the economic efficiency of several thiamin-supplementation alternatives that have been proposed for the prevention of Wernicke's encephalopathy. A series of rankings of these measures is derived from an estimated cost per case averted for each of the alternatives studied. These rankings identify the least cost-effective thiamin-supplementation alternative as that of enriching bread-making flour with thiamin.

  19. Cost-effective and low-technology options for simulation and training in neonatology.

    Science.gov (United States)

    Bruno, Christie J; Glass, Kristen M

    2016-11-01

    The purpose of this review is to explore low-cost options for simulation and training in neonatology. Numerous cost-effective options exist for simulation and training in neonatology. Lower cost options are available for teaching clinical skills and procedural training in neonatal intubation, chest tube insertion, and pericardiocentesis, among others. Cost-effective, low-cost options for simulation-based education can be developed and shared in order to optimize the neonatal simulation training experience. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Occupational therapy: cost-effective solutions for changing health system needs.

    Science.gov (United States)

    Rexe, Kate; Lammi, Brenda McGibbon; Zweck, Claudia von

    2013-01-01

    Evidence shows occupational therapy interventions are cost-effective in treating or preventing injury and improving health outcomes in areas such as falls prevention, musculoskeletal injury, stroke rehabilitation, early intervention in developmental disabilities, respiratory rehabilitation and home care. Additional research indicates opportunities for occupational therapy to play an increased role in the management of health outcomes in complex and chronic diseases, pain management, non-pharmaceutical mental health interventions, dementia, end-of-life or palliative care and home care. This article aligns the discussion of health system transformation with literature identifying the cost-effectiveness of occupational therapy in Canada.

  1. Ultra Precision Machining

    Science.gov (United States)

    1990-05-20

    Sieder , Tate], [Baur, Isermann], [Kays, London, 1984]. We have addressed the question of controolling the temperature of oil used in a precision...Stanford, CA, USA. Sidman, M.D., 1986, Adaptive Control of a Flexible Structure, Ph.D. Thesis, Stanford University, Stanford, CA, USA. Sieder , E.N

  2. Precision Muonium Spectroscopy

    NARCIS (Netherlands)

    Jungmann, Klaus P.

    2016-01-01

    The muonium atom is the purely leptonic bound state of a positive muon and an electron. It has a lifetime of 2.2 $\\mu$s. The absence of any known internal structure provides for precision experiments to test fundamental physics theories and to determine accurate values of fundamental constants. In p

  3. Teaching with Precision.

    Science.gov (United States)

    Raybould, Ted; Solity, Jonathan

    1982-01-01

    Use of precision teaching principles with learning problem students involves five steps: specifying performance, recording daily behavior, charting daily behavior, recording the teaching approach, and analyzing data. The approach has been successfully implemented through consultation of school psychologists in Walsall, England. (CL)

  4. Cost-effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy in Denmark--cost-effectiveness analysis based on five randomised controlled trials

    DEFF Research Database (Denmark)

    Wickstrøm, Jannie; Dam, Nanna; Malmberg, Irena;

    2009-01-01

    Budesonide/formoterol maintenance and reliever therapy (Symbicort SMART) is an effective asthma-management regime where patients use budesonide/formoterol both as maintenance treatment and as additional doses as needed to improve overall asthma control by reducing symptoms and exacerbations....... The aim of this study was to determine the cost-effectiveness of the Symbicort SMART regime in Denmark vs higher dose inhaled corticosteroid (ICS) plus reliever medication, similar dose inhaled corticosteroid/long-acting beta(2)-agonist (ICS/LABA) combination therapy plus reliever medication or higher...

  5. Cost-effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy in Denmark--cost-effectiveness analysis based on five randomised controlled trials

    DEFF Research Database (Denmark)

    Wickstrøm, Jannie; Dam, Nanna; Malmberg, Irena

    2009-01-01

    Budesonide/formoterol maintenance and reliever therapy (Symbicort SMART) is an effective asthma-management regime where patients use budesonide/formoterol both as maintenance treatment and as additional doses as needed to improve overall asthma control by reducing symptoms and exacerbations....... The aim of this study was to determine the cost-effectiveness of the Symbicort SMART regime in Denmark vs higher dose inhaled corticosteroid (ICS) plus reliever medication, similar dose inhaled corticosteroid/long-acting beta(2)-agonist (ICS/LABA) combination therapy plus reliever medication or higher...

  6. The cost-effectiveness of 1% or less media campaigns promoting low-fat milk consumption.

    Science.gov (United States)

    Wootan, Margo G; Reger-Nash, Bill; Booth-Butterfield, Steve; Cooper, Linda

    2005-10-01

    The purpose of our study was to compare the cost-effectiveness of four strategies using components of 1% Or Less to promote population-based behavior change. 1% Or Less is a mass-media campaign that encourages switching from high-fat (whole or 2%) to low-fat (1% or skim) milk. Using a quasi-experimental design, campaigns were previously conducted in four West Virginia communities using different combinations of 1) paid advertising, 2) media relations, and 3) community-based educational activities. Telephone surveys and supermarket milk sales data were used to measure the campaigns' effectiveness. Using data from the previously completed studies, we analyzed the cost of each campaign. We then calculated the cost per person exposed to the campaign and cost per person who switched from high- to low-fat milk. The combination of paid advertising and media relations was the most cost-effective campaign, with a cost of 0.57 dollars per person to elicit a switch from high- to low-fat milk, and the combination of media relations and community-based educational activities was the least cost-effective campaign, with a cost of 11.85 dollars per person to elicit a switch. Population-based campaigns using a combination of paid advertising and media relations strategies can be a cost-effective way to promote a behavior change in a community.

  7. The Case for Adolescent HIV Vaccination in South Africa: A Cost-Effectiveness Analysis.

    Science.gov (United States)

    Moodley, Nishila; Gray, Glenda; Bertram, Melanie

    2016-01-01

    Despite comprising 0.7% of the world population, South Africa is home to 18% of the global human immunodeficiency virus (HIV) prevalence. Unyielding HIV subepidemics among adolescents threaten national attempts to curtail the disease burden. Should an HIV vaccine become available, establishing its point of entry into the health system becomes a priority. This study assesses the impact of school-based HIV vaccination and explores how variations in vaccine characteristics affect cost-effectiveness. The cost per quality adjusted life year (QALY) gained associated with school-based adolescent HIV vaccination services was assessed using Markov modeling that simulated annual cycles based on national costing data. The estimation was based on a life expectancy of 70 years and employs the health care provider perspective. The simultaneous implementation of HIV vaccination services with current HIV management programs would be cost-effective, even at relatively higher vaccine cost. At base vaccine cost of US$ 12, the incremental cost effectiveness ratio (ICER) was US$ 43 per QALY gained, with improved ICER values yielded at lower vaccine costs. The ICER was sensitive to duration of vaccine mediated protection and variations in vaccine efficacy. Data from this work demonstrate that vaccines offering longer duration of protection and at lower cost would result in improved ICER values. School-based HIV vaccine services of adolescents, in addition to current HIV prevention and treatment health services delivered, would be cost-effective.

  8. Link Design Rules for Cost-Effective Short-Range Radio Over Multimode Fiber Systems

    DEFF Research Database (Denmark)

    Visani, Davide; Tartarini, Giovanni; Petersen, Martin Nordal

    2010-01-01

    Referring to short-range radio over multimode fiber links, we find out important guidelines for the realization of cost-effective intensity modulated directly detected systems. Since the quality of today's connectors is considerably higher than in the past, we demonstrate that two important param...

  9. 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)

  10. Cost-effectiveness of 'immediate IVF' versus 'delayed IVF': a prospective study

    NARCIS (Netherlands)

    Eijkemans, M.J.; Kersten, F.A.M.; Lintsen, A.M.E.; Hunault, C.C.; Bouwmans, C.A.; Roijen, L.H.; Habbema, J.D.; Braat, D.D.M.

    2017-01-01

    STUDY QUESTION: How does the cost-effectiveness (CE) of immediate IVF compared with postponing IVF for 1 year, depend on prognostic characteristics of the couple? SUMMARY ANSWER: The CE ratio, i.e. the incremental costs of immediate versus delayed IVF per extra live birth, is the highest (range of

  11. Cost-effectiveness of home visits in the outpatient treatment of patients with alcohol dependence.

    Science.gov (United States)

    Moraes, Edilaine; Campos, Geraldo M; Figlie, Neliana B; Laranjeira, Ronaldo; Ferraz, Marcos B

    2010-01-01

    The purpose of this study was to compare the cost-effectiveness of conventional outpatient treatment for alcoholic patients (CT) with this same conventional treatment plus home visits (HV), a new proposal for intervention within the Brazilian outpatient treatment system. A cost-effectiveness evaluation alongside a 12-week randomized clinical trial was performed. We identified the resources utilized by each intervention, as well as the cost according to National Health System (SUS), Brazilian Medical Association (AMB) tables of fees, and others based on 2005 data. The incremental cost-effectiveness ratio (ICER) was estimated as the main outcome measure - abstinent cases at the end of treatment. There were 51.8% abstinent cases for HV and 43.1% for CT, a clinically relevant finding. Other outcome measures, such as quality of life, also showed significant improvements that favored HV. The baseline scenario presented an ICER of USD 1,852. Sensitivity analysis showed an ICER of USD 689 (scenario favoring HV) and USD 2,334 (scenario favoring CT). The HV treatment was found to be cost-effective according to the WHO Commission on Macroeconomics and Health. 2009 S. Karger AG, Basel.

  12. Cost-Effectiveness of Guided Self-Help Treatment for Recurrent Binge Eating

    Science.gov (United States)

    Lynch, Frances L.; Striegel-Moore, Ruth H.; Dickerson, John F.; Perrin, Nancy; DeBar, Lynn; Wilson, G. Terence; Kraemer, Helena C.

    2010-01-01

    Objective: Adoption of effective treatments for recurrent binge-eating disorders depends on the balance of costs and benefits. Using data from a recent randomized controlled trial, we conducted an incremental cost-effectiveness analysis (CEA) of a cognitive-behavioral therapy guided self-help intervention (CBT-GSH) to treat recurrent binge eating…

  13. Breast cancer control in low and middle income countries: cost-effectiveness and other considerations

    NARCIS (Netherlands)

    Zelle, S.G.

    2015-01-01

    In an effort to reduce the high number of breast cancer deaths in LMICs, this thesis provides careful recommendations on the types of early detection and treatment strategies that should be provided in these countries. It finds that CBE screening strategies (ages 40–69) are cost-effective and can be

  14. Implications of ICU triage decisions on patient mortality : a cost-effectiveness analysis

    NARCIS (Netherlands)

    Edbrooke, David L.; Minelli, Cosetta; Mills, Gary H.; Iapichino, Gaetano; Pezzi, Angelo; Corbella, Davide; Jacobs, Philip; Lippert, Anne; Wiis, Joergen; Pesenti, Antonio; Patroniti, Nicolo; Pirracchio, Romain; Payen, Didier; Gurman, Gabriel; Bakker, Jan; Kesecioglu, Jozef; Hargreaves, Chris; Cohen, Simon L.; Baras, Mario; Artigas, Antonio; Sprung, Charles L.

    2011-01-01

    Introduction: Intensive care is generally regarded as expensive, and as a result beds are limited. This has raised serious questions about rationing when there are insufficient beds for all those referred. However, the evidence for the cost effectiveness of intensive care is weak and the work that d

  15. Performance management and cost effectiveness of public services : empirical evidence from Dutch municipalities

    NARCIS (Netherlands)

    Groot, de H.; Hulst, van B.L.

    2011-01-01

    The performance of public organizations is one of the key topics in public administration research. Cost-effectiveness as a dimension of performance has hardly been studied in this literature, however. Many governments currently are cutting budgets on an unprecedented scale after the world-wide fina

  16. One-year cost-effectiveness of tiotropium versus ipratropium to treat chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    J.B. Oostenbrink (Jan); M.J. Al (Maiwenn); J.A. van Noord; W. Vincken; M.P.M.H. Rutten-van Mölken (Maureen)

    2004-01-01

    textabstractThe aim of this paper is to assess the health economic consequences of substituting ipratropium with the new, once-daily bronchodilator tiotropium in patients with a diagnosis of chronic obstructive pulmonary disease (COPD). This prospective cost-effectiveness analysis

  17. Cost-effectiveness of universal vaccination ag ainst varicella in the Netherlands

    NARCIS (Netherlands)

    De Boer, P.T.; Postma, M.J.

    2013-01-01

    Objectives: The Netherlands has no varicella vaccination in its National Immunization Program (NIP). Although varicella is regarded as a mild disease, implementation of varicella vaccination in the immunization schedule of several countries has shown to be cost-effective. Dutch children are infected

  18. Cost-Effectiveness of Connecticut's In-Prison Substance Abuse Treatment

    Science.gov (United States)

    Daley, Marilyn; Love, Craig T.; Shepard, Donald S.; Petersen, Cheryl B.; White, Karen L.; Hall, Frank B.

    2004-01-01

    Over the past two decades, the criminal justice population in the US has grown by over 200%, most of this due to an increase in drug-involved offenders. Although there is good evidence that prison-based substance abuse treatment programs can be effective in reducing rearrest, few cost-effectiveness studies have been conducted. Using data from the…

  19. THE EARLY BIRD CATCHES THE WORM : EARLY COST-EFFECTIVENESS ANALYSIS OF NEW MEDICAL TESTS

    NARCIS (Netherlands)

    Buisman, Leander R; Rutten-van Mölken, Maureen P M H; Postmus, Douwe; Luime, Jolanda J; Uyl-de Groot, Carin A; Redekop, William K

    2016-01-01

    OBJECTIVES: There is little specific guidance on performing an early cost-effectiveness analysis (CEA) of medical tests. We developed a framework with general steps and applied it to two cases. METHODS: Step 1 is to narrow down the scope of analysis by defining the test's application, target populat

  20. Cost-effectiveness of an Intensive Smoking Cessation Intervention for COPD Outpatients

    NARCIS (Netherlands)

    Christenhusz, L.C.A.; Prenger, H.C.; Pieterse, M.E.; Seydel, E.R.; Palen, van der J.

    2012-01-01

    Introduction: To determine the cost-effectiveness of a high-intensity smoking cessation program (SmokeStop Therapy; SST) versus a medium-intensity treatment (Minimal Intervention Strategy for Lung patients [LMIS]) for chronic obstructive pulmonary disease outpatients. Methods: The cost-effectiven

  1. A Cost-Effective Atomic Force Microscope for Undergraduate Control Laboratories

    Science.gov (United States)

    Jones, C. N.; Goncalves, J.

    2010-01-01

    This paper presents a simple, cost-effective and robust atomic force microscope (AFM), which has been purposely designed and built for use as a teaching aid in undergraduate controls labs. The guiding design principle is to have all components be open and visible to the students, so the inner functioning of the microscope has been made clear to…

  2. Understanding and improving the one and three times GDP per capita cost-effectiveness thresholds.

    Science.gov (United States)

    Robinson, Lisa A; Hammitt, James K; Chang, Angela Y; Resch, Stephen

    2017-02-01

    Researchers and policymakers have long been interested in developing simple decision rules to aid in determining whether an intervention is, or is not, cost-effective. In global health, interventions that impose costs per disability-adjusted life year averted less than three and one times gross domestic product per capita are often considered cost-effective and very cost-effective, respectively. This article explores the conceptual foundation and derivation of these thresholds. Its goal is to promote understanding of how these thresholds were derived and their implications, as well as to suggest options for improvement. These thresholds are intended to reflect the monetary value of the benefits to affected individuals, based on their preferences for spending on health vs spending on other goods and services. However, the current values were not rigorously derived, which means that their application may lead to inappropriate conclusions regarding which interventions should be adopted as well as misallocation of resources across health and other investments. Improving the basis for these cost-effectiveness thresholds is of particular importance in low- and middle-income countries, given the limited resources available and the significant needs of their populations.

  3. Basic versus Supplementary Health Insurance : The Role of Cost Effectiveness and Prevalence

    NARCIS (Netherlands)

    Boone, J.

    2014-01-01

    In a model where patients face budget constraints that make some treatments unaffordable, we ask which treatments should be covered by universal basic insurance and which by private voluntary insurance. We argue that both cost effectiveness and prevalence are important if the government wants to

  4. Cost-effectiveness of Campylobacter interventions on broiler farms in six European countries

    DEFF Research Database (Denmark)

    van Wagenberg, C.P.A.; van Horne, P.L.M.; Sommer, Helle Mølgaard

    2016-01-01

    Broilers are an important reservoir for human Campylobacter infections, one of the leading causes of acute diarrheal disease in humans worldwide. Therefore, it is relevant to control Campylobacter on broiler farms. This study estimated the cost-effectiveness ratios of eight Campylobacter interven...

  5. Cost-effectiveness estimates for antenatal HIV testing in the Netherlands.

    NARCIS (Netherlands)

    Rozenbaum, M.H.; Verweel, G.; Folkerts, D.K.; Dronkers, F.; Hoek, JA van den; Hartwig, N.G.; Groot, R. de; Postma, M.J.

    2008-01-01

    This paper provides an estimation of the lifetime health-care cost of HIV-infected children and an update of the cost-effectiveness of universal HIV-screening of pregnant women in Amsterdam (The Netherlands). During 2003-2005, we collected data concerning the prevalence of newly diagnosed HIV-infect

  6. Cost effective measures to prevent obesity: epidemiological basis and appropriate target groups

    NARCIS (Netherlands)

    Seidell, J.C.; Nooyens, A.C.J.; Visscher, T.L.S.

    2005-01-01

    Cost-effective prevention strategies to prevent weight gain and the development of obesity should be based on appropriate knowledge of the determinants of weight gain. The body of evidence on the dietary determinants of weight gain is, however, fragmentary at best, partly because inappropriate

  7. Cost-effectiveness of face-to-face smoking cessation interventions : a dynamic modeling study

    NARCIS (Netherlands)

    Feenstra, Talitha L; Hamberg-van Reenen, Heleen H; Hoogenveen, Rudolf T; Rutten-van Mölken, Maureen P M H

    2005-01-01

    OBJECTIVES: To estimate the cost-effectiveness of five face-to-face smoking cessation interventions (i.e., minimal counseling by a general practitioner (GP) with, or without nicotine replacement therapy (NRT), intensive counseling with NRT, or bupropion, and telephone counseling) in terms of costs p

  8. Is centralization of ovarian cancer care warranted? A cost-effectiveness analysis

    NARCIS (Netherlands)

    Greving, Jacoba P.; Vernooji, Flora; Heintz, A. Peter M.; van der Graaf, Yolanda; Buskens, Erik

    2009-01-01

    Objective. To evaluate the cost-effectiveness of tertiary referral care for ovarian cancer patients in the Netherlands. Methods. We collected clinical and registry data on 1077 newly diagnosed ovarian cancer patients treated from 1996-2003 in a random sample of Dutch hospitals. Decision modelling wa

  9. Cost effectiveness analysis of strategies for tuberculosis control in developing countries.

    NARCIS (Netherlands)

    Baltussen, R.M.P.M.; Floyd, K.; Dye, C.

    2005-01-01

    OBJECTIVE: To assess the costs and health effects of tuberculosis control interventions in Africa and South East Asia in the context of the millennium development goals. DESIGN: Cost effectiveness analysis based on an epidemiological model. SETTING: Analyses undertaken for two regions classified by

  10. Cost-effectiveness of intestinal transplantation for adult patients with intestinal failure : a simulation study

    NARCIS (Netherlands)

    Roskott, Anne Margot; Groen, Henk; Rings, Edmond H. H. M.; Haveman, Jan Willem; Ploeg, Rutger J.; Serlie, Mireille J.; Wanten, Geert; Krabbe, Paul F. M.; Dijkstra, Gerard

    2015-01-01

    Background: Home parenteral nutrition (HPN) and intestinal transplantation (ITx) are the 2 treatment options for irreversible intestinal failure (IF). Objective: This study simulated the disease course of irreversible IF and both of these treatments HPN and ITx to estimate the cost-effectiveness of

  11. Intestinal rehabilitation for children with intestinal failure is cost-effective : a simulation study

    NARCIS (Netherlands)

    Groen, Henk; Neelis, Esther G; Poley, Marten J; Olieman, Joanne F; Scheenstra, René; Krabbe, Paul Fm; Dijkstra, Gerard; Rings, Edmond Hhm

    2017-01-01

    BACKGROUND: Children with intestinal failure (IF) depend on parenteral nutrition (PN). The goal in the treatment of IF is to wean children off PN through intestinal rehabilitation (IR). Although the healthcare burden of IF is enormous, to our knowledge there has been no previous cost-effectiveness a

  12. Cost-Effectiveness of Escitalopram in Major Depressive Disorder in the Dutch Health Care Setting

    NARCIS (Netherlands)

    Nuijten, Mark J. C.; Brignone, Melanie; Marteau, Florence; den Boer, Johan A.; Hoencamp, Erik

    2012-01-01

    Objective: This study assessed the cost-effectiveness of escitalopram for the treatment of depression in the Netherlands from a societal perspective. Methods: A decision tree model was constructed using decision analytical techniques. Data sources included published literature, clinical trials, offi

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

    NARCIS (Netherlands)

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

    2006-01-01

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

  14. From productivity strategy to business case : Choosing a cost-effective intervention for workplace innovations

    NARCIS (Netherlands)

    Oeij, P.R.A.; Looze, M.P. de; Have, K. ten; Rhijn, J.W. van; Graaf, H.A.L.M. de

    2012-01-01

    The article presents an approach to developing cost-effective interventions for workplace innovations for entrepreneurs who seek to enhance the productivity of an organization. The business case method is used to extend the Q4-model of productivity, which supports developing a productivity strategy

  15. Selective solar absorbers: A cost effective solution for access to clean energy in rural Africa

    CSIR Research Space (South Africa)

    Katumba, G

    2008-11-01

    Full Text Available In this present era of global energy crisis there is a greater need to turn to renewable, cost effective and sustainable energy resources. In rural Africa, in particular, the demand for domestic energy is even higher. This is exacerbated...

  16. Evaluation of cost-effective aeration technology solutions to address total trihalomethane (TTHM) compliance

    Science.gov (United States)

    The primary objective of this project was to evaluate cost-effective aeration technology solutions to address TTHM compliance at a water treatment plant clearwell. The project team worked closely with EPA Region 6 and the EPA Office of Research and Development (ORD) to identify a...

  17. Cost-effectiveness of rotavirus immunization in Vietnam: Results and challenges

    NARCIS (Netherlands)

    Tu, H.A.T.; Rozenbaum, M.; Coyte, P.C.; Li, S.C.; Postma, M.J.

    2011-01-01

    OBJECTIVES: To assess the cost-effectiveness of universal rotavirus immunization, explicitly the use of Rotateq® and affordability of implementing rotavirus immunization based on the Global Alliance for Vaccines and Immunization (GAVI)-subsidized vaccine price in the context of Vietnamese health car

  18. Cost-Effectiveness and Resource Allocation (CERA) - directions for the future.

    NARCIS (Netherlands)

    Baltussen, R.M.P.M.; Acharya, A.; Antioch, K.; Chisholm, D.; Grieve, R.; Kirigia, J.; Torres-Edejer, T.T.; Walker, D.; Evans, D.

    2009-01-01

    ABSTRACT: The journal Cost-Effectiveness and Resource Allocation (CERA) is now in its seventh year, and is an excellent example of how open access publishing can improve dissemination. Now the journal is through its infancy, it is time to reflect on its orientation and to define the strategy for the

  19. Evaluating the cost-effectiveness of ecosystem-based adaptation: Kamiesberg wetlands case study

    Directory of Open Access Journals (Sweden)

    David Black

    2016-12-01

    Full Text Available Ecosystem-based adaptation (EbA is increasingly being promoted as a cost-effective means of adaptation to climate change. However, in spite of considerable international press, there is still little evidence to substantiate this claim. This study proposes a method through which the cost-effectiveness of EbA strategies can be evaluated against alternative adaptation options, and contributes to South African literature on the subject. The potential cost-effectiveness of wetland restoration is assessed as a means of securing the carrying capacity of land for pastoralist communities of the Kamiesberg communal area in South Africa under projected future climate conditions. The conventional alternatives would be to respond to increasingly dry conditions by drilling boreholes and using supplemental feed for livestock. It was assumed that the EbA interventions would occur upfront, whereas the alternatives are more likely to be implemented in reaction to droughts over a longer time period. The study found the implementation of conventional alternatives to be more cost-effective than EbA as a means to sustaining livestock stocking rates, with EbA being twice as costly. However, this is framed from the perspective of those directly affected (the landowners, and does not include the benefits to broader society.

  20. Cost-effectiveness of screening programs for Chlamydia trachomatis - A population-based dynamic approach

    NARCIS (Netherlands)

    Welte, R; Kretzschmar, M; Leidl, R; Van den Hoek, A; Jager, JC; Postma, MJ

    2000-01-01

    Background: Models commonly used for the economic assessment of chamydial screening programs do not consider population effects. Goal: To develop a novel dynamic approach for the economic evaluation of chlamydial prevention measures and to determine the cost-effectiveness of a general practitioner-b