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Sample records for cost-effective phosphorus management

  1. Engaging Watershed Stakeholders for Cost-Effective Environmental Management Planning with "Watershed Manager"

    Science.gov (United States)

    Williams, Jeffery R.; Smith, Craig M.; Roe, Josh D.; Leatherman, John C.; Wilson, Robert M.

    2012-01-01

    "Watershed Manager" is a spreadsheet-based model that is used in extension education programs for learning about and selecting cost-effective watershed management practices to reduce soil, nitrogen, and phosphorus losses from cropland. It can facilitate Watershed Restoration and Protection Strategy (WRAPS) stakeholder groups' development…

  2. Spatially-Distributed Cost-Effectiveness Analysis Framework to Control Phosphorus from Agricultural Diffuse Pollution.

    Directory of Open Access Journals (Sweden)

    Runzhe Geng

    Full Text Available Best management practices (BMPs for agricultural diffuse pollution control are implemented at the field or small-watershed scale. However, the benefits of BMP implementation on receiving water quality at multiple spatial is an ongoing challenge. In this paper, we introduce an integrated approach that combines risk assessment (i.e., Phosphorus (P index, model simulation techniques (Hydrological Simulation Program-FORTRAN, and a BMP placement tool at various scales to identify the optimal location for implementing multiple BMPs and estimate BMP effectiveness after implementation. A statistically significant decrease in nutrient discharge from watersheds is proposed to evaluate the effectiveness of BMPs, strategically targeted within watersheds. Specifically, we estimate two types of cost-effectiveness curves (total pollution reduction and proportion of watersheds improved for four allocation approaches. Selection of a ''best approach" depends on the relative importance of the two types of effectiveness, which involves a value judgment based on the random/aggregated degree of BMP distribution among and within sub-watersheds. A statistical optimization framework is developed and evaluated in Chaohe River Watershed located in the northern mountain area of Beijing. Results show that BMP implementation significantly (p >0.001 decrease P loss from the watershed. Remedial strategies where BMPs were targeted to areas of high risk of P loss, deceased P loads compared with strategies where BMPs were randomly located across watersheds. Sensitivity analysis indicated that aggregated BMP placement in particular watershed is the most cost-effective scenario to decrease P loss. The optimization approach outlined in this paper is a spatially hierarchical method for targeting nonpoint source controls across a range of scales from field to farm, to watersheds, to regions. Further, model estimates showed targeting at multiple scales is necessary to optimize program

  3. 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.

  4. Simple, cost effective method for determination of phosphorus in uranium ore concentrate

    International Nuclear Information System (INIS)

    Misra, U.B.; Ramamurty, Vasantha; Dutta, M.; Balaji Rao, Y.; Subba Rao, Y.

    2015-01-01

    In this paper determination of phosphate as phosphorus in uranium ore concentrate has been described. The method used is spectrophotometric determination of phosphorus as phospho-molybdenum blue complex. As uranyl ion do not absorb in 600-900 nm range of visible region in the present medium, the phosphomolybdenum blue complex formation which is having maximum absorbance at 825 nm is exploited for determination of phosphorus. The molar absorptivity coefficient with and without the presence of uranium matrix are 2.6048 x 10 4 and 2.6730 x 10 4 lmol -1 cm -1 . The effect of matrix is not evident from the experiment carried out. (author)

  5. Designing cost effective water demand management programs in Australia.

    Science.gov (United States)

    White, S B; Fane, S A

    2002-01-01

    This paper describes recent experience with integrated resource planning (IRP) and the application of least cost planning (LCP) for the evaluation of demand management strategies in urban water. Two Australian case studies, Sydney and Northern New South Wales (NSW) are used in illustration. LCP can determine the most cost effective means of providing water services or alternatively the cheapest forms of water conservation. LCP contrasts to a traditional approach of evaluation which looks only at means of increasing supply. Detailed investigation of water usage, known as end-use analysis, is required for LCP. End-use analysis allows both rigorous demand forecasting, and the development and evaluation of conservation strategies. Strategies include education campaigns, increasing water use efficiency and promoting wastewater reuse or rainwater tanks. The optimal mix of conservation strategies and conventional capacity expansion is identified based on levelised unit cost. IRP uses LCP in the iterative process, evaluating and assessing options, investing in selected options, measuring the results, and then re-evaluating options. Key to this process is the design of cost effective demand management programs. IRP however includes a range of parameters beyond least economic cost in the planning process and program designs, including uncertainty, benefit partitioning and implementation considerations.

  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. Global cost-effectiveness of GDM screening and management

    DEFF Research Database (Denmark)

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

    2015-01-01

    a systematic search and abstraction of cost-effectiveness and cost-utility studies from 2002 to 2014. We standardized all findings to 2014 US dollars. We found that cost-effectiveness ratios varied widely. Most variation was found to be due to differences in geographic setting, diagnostic criteria...... and intervention approaches, and outcomes (e.g., inclusion or exclusion of long-term type 2 diabetes risk and associated costs). We concluded that incorporation of long-term benefits of GDM screening and treatment has huge impact on cost-effectiveness estimates. Based on the large methodological heterogeneity...

  8. Cost effective waste management through composting in Africa

    Energy Technology Data Exchange (ETDEWEB)

    Couth, R. [CRECHE, Centre for Environmental, Coastal and Hydrological Engineering, Civil Engineering Programme, School of Engineering, University of KwaZulu-Natal, Durban 4041 (South Africa); Trois, C., E-mail: troisc@ukzn.ac.za [CRECHE, Centre for Environmental, Coastal and Hydrological Engineering, Civil Engineering Programme, School of Engineering, University of KwaZulu-Natal, Durban 4041 (South Africa)

    2012-12-15

    Highlights: Black-Right-Pointing-Pointer The financial/social/institutional sustainability of waste management in Africa is analysed. Black-Right-Pointing-Pointer This note is a compendium of a study on the potential for GHG control via improved zero waste in Africa. Black-Right-Pointing-Pointer This study provides the framework for Local Authorities for realizing sustained GHG reductions. - Abstract: Greenhouse gas (GHG) emissions per person from urban waste management activities are greater in sub-Saharan African countries than in other developing countries, and are increasing as the population becomes more urbanised. Waste from urban areas across Africa is essentially dumped on the ground and there is little control over the resulting gas emissions. The clean development mechanism (CDM), from the 1997 Kyoto Protocol has been the vehicle to initiate projects to control GHG emissions in Africa. However, very few of these projects have been implemented and properly registered. A much more efficient and cost effective way to control GHG emissions from waste is to stabilise the waste via composting and to use the composted material as a soil improver/organic fertiliser or as a component of growing media. Compost can be produced by open windrow or in-vessel composting plants. This paper shows that passively aerated open windrows constitute an appropriate low-cost option for African countries. However, to provide an usable compost material it is recommended that waste is processed through a materials recovery facility (MRF) before being composted. The paper demonstrates that material and biological treatment (MBT) are viable in Africa where they are funded, e.g. CDM. However, they are unlikely to be instigated unless there is a replacement to the Kyoto Protocol, which ceases for Registration in December 2012.

  9. Cost effective waste management through composting in Africa

    International Nuclear Information System (INIS)

    Couth, R.; Trois, C.

    2012-01-01

    Highlights: ► The financial/social/institutional sustainability of waste management in Africa is analysed. ► This note is a compendium of a study on the potential for GHG control via improved zero waste in Africa. ► This study provides the framework for Local Authorities for realizing sustained GHG reductions. - Abstract: Greenhouse gas (GHG) emissions per person from urban waste management activities are greater in sub-Saharan African countries than in other developing countries, and are increasing as the population becomes more urbanised. Waste from urban areas across Africa is essentially dumped on the ground and there is little control over the resulting gas emissions. The clean development mechanism (CDM), from the 1997 Kyoto Protocol has been the vehicle to initiate projects to control GHG emissions in Africa. However, very few of these projects have been implemented and properly registered. A much more efficient and cost effective way to control GHG emissions from waste is to stabilise the waste via composting and to use the composted material as a soil improver/organic fertiliser or as a component of growing media. Compost can be produced by open windrow or in-vessel composting plants. This paper shows that passively aerated open windrows constitute an appropriate low-cost option for African countries. However, to provide an usable compost material it is recommended that waste is processed through a materials recovery facility (MRF) before being composted. The paper demonstrates that material and biological treatment (MBT) are viable in Africa where they are funded, e.g. CDM. However, they are unlikely to be instigated unless there is a replacement to the Kyoto Protocol, which ceases for Registration in December 2012.

  10. A Comparison of Alternative Strategies for Cost-Effective Water Quality Management in Lakes

    Science.gov (United States)

    Kramer, Daniel Boyd; Polasky, Stephen; Starfield, Anthony; Palik, Brian; Westphal, Lynne; Snyder, Stephanie; Jakes, Pamela; Hudson, Rachel; Gustafson, Eric

    2006-09-01

    Roughly 45% of the assessed lakes in the United States are impaired for one or more reasons. Eutrophication due to excess phosphorus loading is common in many impaired lakes. Various strategies are available to lake residents for addressing declining lake water quality, including septic system upgrades and establishing riparian buffers. This study examines 25 lakes to determine whether septic upgrades or riparian buffers are a more cost-effective strategy to meet a phosphorus reduction target. We find that riparian buffers are the more cost-effective strategy in every case but one. Large transaction costs associated with the negotiation and monitoring of riparian buffers, however, may be prohibiting lake residents from implementing the most cost-effective strategy.

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

    African Journals Online (AJOL)

    Several production constraints have led to low yields (< 2.5 t ha-1) in maize (Zea mays L.) inUganda, among which are weeds. This study investigated the most cost-effective integrated weedmanagement (IWM) approach in maize in eastern Uganda. An experiment was conducted atIkulwe station, Mayuge in 2011 and 2012 ...

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

    African Journals Online (AJOL)

    Objectives. To describe the pattern of prescribing for hypertension at a community health centre (CHC) and to evaluate the impact of introducing treatment guidelines and restricting availability of less cost-effective antihypertensive drugs on prescribing patterns, costs of drug treatment and blood pressure (BP) control. Design ...

  13. Cost-effectiveness analysis of diarrhoea management approaches in Nigeria: A decision analytical model.

    Directory of Open Access Journals (Sweden)

    Charles E Okafor

    2017-12-01

    Full Text Available Diarrhoea is a leading cause of death in Nigerian children under 5 years. Implementing the most cost-effective approach to diarrhoea management in Nigeria will help optimize health care resources allocation. This study evaluated the cost-effectiveness of various approaches to diarrhoea management namely: the 'no treatment' approach (NT; the preventive approach with rotavirus vaccine; the integrated management of childhood illness for diarrhoea approach (IMCI; and rotavirus vaccine plus integrated management of childhood illness for diarrhoea approach (rotavirus vaccine + IMCI.Markov cohort model conducted from the payer's perspective was used to calculate the cost-effectiveness of the four interventions. The markov model simulated a life cycle of 260 weeks for 33 million children under five years at risk of having diarrhoea (well state. Disability adjusted life years (DALYs averted was used to quantify clinical outcome. Incremental cost-effectiveness ratio (ICER served as measure of cost-effectiveness.Based on cost-effectiveness threshold of $2,177.99 (i.e. representing Nigerian GDP/capita, all the approaches were very cost-effective but rotavirus vaccine approach was dominated. While IMCI has the lowest ICER of $4.6/DALY averted, the addition of rotavirus vaccine was cost-effective with an ICER of $80.1/DALY averted. Rotavirus vaccine alone was less efficient in optimizing health care resource allocation.Rotavirus vaccine + IMCI approach was the most cost-effective approach to childhood diarrhoea management. Its awareness and practice should be promoted in Nigeria. Addition of rotavirus vaccine should be considered for inclusion in the national programme of immunization. Although our findings suggest that addition of rotavirus vaccine to IMCI for diarrhoea is cost-effective, there may be need for further vaccine demonstration studies or real life studies to establish the cost-effectiveness of the vaccine in Nigeria.

  14. Cost-Effectiveness of Management Training in the Informal Sector. Discussion Paper No. 101.

    Science.gov (United States)

    Nubler, Irmgard

    A research project in the Ivory Coast, Kenya, and Tanzania evaluated the cost effectiveness of management training seminars for women entrepreneurs in the informal sector. Women, a large and growing part of entrepreneurs, had less access to needed resources, skills, and information than men. Reasons for failure to study the cost effectiveness and…

  15. 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...alternative view point is necessary. ERDC/EL SR-17-3 4 Levee setbacks are a relatively recent innovation in Corps flood risk management practice

  16. Surgical management of bilateral vocal fold paralysis: A cost-effectiveness comparison of two treatments.

    Science.gov (United States)

    Naunheim, Matthew R; Song, Phillip C; Franco, Ramon A; Alkire, Blake C; Shrime, Mark G

    2017-03-01

    Endoscopic management of bilateral vocal fold paralysis (BVFP) includes cordotomy and arytenoidectomy, and has become a well-accepted alternative to tracheostomy. However, the costs and quality-of-life benefits of endoscopic management have not been examined with formal economic analysis. This study undertakes a cost-effectiveness analysis of tracheostomy versus endoscopic management of BVFP. Cost-effectiveness analysis. A literature review identified a range of costs and outcomes associated with surgical options for BVFP. Additional costs were derived from Medicare reimbursement data; all were adjusted to 2014 dollars. Cost-effectiveness analysis evaluated both therapeutic strategies in short-term and long-term scenarios. Probabilistic sensitivity analysis was used to assess confidence levels regarding the economic evaluation. The incremental cost effectiveness ratio for endoscopic management versus tracheostomy is $31,600.06 per quality-adjusted life year (QALY), indicating that endoscopic management is the cost-effective short-term strategy at a willingness-to-pay (WTP) threshold of $50,000/QALY. The probability that endoscopic management is more cost-effective than tracheostomy at this WTP is 65.1%. Threshold analysis demonstrated that the model is sensitive to both utilities and cost in the short-term scenario. When costs of long-term care are included, tracheostomy is dominated by endoscopic management, indicating the cost-effectiveness of endoscopic management at any WTP. Endoscopic management of BVFP appears to be more cost-effective than tracheostomy. Though endoscopic cordotomy and arytenoidectomy require expertise and specialized equipment, this model demonstrates utility gains and long-term cost advantages to an endoscopic strategy. These findings are limited by the relative paucity of robust utility data and emphasize the need for further economic analysis in otolaryngology. NA Laryngoscope, 127:691-697, 2017. © 2016 The American Laryngological

  17. Facilitating Sound, Cost-Effective Federal Energy Management

    Energy Technology Data Exchange (ETDEWEB)

    FEMP

    2016-07-01

    Fact sheet offers an overview of the Federal Energy Management Program (FEMP), which provides agencies and organizations with the information, tools, and assistance they need to achieve their energy-related requirements and goals through specialized initiatives.

  18. Cost-effectiveness of Intensive Blood Pressure Management

    DEFF Research Database (Denmark)

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

    2016-01-01

    Importance: Among high-risk patients with hypertension, targeting a systolic blood pressure of 120 mm Hg reduces cardiovascular morbidity and mortality compared with a higher target. However, intensive blood pressure management incurs additional costs from treatment and from adverse events......-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...... and accrued $155 261 in lifetime costs, while intensive management yielded 10.5 QALYs and accrued $176 584 in costs. Intensive blood pressure management cost $23 777 per QALY gained. In a sensitivity analysis, serious adverse events would need to occur at 3 times the rate observed in SPRINT and be 3 times...

  19. Use of Phosphorus Isotopes for Improving Phosphorus Management in Agricultural Systems

    International Nuclear Information System (INIS)

    2016-10-01

    Phosphorus is an essential element in plant, human and animal nutrition. Soils with low levels of phosphorus are widespread in many regions of the world, and the deficiency limits plant growth and reduces crop production and food quality. This publication provides comprehensive and up to date information on several topics related to phosphorus in soil–plant systems, in agricultural systems and in the environment. It presents the theoretical background as well as practical information on how to use nuclear and radioisotope tracer techniques in both laboratory and greenhouse experiments to assess soil phosphorus forms and plant-available soil phosphorus pools, and to understand the cycling processes in soil–plant systems. The publication focuses on practical applications of radiotracer techniques and can serve as resource material for research projects on improving sustainable phosphorus management in agricultural systems and as practical guidance on the use of phosphate isotopes in soil–plant research

  20. Determination of cost effective waste management system receipt rates

    International Nuclear Information System (INIS)

    McKee, R.W.; Huber, H.D.

    1991-01-01

    A comprehensive logistics and cost analysis has been carried out to determine if there are potential benefits to the high-level waste management system for receipt rates other than the current 3000 MTU/yr design-basis. The analysis includes both a Repository-Only System and a Storage-Only System. Repository startup dates of 2010 and 2015 and MRS startup dates of 1988 and three years prior to the repository have been evaluated. Receipt rates ranging from 1,500 to 6, 000 MTU/yr have been considered. Higher receipt rates appear to be economically justified, for either system, minimum costs are found at a repository receipt rate of 6000 MTU/yr. However, the MRS receipt rate for minimum system costs depends on the MRS startup date. With a 1988 MRS and a 2010 repository, the added cost of providing the MRS is offset by at-reactor storage cost reductions and the total system cost of $10.0 billion is virtually the same as for the repository- only system. 9 refs., 8 figs., 3 tabs

  1. Determination of cost effective waste management system receipt rates

    International Nuclear Information System (INIS)

    McKee, R.W.; Huber, H.D.

    1991-01-01

    A comprehensive logistics and cost analysis has been carried out to determine if there are potential benefits to the high-level waste management system for receipt rates other than the current 3,000 MTU/yr design-basis receipt rate. The scope of the analysis includes both a Repository-Only System and a Storage-Only or Basic MRS System. To allow for current uncertainties in facility startup scheduling, cases considering repository startup dates of 2010 and 2015 and MRS startup dates of 1998 and three years prior to the repository have been evaluated. Receipt rates ranging from 1,500 to 6,000 MTU/yr have been considered for both the MRS and the repository. Higher receipt rates appear to be economically justified for both the repository and an MRS. For a repository-only system, minimum costs are found at a repository receipt rate of 6,000 MTU/yr. When a storage-only MRS is included in the system, minimum system costs are also achieved at a repository receipt rate of 6,000 MTU/yr. However, the MRS receipt rate for minimum system costs depends on the MRS startup date and ranges from 3,500 to 6,000 MTU/yr. With a 1998 MRS and a 2010 repository, the added cost of providing the MRS is offset by at-reactor storage cost reductions and the total system cost of $10.0 billion is virtually the same as for the repository-only system

  2. Cost-effective management alternatives for Snake River Chinook salmon: a biological-economic synthesis.

    Science.gov (United States)

    Halsing, David L; Moore, Michael R

    2008-04-01

    The mandate to increase endangered salmon populations in the Columbia River Basin of North America has created a complex, controversial resource-management issue. We constructed an integrated assessment model as a tool for analyzing biological-economic trade-offs in recovery of Snake River spring- and summer-run chinook salmon (Oncorhynchus tshawytscha). We merged 3 frameworks: a salmon-passage model to predict migration and survival of smolts; an age-structured matrix model to predict long-term population growth rates of salmon stocks; and a cost-effectiveness analysis to determine a set of least-cost management alternatives for achieving particular population growth rates. We assessed 6 individual salmon-management measures and 76 management alternatives composed of one or more measures. To reflect uncertainty, results were derived for different assumptions of effectiveness of smolt transport around dams. Removal of an estuarine predator, the Caspian Tern (Sterna caspia), was cost-effective and generally increased long-term population growth rates regardless of transport effectiveness. Elimination of adult salmon harvest had a similar effect over a range of its cost estimates. The specific management alternatives in the cost-effective set depended on assumptions about transport effectiveness. On the basis of recent estimates of smolt transport effectiveness, alternatives that discontinued transportation or breached dams were prevalent in the cost-effective set, whereas alternatives that maximized transportation dominated if transport effectiveness was relatively high. More generally, the analysis eliminated 80-90% of management alternatives from the cost-effective set. Application of our results to salmon management is limited by data availability and model assumptions, but these limitations can help guide research that addresses critical uncertainties and information. Our results thus demonstrate that linking biology and economics through integrated models can

  3. Cash Management, Revenue Sources and Cost Effective Methods of Revenue Collection at Local Government Level

    OpenAIRE

    Mustapha Gimba Kumshe; Kagu Bukar

    2013-01-01

    The main objective of this paper was to focus on the elements, objectives, goals and importance of cash management; and also to examine the sources of revenue and cost effective collections for local governments. The elements of cash management are identified as establishing bank relations, preparing cash flow statements, estimating collection receipts and analyzing cash flow and preparing a budget. Amongst the objectives of cash management is to ensure availability of cash resources at all t...

  4. Cost-effectiveness of endovascular repair, open repair, and conservative management of splenic artery aneurysms

    NARCIS (Netherlands)

    Hogendoorn, Wouter; Lavida, Anthi; Hunink, M. G Myriam; Moll, Frans L.; Geroulakos, George; Muhs, Bart E.; Sumpio, Bauer E.

    2015-01-01

    Objective Open repair (OPEN) and conservative management (CONS) have been the treatments of choice for splenic artery aneurysms (SAAs) for many years. Endovascular repair (EV) has been increasingly used with good short-term results. In this study, we evaluated the cost-effectiveness of OPEN, EV, and

  5. Cost-effectiveness of competing strategies for management of recurrent Clostridium difficile infection: a decision analysis.

    Science.gov (United States)

    Konijeti, Gauree G; Sauk, Jenny; Shrime, Mark G; Gupta, Meera; Ananthakrishnan, Ashwin N

    2014-06-01

    Clostridium difficile infection (CDI) is an important cause of morbidity and healthcare costs, and is characterized by high rates of disease recurrence. The cost-effectiveness of newer treatments for recurrent CDI has not been examined, yet would be important to inform clinical practice. The aim of this study was to analyze the cost effectiveness of competing strategies for recurrent CDI. We constructed a decision-analytic model comparing 4 treatment strategies for first-line treatment of recurrent CDI in a population with a median age of 65 years: metronidazole, vancomycin, fidaxomicin, and fecal microbiota transplant (FMT). We modeled up to 2 additional recurrences following the initial recurrence. We assumed FMT delivery via colonoscopy as our base case, but conducted sensitivity analyses based on different modes of delivery. Willingness-to-pay threshold was set at $50 000 per quality-adjusted life-year. At our base case estimates, initial treatment of recurrent CDI using FMT colonoscopy was the most cost-effective strategy, with an incremental cost-effectiveness ratio of $17 016 relative to oral vancomycin. Fidaxomicin and metronidazole were both dominated by FMT colonoscopy. On sensitivity analysis, FMT colonoscopy remained the most cost-effective strategy at cure rates >88.4% and CDI recurrence rates cost cost-effectiveness threshold. In clinical settings where FMT is not available or applicable, the preferred strategy appears to be initial treatment with oral vancomycin. In this decision analysis examining treatment strategies for recurrent CDI, we demonstrate that FMT colonoscopy is the most cost-effective initial strategy for management of recurrent CDI.

  6. Cost-Effectiveness Analysis of the Self-Management Program for Thai Patients with Metabolic Syndrome.

    Science.gov (United States)

    Sakulsupsiri, Anut; Sakthong, Phantipa; Winit-Watjana, Win

    2016-05-01

    Lifestyle modification programs are partly evaluated for their usefulness. This study aimed to assess the cost-effectiveness and healthy lifestyle persistence of a self-management program (SMP) for patients with metabolic syndrome (MetS) in Thai health care settings. A cost-effectiveness analysis was performed on the basis of an intervention study of 90 patients with MetS randomly allocated to the SMP and control groups. A Markov model with the Difference-in-Difference method was used to predict the lifetime costs from a societal perspective and quality-adjusted life-years (QALYs), of which 95% confidence intervals (CIs) were estimated by bootstrapping. The cost-effectiveness analysis, along with healthy lifestyle persistence, was performed using the discount rate of 3% per annum. Parameter uncertainties were identified using one-way and probabilistic sensitivity analyses. The lifetime costs tended to decrease in both groups. The SMP could save lifetime costs (-2310 baht; 95% CI -5960 to 1400) and gain QALYs (0.0098; 95% CI -0.0003 to 0.0190), compared with ordinary care. The probability of cost-effectiveness was 99.4% from the Monte-Carlo simulation, and the program was deemed cost-effective at dropout rates below 69% per year as determined by the threshold of 160,000 baht per QALY gained. The cost of macrovascular complications was the most influencing variable for the overall incremental cost-effectiveness ratio. The SMP provided by the health care settings is marginally cost-effective, and the persistence results support the implementation of the program to minimize the complications and economic burden of patients with MetS. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  7.   A Cost-Effectiveness Analysis of Two Management Strategies for Dyspepsia

    DEFF Research Database (Denmark)

    Kjeldsen, Hans Chr; Bech, Mickael; Christensen, Bo

    2007-01-01

    Objectives: To compare the cost-effectiveness of endoscopy and empirical proton pump inhibition (PPI) therapy for management of dyspepsia in primary care. Methods: A randomized controlled trial (RCT) including prospective collection of economic resource data was conducted in general practice from...... of dyspeptic symptoms and proportion of patients with dyspepsia after one year based on patients' and general practitioners' (GPs') assessment. Costs were estimated from patient and GP questionnaires and from medical records. Results: The incremental cost-effectiveness (CE) ratio for one day free of dyspeptic...

  8. Cost-effectiveness in the contemporary management of critical limb ischemia with tissue loss.

    Science.gov (United States)

    Barshes, Neal R; Chambers, James D; Cohen, Joshua; Belkin, Michael

    2012-10-01

    The care of patients with critical limb ischemia (CLI) and tissue loss is notoriously challenging and expensive. We evaluated the cost-effectiveness of various management strategies to identify those that would optimize value to patients. A probabilistic Markov model was used to create a detailed simulation of patient-oriented outcomes, including clinical events, wound healing, functional outcomes, and quality-adjusted life-years (QALYs) after various management strategies in a CLI patient cohort during a 10-year period. Direct and indirect cost estimates for these strategies were obtained using transition cost-accounting methodology. Incremental cost-effectiveness ratios (ICERs), in 2009 U.S. dollars per QALYs, were calculated compared with the most conservative management strategy of local wound care with amputation as needed. With an ICER of $47,735/QALY, an initial surgical bypass with subsequent endovascular revision(s) as needed was the most cost-effective alternative to local wound care alone. Endovascular-first management strategies achieved comparable clinical outcomes but at higher cost (ICERs ≥$101,702/QALY); however, endovascular management did become cost-effective when the initial foot wound closure rate was >37% or when procedural costs were decreased by >42%. Primary amputation was dominated (less effectiveness and more costly than wound care alone). Contemporary clinical effectiveness and cost estimates show an initial surgical bypass is the most cost-effective alternative to local wound care alone for CLI with tissue loss and can be supported even in a cost-averse health care environment. Copyright © 2012. Published by Mosby, Inc.

  9. Febuxostat in the management of gout: a cost-effectiveness analysis.

    Science.gov (United States)

    Smolen, Lee J; Gahn, James C; Mitri, Ghaith; Shiozawa, Aki

    2016-01-01

    To determine the cost-effectiveness of febuxostat vs allopurinol for the management of gout. A stochastic microsimulation cost-effectiveness model with a US private-payer perspective and 5-year time horizon was developed. Model flow based on guideline and real-world treatment paradigms incorporated gout flare, serum uric acid (sUA) testing, treatment titration, discontinuation, and adverse events, chronic kidney disease (CKD) incidence and progression, and type 2 diabetes mellitus (T2DM) incidence. Outcomes were estimated for the general gout population and for gout patients with CKD stages 3/4. Modeled treatment interventions were daily oral febuxostat 40-80 mg and allopurinol 100-300 mg. Baseline patient characteristics were taken from epidemiologic studies, efficacy data from randomized controlled trials, adverse event rates from package inserts, and costs from the literature, government sources, and expert opinion. Eight clinically-relevant incremental cost-effectiveness ratios were estimated: per patient reaching target sUA, per flare avoided, per CKD incidence, progression, stages 3/4 progression, and stage 5 progression avoided, per incident T2DM avoided, and per death avoided. Five-year incremental cost-effectiveness ratios for the general gout population were $5377 per patient reaching target sUA, $1773 per flare avoided, $221,795 per incident CKD avoided, $29,063 per CKD progression avoided, $36,018 per progression to CKD 3/4 avoided, $71,426 per progression to CKD 5 avoided, $214,277 per incident T2DM avoided, and $217,971 per death avoided. In patients with CKD 3/4, febuxostat dominated allopurinol for all cost-effectiveness outcome measures. Febuxostat may be a cost-effective alternative to allopurinol, especially for patients with CKD stages 3 or 4.

  10. Patient education for phosphorus management in chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Kalantar-Zadeh K

    2013-05-01

    Full Text Available Kamyar Kalantar-ZadehHarold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine’s School of Medicine, Irvine, CA, USAObjectives: This review explores the challenges and solutions in educating patients with chronic kidney disease (CKD to lower serum phosphorus while avoiding protein insufficiency and hypercalcemia.Methods: A literature search including terms “hyperphosphatemia,” “patient education,” “food fatigue,” “hypercalcemia,” and “phosphorus–protein ratio” was undertaken using PubMed.Results: Hyperphosphatemia is a strong predictor of mortality in advanced CKD and is remediated via diet, phosphorus binders, and dialysis. Dietary counseling should encourage the consumption of foods with the least amount of inorganic or absorbable phosphorus, low phosphorus-to-protein ratios, and adequate protein content, and discourage excessive calcium intake in high-risk patients. Emerging educational initiatives include food labeling using a “traffic light” scheme, motivational interviewing techniques, and the Phosphate Education Program – whereby patients no longer have to memorize the phosphorus content of each individual food component, but only a “phosphorus unit” value for a limited number of food groups. Phosphorus binders are associated with a clear survival advantage in CKD patients, overcome the limitations associated with dietary phosphorus restriction, and permit a more flexible approach to achieving normalization of phosphorus levels.Conclusion: Patient education on phosphorus and calcium management can improve concordance and adherence and empower patients to collaborate actively for optimal control of mineral metabolism.Keywords: hyperphosphatemia, renal diet, phosphorus binders, educational programs, food fatigue, concordance

  11. Cost-effectiveness of chiropractic care versus self-management in patients with musculoskeletal chest pain

    DEFF Research Database (Denmark)

    Stochkendahl, Mette Jensen; Sørensen, Jan; Vach, Werner

    2016-01-01

    suggested that chiropractic care was cost-effective with a probability of 97%, given a threshold value of €30 000 per QALY gained. In both groups, there was an increase in the health-related quality of life, and the mean increases were similar over the 12-month evaluation period. The mean differences......AIMS: To assess whether primary sector healthcare in the form of chiropractic care is cost-effective compared with self-management in patients with musculoskeletal chest pain, that is, a subgroup of patients with non-specific chest pain. METHODS AND RESULTS: 115 adults aged 18-75 years with acute......-dimension questionnaire (EQ-5D) and Short Form 36-item Health Survey (SF-36)) were compared in cost-effectiveness analyses over 12 months from baseline. Mean costs were €2183 lower for the group with chiropractic care, but not statistically significant (95% CI -4410.5 to 43.0). The incremental cost-effectiveness ratio...

  12. Long-term cost-effectiveness of disease management in systolic heart failure.

    Science.gov (United States)

    Miller, George; Randolph, Stephen; Forkner, Emma; Smith, Brad; Galbreath, Autumn Dawn

    2009-01-01

    Although congestive heart failure (CHF) is a primary target for disease management programs, previous studies have generated mixed results regarding the effectiveness and cost savings of disease management when applied to CHF. We estimated the long-term impact of systolic heart failure disease management from the results of an 18-month clinical trial. We used data generated from the trial (starting population distributions, resource utilization, mortality rates, and transition probabilities) in a Markov model to project results of continuing the disease management program for the patients' lifetimes. Outputs included distribution of illness severity, mortality, resource consumption, and the cost of resources consumed. Both cost and effectiveness were discounted at a rate of 3% per year. Cost-effectiveness was computed as cost per quality-adjusted life year (QALY) gained. Model results were validated against trial data and indicated that, over their lifetimes, patients experienced a lifespan extension of 51 days. Combined discounted lifetime program and medical costs were $4850 higher in the disease management group than the control group, but the program had a favorable long-term discounted cost-effectiveness of $43,650/QALY. These results are robust to assumptions regarding mortality rates, the impact of aging on the cost of care, the discount rate, utility values, and the targeted population. Estimation of the clinical benefits and financial burden of disease management can be enhanced by model-based analyses to project costs and effectiveness. Our results suggest that disease management of heart failure patients can be cost-effective over the long term.

  13. The cost-effectiveness of OM-85 in managing respiratory tract infections in China.

    Science.gov (United States)

    Xuan, Jianwei; Wang, Lijie; Yin, Hongjun; Xuan, Dennis; Zhou, Yan; Hu, Shanlian

    2015-03-01

    To demonstrate the health economic impact of OM-85, a bacterial lysates based immunostimulant, for its approved indications in China. A cost-effectiveness decision tree model was constructed comparing OM-85 with the best supportive care/placebo therapy for managing the acute exacerbation of chronic bronchitis and rhinosinusitis in the Chinese population. Clinical efficacy and adverse events (AE) data were included in the model based on a thorough literature review. All localized direct treatment costs, including drug cost, AE costs, and medical treatment costs for underlining diseases were included from a Chinese third party payer perspective. A Key Opinion Leaders (KOL) survey was conducted with 20 senior physicians specialized in respiratory, ENT, allergy, and immunology fields from tertiary hospitals in Beijing, Shanghai, Guangzhou, Hangzhou, Shenyang, and Wuhan to validate the local treatment costs. Incremental cost-effectiveness ratio (ICER) was calculated based on the above efficacy and cost information. OM-85 is a cost-effective therapy when compared with placebo (standard care). OM-85 can treat/prevent one additional full episode exacerbation of chronic bronchitis and one additional full episode exacerbation of rhinosinusitis with only additional costs of RMB 653 and RMB 1182.84, respectively. In comparison, each acute exacerbation of chronic bronchitis will cost RMB 4510.10, and each acute exacerbation of rhinosinuisitis will cost RMB 1807.21 in a Chinese clinical management setting. One-way sensitivity analyses were performed and the ICER result was demonstrated to be consistent. OM 85 reduces acute exacerbations among patients with chronic bronchitis and chronic rhinosinusitis when compared with Placebo (standard care). From a Chinese payer perspective, OM 85 is a cost-effective therapy in the clinical management of both chronic bronchitis and rhinosinusitis in the adult population.

  14. Cost-effectiveness of nitrogen mitigation by alternative household wastewater management technologies.

    Science.gov (United States)

    Wood, Alison; Blackhurst, Michael; Hawkins, Troy; Xue, Xiaobo; Ashbolt, Nicholas; Garland, Jay

    2015-03-01

    Household wastewater, especially from conventional septic systems, is a major contributor to nitrogen pollution. Alternative household wastewater management technologies provide similar sewerage management services but their life cycle costs and nitrogen flow implications remain uncertain. This paper addresses two key questions: (1) what are the total costs, nitrogen mitigation potential, and cost-effectiveness of a range of conventional and alternative municipal wastewater treatment technologies, and (2) what uncertainties influence these outcomes and how can we improve our understanding of these technologies? We estimate a household nitrogen mass balance for various household wastewater treatment systems and combine this mass balance with life cycle cost assessment to calculate the cost-effectiveness of nitrogen mitigation, which we define as nitrogen removed from the local watershed. We apply our methods to Falmouth, MA, where failing septic systems have caused heightened eutrophication in local receiving water bodies. We find that flushing and dry (composting) urine-diversion toilets paired with conventional septic systems for greywater management demonstrate the lowest life cycle cost and highest cost-effectiveness (dollars per kilogram of nitrogen removed from the watershed). Composting toilets are also attractive options in some cases, particularly best-case nitrogen mitigation. Innovative/advanced septic systems designed for high-level nitrogen removal are cost-competitive options for newly constructed homes, except at their most expensive. A centralized wastewater treatment plant is the most expensive and least cost-effective option in all cases. Using a greywater recycling system with any treatment technology increases the cost without adding any nitrogen removal benefits. Sensitivity analysis shows that these results are robust considering a range of cases and uncertainties. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Management of dental caries among children: a look at the cost-effectiveness.

    Science.gov (United States)

    Ladewig, Nathalia Miranda; Camargo, Lucila Basto; Tedesco, Tamara Kerber; Floriano, Isabela; Gimenez, Thais; Imparato, José Carlos P; Mendes, Fausto Medeiros; Braga, Mariana Minatel; Raggio, Daniela Prócida

    2018-04-01

    Dental caries is the most prevalent non-communicative disease worldwide. Although the etiological factors are well known for years, reducing the number of decayed and missing teeth in children still remains as a barrier. Preventive and curative options are numerous but little is known about their economical advantages. Selecting the intervention that offers the best balance of effectiveness and financial resources becomes crucial in the current situation of budget restrictions worldwide. Areas covered: This expert review summarizes available evidence on cost-effectiveness analyses of preventive and curative measures to manage dental caries in children. Expert commentary: Preventive measures have been more extensively studied than dental caries treatment. Only water fluoridation and tooth brushing are well-established as cost-effective preventive approaches. Despite the increasing number of cost analysis treatment studies in the literature, most of them focus on the cost description, with no correlation to the intervention effectiveness. There is a current need of well-designed and well-reported cost-effectiveness regarding dental caries management.

  16. The cost-effectiveness of nonoperative management versus laparoscopic appendectomy for the treatment of acute, uncomplicated appendicitis in children.

    Science.gov (United States)

    Wu, James X; Sacks, Greg D; Dawes, Aaron J; DeUgarte, Daniel; Lee, Steven L

    2017-07-01

    Several studies have demonstrated the safety and short-term success of nonoperative management in children with acute, uncomplicated appendicitis. Nonoperative management spares the patients and their family the upfront cost and discomfort of surgery, but also risks recurrent appendicitis. Using decision-tree software, we evaluated the cost-effectiveness of nonoperative management versus routine laparoscopic appendectomy. Model variables were abstracted from a review of the literature, Healthcare Cost and Utilization Project, and Medicare Physician Fee schedule. Model uncertainty was assessed using both one-way and probabilistic sensitivity analyses. We used a $100,000 per quality adjusted life year (QALY) threshold for cost-effectiveness. Operative management cost $11,119 and yielded 23.56 quality-adjusted life months (QALMs). Nonoperative management cost $2277 less than operative management, but yielded 0.03 fewer QALMs. The incremental cost-to-effectiveness ratio of routine laparoscopic appendectomy was $910,800 per QALY gained. This greatly exceeds the $100,000/QALY threshold and was not cost-effective. One-way sensitivity analysis found that operative management would become cost-effective if the 1-year recurrence rate of acute appendicitis exceeded 39.8%. Probabilistic sensitivity analysis indicated that nonoperative management was cost-effective in 92% of simulations. Based on our model, nonoperative management is more cost-effective than routine laparoscopic appendectomy for children with acute, uncomplicated appendicitis. Cost-Effectiveness Study: Level II. Published by Elsevier Inc.

  17.   A Cost-Effectiveness Analysis of Two Management Strategies for Dyspepsia

    DEFF Research Database (Denmark)

    Kjeldsen, Hans Chr; Bech, Mickael; Christensen, Bo

    2007-01-01

    Objectives: To compare the cost-effectiveness of endoscopy and empirical proton pump inhibition (PPI) therapy for management of dyspepsia in primary care. Methods: A randomized controlled trial (RCT) including prospective collection of economic resource data was conducted in general practice from...... of dyspeptic symptoms and proportion of patients with dyspepsia after one year based on patients' and general practitioners' (GPs') assessment. Costs were estimated from patient and GP questionnaires and from medical records. Results: The incremental cost-effectiveness (CE) ratio for one day free of dyspeptic...... symptoms using the endoscopy strategy was €/day 154 compared with the PPI strategy. The incremental CE ratio for one person free of dyspeptic symptoms after one year using the endoscopy strategy was € 13,905 based on the patients' evaluation and the incremental CE ratio for one person free of predominant...

  18. Cost-effectiveness of different strategies to manage patients with sciatica.

    Science.gov (United States)

    Fitzsimmons, Deborah; Phillips, Ceri J; Bennett, Hayley; Jones, Mari; Williams, Nefyn; Lewis, Ruth; Sutton, Alex; Matar, Hosam E; Din, Nafees; Burton, Kim; Nafees, Sadia; Hendry, Maggie; Rickard, Ian; Wilkinson, Claire

    2014-07-01

    The aim of this paper is to estimate the relative cost-effectiveness of treatment regimens for managing patients with sciatica. A deterministic model structure was constructed based on information from the findings from a systematic review of clinical effectiveness and cost-effectiveness, published sources of unit costs, and expert opinion. The assumption was that patients presenting with sciatica would be managed through one of 3 pathways (primary care, stepped approach, immediate referral to surgery). Results were expressed as incremental cost per patient with symptoms successfully resolved. Analysis also included incremental cost per utility gained over a 12-month period. One-way sensitivity analyses were used to address uncertainty. The model demonstrated that none of the strategies resulted in 100% success. For initial treatments, the most successful regime in the first pathway was nonopioids, with a probability of success of 0.613. In the second pathway, the most successful strategy was nonopioids, followed by biological agents, followed by epidural/nerve block and disk surgery, with a probability of success of 0.996. Pathway 3 (immediate surgery) was not cost-effective. Sensitivity analyses identified that the use of the highest cost estimates results in a similar overall picture. While the estimates of cost per quality-adjusted life year are higher, the economic model demonstrated that stepped approaches based on initial treatment with nonopioids are likely to represent the most cost-effective regimens for the treatment of sciatica. However, development of alternative economic modelling approaches is required. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  19. Are cardiovascular disease risk assessment and management programmes cost effective? A systematic review of the evidence.

    Science.gov (United States)

    Lee, John Tayu; Lawson, Kenny D; Wan, Yizhou; Majeed, Azeem; Morris, Stephen; Soljak, Michael; Millett, Christopher

    2017-06-01

    The World Health Organization recommends that countries implement population-wide cardiovascular disease (CVD) risk assessment and management programmes. The aim of this study was to conduct a systematic review to evaluate whether this recommendation is supported by cost-effectiveness evidence. Published economic evaluations were identified via electronic medical and social science databases (including Medline, Web of Science, and the NHS Economic Evaluation Database) from inception to March 2016. Study quality was evaluated using a modified version of the Consolidated Health Economic Evaluation Reporting Standards. Fourteen economic evaluations were included: five studies based on randomised controlled trials, seven studies based on observational studies and two studies using hypothetical modelling synthesizing secondary data. Trial based studies measured CVD risk factor changes over 1 to 3years, with modelled projections of longer term events. Programmes were either not, or only, cost-effective under non-verified assumptions such as sustained risk factor changes. Most observational and hypothetical studies suggested programmes were likely to be cost-effective; however, study deigns are subject to bias and subsequent empirical evidence has contradicted key assumptions. No studies assessed impacts on inequalities. In conclusion, recommendations for population-wide risk assessment and management programmes lack a robust, real world, evidence basis. Given implementation is resource intensive there is a need for robust economic evaluation, ideally conducted alongside trials, to assess cost effectiveness. Further, the efficiency and equity impact of different delivery models should be investigated, and also the combination of targeted screening with whole population interventions recognising that there multiple approaches to prevention. Copyright © 2017. Published by Elsevier Inc.

  20. Strategies to Improve Management of Acute Watery Diarrhea during a Military Deployment: A Cost Effectiveness Analysis.

    Science.gov (United States)

    Schrader, Andrew J; Tribble, David R; Riddle, Mark S

    2017-12-01

    To inform policy and decision makers, a cost-effectiveness model was developed to predict the cost-effectiveness of implementing two hypothetical management strategies separately and concurrently on the mitigation of deployment-associated travelers' diarrhea (TD) burden. The first management strategy aimed to increase the likelihood that a deployed service member with TD will seek medical care earlier in the disease course compared with current patterns; the second strategy aimed to optimize provider treatment practices through the implementation of a Department of Defense Clinical Practice Guideline. Outcome measures selected to compare management strategies were duty days lost averted (DDL-averted) and a cost effectiveness ratio (CER) of cost per DDL-averted (USD/DDL-averted). Increasing health care and by seeking it more often and earlier in the disease course as a stand-alone management strategy produced more DDL (worse) than the base case (up to 8,898 DDL-gained per year) at an increased cost to the Department of Defense (CER $193). Increasing provider use of an optimal evidence-based treatment algorithm through Clinical Practice Guidelines prevented 5,299 DDL per year with overall cost savings (CER -$74). A combination of both strategies produced the greatest gain in DDL-averted (6,887) with a modest cost increase (CER $118). The application of this model demonstrates that changes in TD management during deployment can be implemented to reduce DDL with likely favorable impacts on mission capability and individual health readiness. The hypothetical combination strategy evaluated prevents the most DDL compared with current practice and is associated with a modest cost increase.

  1. Efficacy and cost-effectiveness of environmental management for malaria control.

    Science.gov (United States)

    Utzinger, J; Tozan, Y; Singer, B H

    2001-09-01

    Roll back malaria (RBM) aims at halving the current burden of the disease by the year 2010. The focus is on sub-Saharan Africa, and it is proposed to implement efficacious and cost-effective control strategies. But the evidence base of such information is scarce, and a notable missing element is the discussion of the potential of environmental management. We reviewed the literature and identified multiple malaria control programmes that incorporated environmental management as the central feature. Prominent among them are programmes launched in 1929 and implemented for two decades at copper mining communities in Zambia. The full package of control measures consisted of vegetation clearance, modification of river boundaries, draining swamps, oil application to open water bodies and house screening. Part of the population also was given quinine and was sleeping under mosquito nets. Monthly malaria incidence rates and vector densities were used for surveillance and adaptive tuning of the environmental management strategies to achieve a high level of performance. Within 3-5 years, malaria-related mortality, morbidity and incidence rates were reduced by 70-95%. Over the entire 20 years of implementation, the programme had averted an estimated 4173 deaths and 161,205 malaria attacks. The estimated costs per death and malaria attack averted were US$ 858 and US$ 22.20, respectively. Over the initial 3-5 years start-up period, analogous to the short-duration of cost-effectiveness analyses of current studies, we estimated that the costs per disability adjusted life year (DALY) averted were US$ 524-591. However, the strategy has a track record of becoming cost-effective in the longer term, as maintenance costs were much lower: US$ 22-92 per DALY averted. In view of fewer adverse ecological effects, increased sustainability and better uses of local resources and knowledge, environmental management--integrated with pharmacological, insecticidal and bednet interventions

  2. Cost-Effective Location Management for Mobile Agents on the Internet

    Directory of Open Access Journals (Sweden)

    Chien-Sheng Chen

    2015-01-01

    Full Text Available Many mobile agent system-related services and applications require interacting with a mobile agent by passing messages. However, an agent’s mobility raises several challenges in delivering messages to a mobile agent accurately. Consisting of tracking and message delivery phases, most mobile agent location management schemes create or receive many update messages and interaction messages to ensure the effectiveness of the schemes. In addition to downgrading the overall performance of a mobile agent location management scheme, excessive transmission of messages increases the network load. The migration locality of a mobile agent and the interaction rate between mobile agents significantly affect the performance of a mobile agent location management scheme with respect to location management cost. This work presents a novel Dual Home based Scheme (DHS that can lower the location management costs in terms of migration locality and interaction rate. While the DHS scheme uniquely adopts dual home location management architecture, a selective update strategy based on that architecture is also designed for cost-effective location management of mobile agents. Moreover, DHS is compared with available schemes based on formulations and simulation experiments from the perspective of location management costs. Simulation results demonstrate that the proposed DHS scheme performs satisfactorily in terms of migration locality and interaction rate.

  3. Applicability of the cost-effectiveness approach for comparison of waste management options

    International Nuclear Information System (INIS)

    Vuori, S.; Peltonen, E.; Vieno, T.; Vira, J.

    1984-01-01

    There is an obvious need to consider the achievable level of safety of waste management in view of the costs involved. The feasibility of the cost-effectiveness approach for this purpose is discussed in the framework of practical case studies. The analysis indicates that such an approach has clear benefits, but it also reveals several issues and ambiguities in its application. The waste management alternatives considered include various concepts for the disposal of low- and intermediate-level reactor wastes as well as of the unreprocessed spent fuel. The employed impact indicators describe both the individual and collective risks. In addition, indicators simultaneously giving a perspective into other risks in the society and a means to make a rank ordering of the alternative options are proposed. The cost-effectiveness ratios for collective risks vary in the range of ten to hundreds of millions US $ per man.Sv. The examples considered also indicate that increased costs do not necessarily improve safety. Furthermore, the comparison of the safety of different options requires more sophisticated and realistic models than those employed in the present analyses, because an unbalanced degree of conservatism could result in misleading conclusions. (author)

  4. A cost effective waste management methodology for power reactor waste streams

    International Nuclear Information System (INIS)

    Granus, M.W.; Campbell, A.D.

    1984-01-01

    This paper describes a computer based methodology for the selection of the processing methods (solidification/dewatering) for various power reactor radwaste streams. The purpose of this methodology is to best select the method that provides the most cost effective solution to waste management. This method takes into account the overall cost of processing, transportation and disposal. The selection matrix on which the methodology is based is made up of over ten thousand combinations of liner, cask, process, and disposal options from which the waste manager can choose. The measurement device for cost effective waste management is the concurrent evaluation of total dollars spent. The common denominator is dollars per cubic foot of the input waste stream. Dollars per curie of the input waste stream provides for proper checks and balances. The result of this analysis can then be used to assess the total waste management cost. To this end, the methodology can then be employed to predict a given number of events (processes, transportation, and disposals) and project the annual cost of waste management. For the purposes of this paper, the authors provide examples of the application of the methodology on a typical BWR at 2, 4 and 6 years. The examples are provided in 1984 dollars. Process selection is influenced by a number of factors which must be independently evaluated for each waste stream. Final processing cost is effected by the particular process efficiency and a variety of regulatory constraints. The interface between process selection and cask selection/transportation driven by the goal of placing the greatest amount of pre-processed waste in the package and remaining within the bounds of weight, volume, regulatory, and cask availability limitations. Disposal is the cost of burial and can be affected by disposal, but availability of burial space, and the location of the disposal site in relation to the generator

  5. Cost-effective management of hydrocarbon plumes using monitored natural attenuation: case studies

    International Nuclear Information System (INIS)

    Borg, G.A.

    2000-01-01

    Engineered remediation of hydrocarbon plumes in groundwater at operating service station sites is expensive, disruptive, does not improve the management of risks to receptors, and does not provide certainty of outcome. When plumes are delineated, potential receptors identified and primary sources removed, monitored natural attenuation (MINA) is a cost-effective remediation option. If available, hydrocarbon concentration data from successive groundwater monitoring events showing that a plume is stable or reducing will provide enough primary evidence that natural attenuation is occurring. Where potential receptors will not be impacted in the short to medium term, MNA provides the same level of risk management as engineered remediation with much less cost, no disruption to the service station business, and with a certainty of meeting the objectives of the remediation

  6. Cost-effectiveness of ambulatory blood pressure monitoring in the management of hypertension.

    Science.gov (United States)

    Costa, Diogo; Peixoto Lima, Ricardo

    2017-02-01

    The prevalence of hypertension in Portugal is between 29.1% and 42.2%. International studies show that 13% of individuals have masked hypertension and 13% of diagnoses based on office blood pressure measurements are in fact white coat hypertension. More sensitive and specific blood pressure measuring methods could avoid costs associated with misdiagnosis. The aim of this study was to review the cost-effectiveness of ambulatory blood pressure monitoring (ABPM) compared to other methods in the management of hypertension. We performed a literature search in CMA Infobase, Guidelines Finder, National Guideline Clearinghouse, Bandolier, BMJ Clinical Evidence, the Cochrane Library, DARE, Medline, the Trip Database, SUMSearch and Índex das Revistas Médicas Portuguesas. We researched articles published between January 2005 and August 2015 in Portuguese, English and Spanish, using the MeSH terms "Hypertension", "Blood Pressure Monitoring, Ambulatory" and "Cost-Benefit Analysis" and the Portuguese search terms "Hipertensão", "Monitorização Ambulatorial da Pressão Arterial" and "Análise Custo-Benefício". Levels of evidence and grades of recommendation were attributed according to the Oxford Centre for Evidence-Based Medicine scale. Five hundred and twenty-five articles were identified. We included five original studies and one clinical practice guideline. All of them state that ABPM is the most cost-effective method. Two report better blood pressure control, and a Portuguese study revealed a saving of 23%. The evidence shows that ABPM is cost-effective, avoiding iatrogenic effects and reducing expenditure on treatment (grade of recommendation B). The included studies provide a solid basis, but further evidence of reproducibility is needed in research that is not based mainly on analytical models. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Cost effective radiation risk management in a generic nuclear plant design

    International Nuclear Information System (INIS)

    Maan, M.A.

    1982-11-01

    To determine whether any further dose reduction measures are justified, a method appropriate for cost effective radiation risk management has been developed. This new method is based on the radiation detriment optimization measures advocated in the revised (1977) ALARA concept. The methodology includes the determination of available alternatives, and the determination of the variable monetary ceiling on expenditures to reduce the radiological detriment (both occupational and public). The method used to determine the maximum justifiable expenditure for additional reduction of detriment takes into account the economic and social climate, administrative/legal exposure limits, and the actual magnitude of risk. All these factors may vary from country to country. The variable monetary ceiling, sensitive to an actual level of risk, provides a handy measure allowing designers to make a decision whether or not the modification of design is necessary and/or cost effective. This will ensure rationally and consistently that the utilities and their customers (public) get maximum benefit for their safety dollars

  8. A look at statin cost-effectiveness in view of the 2013 ACC/AHA cholesterol management guidelines.

    Science.gov (United States)

    Deaño, Roderick C; Pandya, Ankur; Jones, Erica C; Borden, William B

    2014-09-01

    The 2013 cholesterol management guidelines presented a major shift in recommendations on which patients at risk of cardiovascular disease should be treated and how to treat them. Implementation of the guidelines is estimated to increase substantially the number of people who would be eligible for statin therapy. As the medical community considers the broad population impact of the new cholesterol guidelines, the issue of cost-effectiveness plays a role. This review covers the basic fundamentals of cost-effectiveness analysis and summarizes the key cost-effectiveness studies that relate to the new cholesterol guidelines.

  9. Cost-effectiveness of transcatheter versus surgical management of structural heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Fanari, Zaher, E-mail: zfanari@gmail.com [Division of Cardiology, University of Kansas School of Medicine, Kansas City, KS (United States); Weintraub, William S. [Section of Cardiology, Christiana Care Health System, Newark, DE (United States); Value institute, Christiana Care Health System, Newark, DE (United States)

    2016-01-15

    Transcatheter management of valvular and structural heart disease is the most growing aspect of interventional cardiology. While the early experience was limited to patients who were not candidate for surgery, the continuous improvement in the efficacy and safety expanded its use to different degree depending on the procedure and the disease involved. The cost of these procedures is a major concern for health care in developed world. Cost-effectiveness of these transcatheter structural procedures varies depending on the procedure itself, the burden of the underlying disease, the feasibility and cost of both the Transcatheter and surgical procedures. In this review, we turn now to a specific discussion of the medical economics of percutaneous valvular and structural interventions.

  10. Using modified multiple phosphorus sensitivity indices for mitigation and management of phosphorus loads on a catchment level

    CSIR Research Space (South Africa)

    Oberholster, Paul J

    2013-01-01

    Full Text Available The relationships between river and lake phosphorus sensitivity, environmental drivers and catchment characteristics within the upper Olifants River and Lake Loskop were studied over a period of four years to come up with mitigation and management...

  11. What do we know about managing Dupuytren's disease cost-effectively?

    Science.gov (United States)

    Dritsaki, Melina; Rivero-Arias, Oliver; Gray, Alastair; Ball, Catherine; Nanchahal, Jagdeep

    2018-01-25

    Dupuytren's disease (DD) is a common and progressive, fibroproliferative disorder of the palmar and digital fascia of the hand. Various treatments have been recommended for advanced disease or to retard progression of early disease and to prevent deterioration of the finger contracture and quality of life. Recent studies have tried to evaluate the clinical and cost-effectiveness of therapies for DD, but there is currently no systematic assessment and appraisal of the economic evaluations. A systematic literature review was conducted, following PRISMA guidelines, to identify studies reporting economic evaluations of interventions for managing DD. Databases searched included the Ovid MEDLINE/Embase (without time restriction), National Health Service (NHS) Economic Evaluation Database (all years) and the National Institute for Health Research (NIHR) Journals Library) Health Technology Assessment (HTA). Cost-effectiveness analyses of treating DD were identified and their quality was assessed using the CHEERS assessment tool for quality of reporting and Phillips checklist for model evaluation. A total of 103 studies were screened, of which 4 met the study inclusion criteria. Two studies were from the US, one from the UK and one from Canada. They all assessed the same interventions for advanced DD, namely collagenase Clostridium histolyticum injection, percutaneous needle fasciotomy and partial fasciectomy. All studies conducting a cost-utility analysis, two implemented a decision analytic model and two a Markov model approach. None of them were based on a single randomised controlled trial, but rather synthesised evidence from various sources. Studies varied in their time horizon, sources of utility estimates and perspective of analysis. The overall quality of study reporting was good based on the CHEERS checklist. The quality of the model reporting in terms of model structure, data synthesis and model consistency varied across the included studies. Cost-effectiveness

  12. Improving the cost effectiveness of financial incentives in managing travel demand management (TDM).

    Science.gov (United States)

    2013-10-01

    Providing financial incentives to commuters to use alternative modes is a common element of managing transportation demand. Although these incentives have become common during the past two decades as elements of transportation demand management (TDM)...

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

    Science.gov (United States)

    Leblanc, R J; Allain, C J; Laughton, P J; Henry, J G

    2004-01-01

    The Greater Moncton Sewerage Commission's 115,000 m3/d advanced, chemically assisted primary wastewater treatment facility located in New Brunswick, Canada, has developed an integrated, long term, sustainable, cost effective programme for the management and beneficial utilization of biosolids from lime stabilized raw sludge. The paper overviews biosolids production, lime stabilization, conveyance, and odour control followed by an indepth discussion of the wastewater sludge as a resource programme, namely: composting, mine site reclamation, landfill cover, land application for agricultural use, tree farming, sod farm base as a soil enrichment, topsoil manufacturing. The paper also addresses the issues of metals, pathogens, organic compounds, the quality control program along with the regulatory requirements. Biosolids capital and operating costs are presented. Research results on removal of metals from primary sludge using a unique biological process known as BIOSOL as developed by the University of Toronto, Canada to remove metals and destroy pathogens are presented. The paper also discusses an ongoing cooperative research project with the Université de Moncton where various mixtures of plant biosolids are composted with low quality soil. Integration, approach to sustainability and "cumulative effects" as part of the overall biosolids management strategy are also discussed.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-07-01

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

  15. Phosphorus runoff from turfgrass as affected by phosphorus fertilization and clipping management.

    Science.gov (United States)

    Bierman, Peter M; Horgan, Brian P; Rosen, Carl J; Hollman, Andrew B; Pagliari, Paulo H

    2010-01-01

    Phosphorus enrichment of surface water is a concern in many urban watersheds. A 3-yr study on a silt loam soil with 5% slope and high soil test P (27 mg kg(-1) Bray P1) was conducted to evaluate P fertilization and clipping management effects on P runoff from turfgrass (Poa pratensis L.) under frozen and nonfrozen conditions. Four fertilizer treatments were compared: (i) no fertilizer, (ii) nitrogen (N)+potassium (K)+0xP, (iii) N+K+1xP, and (iv) N+K+3xP. Phosphorus rates were 21.3 and 63.9 kg ha(-1) yr(-1) the first year and 7.1 and 21.3 kg ha(-1) yr(-1) the following 2 yr. Each fertilizer treatment was evaluated with clippings removed or clippings recycled back to the turf. In the first year, P runoff increased with increasing P rate and P losses were greater in runoff from frozen than nonfrozen soil. In year 2, total P runoff from the no fertilizer treatment was greater than from treatments receiving fertilizer. This was because reduced turf quality resulted in greater runoff depth from the no fertilizer treatment. In year 3, total P runoff from frozen soil and cumulative total P runoff increased with increasing P rate. Clipping management was not an important factor in any year, indicating that returning clippings does not significantly increase P runoff from turf. In the presence of N and K, P fertilization did not improve turf growth or quality in any year. Phosphorus runoff can be reduced by not applying P to high testing soils and avoiding fall applications when P is needed.

  16. Cost-effectiveness of environmental management for vector control in resource development projects.

    Science.gov (United States)

    Bos, R

    1991-01-01

    Vector control methods are traditionally divided in chemical, biological and environmental management approaches, and this distinction also reflected in certain financial and economic aspects. This is particularly true for environmental modification, usually engineering or other structural works. It is highly capital intensive, as opposed to chemical and biological control which require recurrent expenditures, and discount rates are therefore a prominent consideration in deciding for one or the other approach. Environmental manipulation requires recurrent action, but can often be carried out with the community participation, which raises the issue of opportunity costs. The incorporation of environmental management in resource projects is generally impeded by economic considerations. The Internal Rate of Return continues to be a crucial criterion for funding agencies and development banks to support new projects; at the same time Governments of debt-riden countries in the Third World will do their best to avoid additional loans on such frills as environmental and health safeguards. Two approaches can be recommended to nevertheless ensure the incorporation of environmental management measures in resource projects in an affordable way. First, there are several examples of cases where environmental management measures either have a dual benefit (increasing both agricultural production and reducing vector-borne disease transmission) or can be implemented at zero costs. Second, the additional costs involved in structural modifications can be separated from the project development costs considered in the calculations of the Internal Rate of Return, and financial support can be sought from bilateral technical cooperation agencies particularly interested in environmental and health issues. There is a dearth of information in the cost-effectiveness of alternative vector control strategies in the developing country context. The process of integrating vector control in the

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

    Science.gov (United States)

    Baltzer, H; Binhammer, P A

    2013-08-01

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

  18. Cost effectiveness of Alternative Helicobacter pylori Eradication Strategies in the Management of Duodenal Ulcer

    Directory of Open Access Journals (Sweden)

    Bernie O'Brien

    1997-01-01

    Full Text Available Published data and techniques for decision analysis were used to construct a model to estimate the cost effectiveness of nine alternative strategies for the management of patients diagnosed with uncomplicated duodenal ulcer. Two strategies of intermittent therapy with either ranitidine or omeprazole, one strategy of continuous maintenance treatment with ranitidine, and six strategies for ulcer healing and eradication of Helicobacter pylori infection were considered. Healing time curves were estimated by using published data, allowing for estimation of expected time for acute healing episodes. The expected number of weeks to heal per patient, in a one-year period, was estimated by combining healing time data with probability of ulcer recurrence. It was found that patients that underwent any of the six H pylori eradication regimens had fewer days with ulcer per year than those who underwent maintenance or intermittent ranitidine. Four eradication regimens had lower costs and better outcomes than ranitidine therapy. In comparing H pylori strategies, the two strategies of omeprazole plus one antibiotic (either amoxicillin or clarithromycin are more costly than omeprazole plus two antibiotics (specifically amoxicillin and metronidazole or clarithromycin and metronidazole and result in similar outcomes. Although omeprazole-based eradication regimens are more costly than ranitidine bismuth triple therapy, they are associated with fewer recurrences of ulcer and days of symptoms. A limitation of the analysis is that it did not incorporate issues of compliance and metronidazole resistance; however, the former concern may be less of an issue as H pylori regimens become simpler and shorter in duration.

  19. Cost-effectiveness analysis of PET-CT-guided management for locally advanced head and neck cancer.

    Science.gov (United States)

    Smith, A F; Hall, P S; Hulme, C T; Dunn, J A; McConkey, C C; Rahman, J K; McCabe, C; Mehanna, H

    2017-11-01

    A recent large United Kingdom (UK) clinical trial demonstrated that positron-emission tomography-computed tomography (PET-CT)-guided administration of neck dissection (ND) in patients with advanced head and neck cancer after primary chemo-radiotherapy treatment produces similar survival outcomes to planned ND (standard care) and is cost-effective over a short-term horizon. Further assessment of long-term outcomes is required to inform a robust adoption decision. Here we present results of a lifetime cost-effectiveness analysis of PET-CT-guided management from a UK secondary care perspective. Initial 6-month cost and health outcomes were derived from trial data; subsequent incidence of recurrence and mortality was simulated using a de novo Markov model. Health benefit was measured in quality-adjusted life years (QALYs) and costs reported in 2015 British pounds. Model parameters were derived from trial data and published literature. Sensitivity analyses were conducted to assess the impact of uncertainty and broader National Health Service (NHS) and personal social services (PSS) costs on the results. PET-CT management produced an average per-person lifetime cost saving of £1485 and an additional 0.13 QALYs. At a £20,000 willingness-to-pay per additional QALY threshold, there was a 75% probability that PET-CT was cost-effective, and the results remained cost-effective over the majority of sensitivity analyses. When adopting a broader NHS and PSS perspective, PET-CT management produced an average saving of £700 and had an 81% probability of being cost-effective. This analysis indicates that PET-CT-guided management is cost-effective in the long-term and supports the case for wide-scale adoption. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Cost-effectiveness of surgical interventions for the management of osteoarthritis: a systematic review of the literature.

    Science.gov (United States)

    Kamaruzaman, Hanin; Kinghorn, Philip; Oppong, Raymond

    2017-05-10

    The primary purpose of this study is to assess the existing evidence on the cost-effectiveness of surgical interventions for the management of knee and hip osteoarthritis by systematically reviewing published economic evaluation studies. A systematic review was conducted for the period 2004 to 2016. Electronic databases were searched to identify both trial and model based economic evaluation studies that evaluated surgical interventions for knee and hip osteoarthritis. A total of 23 studies met the inclusion criteria and an assessment of these studies showed that total knee arthroplasty (TKA), and total hip arthroplasty (THA) showed evidence of cost-effectiveness and improvement in quality of life of the patients when compared to non-operative and non-surgical procedures. On the other hand, even though delaying TKA and THA may lead to some cost savings in the short-run, the results from the study showed that this was not a cost-effective option. TKA and THA are cost-effective and should be recommended for the management of patients with end stage/severe knee and hip OA. However, there needs to be additional studies to assess the cost-effectiveness of other surgical interventions in order for definite conclusions to be reached.

  1. Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model: A Web-based program designed to evaluate the cost-effectiveness of disease management programs in heart failure.

    Science.gov (United States)

    Reed, Shelby D; Neilson, Matthew P; Gardner, Matthew; Li, Yanhong; Briggs, Andrew H; Polsky, Daniel E; Graham, Felicia L; Bowers, Margaret T; Paul, Sara C; Granger, Bradi B; Schulman, Kevin A; Whellan, David J; Riegel, Barbara; Levy, Wayne C

    2015-11-01

    Heart failure disease management programs can influence medical resource use and quality-adjusted survival. Because projecting long-term costs and survival is challenging, a consistent and valid approach to extrapolating short-term outcomes would be valuable. We developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model, a Web-based simulation tool designed to integrate data on demographic, clinical, and laboratory characteristics; use of evidence-based medications; and costs to generate predicted outcomes. Survival projections are based on a modified Seattle Heart Failure Model. Projections of resource use and quality of life are modeled using relationships with time-varying Seattle Heart Failure Model scores. The model can be used to evaluate parallel-group and single-cohort study designs and hypothetical programs. Simulations consist of 10,000 pairs of virtual cohorts used to generate estimates of resource use, costs, survival, and incremental cost-effectiveness ratios from user inputs. The model demonstrated acceptable internal and external validity in replicating resource use, costs, and survival estimates from 3 clinical trials. Simulations to evaluate the cost-effectiveness of heart failure disease management programs across 3 scenarios demonstrate how the model can be used to design a program in which short-term improvements in functioning and use of evidence-based treatments are sufficient to demonstrate good long-term value to the health care system. The Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model provides researchers and providers with a tool for conducting long-term cost-effectiveness analyses of disease management programs in heart failure. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Cost-Effectiveness Analysis of Screening for and Managing Identified Hypertension for Cardiovascular Disease Prevention in Vietnam

    NARCIS (Netherlands)

    Nguyen, Thi-Phuong-Lan; Wright, E. Pamela; Thanh-Trung Nguyen,; Schuiling-Veninga, C. C. M.; Bijlsma, M. J.; Thi-Bach-Yen Nguyen,; Postma, M. J.

    2016-01-01

    Objective To inform development of guidelines for hypertension management in Vietnam, we evaluated the cost-effectiveness of different strategies on screening for hypertension in preventing cardiovascular disease (CVD). Methods A decision tree was combined with a Markov model to measure incremental

  3. Cost-effectiveness of managing Natura 2000 sites: an exploratory study for Finland, Germany, the Netherlands and Poland

    NARCIS (Netherlands)

    Wätzold, F.; Mewes, M.; Apeldoorn, van R.C.; Varjopuro, R.; Chmielewski, T.; Veeneklaas, F.R.; Kosola, M.L.

    2010-01-01

    Natura 2000 sites are expected to assure the long-term survival of Europe's most valuable and threatened species and habitats. It follows that successful management of the sites is of great importance. Next to goal attainment, cost-effectiveness is increasingly recognised as a key requirement for

  4. Corneal Collagen Cross-Linking in the Management of Keratoconus in Canada: A Cost-Effectiveness Analysis.

    Science.gov (United States)

    Leung, Victoria C; Pechlivanoglou, Petros; Chew, Hall F; Hatch, Wendy

    2017-08-01

    To use patient-level microsimulation models to evaluate the comparative cost-effectiveness of early corneal cross-linking (CXL) and conventional management with penetrating keratoplasty (PKP) when indicated in managing keratoconus in Canada. Cost-utility analysis using individual-based, state-transition microsimulation models. Simulated cohorts of 100 000 individuals with keratoconus who entered each treatment arm at 25 years of age. Fellow eyes were modeled separately. Simulated individuals lived up to a maximum of 110 years. We developed 2 state-transition microsimulation models to reflect the natural history of keratoconus progression and the impact of conventional management with PKP versus CXL. We collected data from the published literature to inform model parameters. We used realistic parameters that maximized the potential costs and complications of CXL, while minimizing those associated with PKP. In each treatment arm, we allowed simulated individuals to move through health states in monthly cycles from diagnosis until death. For each treatment strategy, we calculated the total cost and number of quality-adjusted life years (QALYs) gained. Costs were measured in Canadian dollars. Costs and QALYs were discounted at 5%, converting future costs and QALYs into present values. We used an incremental cost-effectiveness ratio (ICER = difference in lifetime costs/difference in lifetime health outcomes) to compare the cost-effectiveness of CXL versus conventional management with PKP. Lifetime costs and QALYs for CXL were estimated to be Can$5530 (Can$4512, discounted) and 50.12 QALYs (16.42 QALYs, discounted). Lifetime costs and QALYs for conventional management with PKP were Can$2675 (Can$1508, discounted) and 48.93 QALYs (16.09 QALYs, discounted). The discounted ICER comparing CXL to conventional management was Can$9090/QALY gained. Sensitivity analyses revealed that in general, parameter variations did not influence the cost-effectiveness of CXL. CXL is

  5. Cost-effectiveness of the management of rh-negative pregnant women.

    Science.gov (United States)

    Duplantie, Julie; Gonzales, Odilon Martinez; Bois, Antoine; Nshimyumukiza, Léon; Gekas, Jean; Bujold, Emmanuel; Morin, Valérie; Vallée, Maud; Giguère, Yves; Gagné, Christian; Rousseau, François; Reinharz, Daniel

    2013-08-01

    The purpose of this study was to determine the most cost-effective option to prevent alloimmunization against the Rh factor. A virtual population of Rh-negative pregnant women in Quebec was built to simulate the cost-effectiveness of preventing alloimmunization. The model considered four options: (1) systematic use of anti-D immunoglobulin; (2) fetal Rh(D) genotyping; (3) immunological determination of the father's Rh type; (4) mixed screening: immunological determination of the father's Rh type, followed if positive by fetal Rh(D) genotyping. Two outcomes were considered, in addition to the estimated costs: (1) the number of babies without hemolytic disease, and (2) the number of surviving infants. In a first pregnancy, two options emerged as the most cost-effective options: systematic prophylaxis and immunological Rh typing of the father, with overlapping confidence intervals between them. In a second pregnancy, the results were similar. In all cases (first or second pregnancy or a combination of the two) fetal genotyping was not found to be a cost-effective option. Routine prophylaxis and immunological Rh typing of the father are the most cost-effective options for the prevention of Rh alloimmunization. Considering that immunological typing of the father would probably not be carried out by the majority of clinicians, routine prophylaxis remains the preferred option. However, this could change if the cost of Rh(D) fetal genotyping fell below $140 per sample.

  6. Management of Natural and Added Dietary Phosphorus Burden in Kidney Disease

    Science.gov (United States)

    Cupisti, Adamasco; Kalantar-Zadeh, Kamyar

    2018-01-01

    Phosphorus retention occurs from higher dietary phosphorus intake relative to its renal excretion or dialysis removal. In the gastrointestinal tract the naturally existing organic phosphorus is only partially (~60%) absorbable; however, this absorption varies widely and is lower for plant-based phosphorus including phytate (80%). The latter phosphorus often remains unrecognized by patients and health care professionals, even though it is widely used in contemporary diets, in particular low-cost foods. In a non-enhanced mixed diet, the digestible phosphorus is closely correlated with total protein content, making protein-rich foods a main source of natural phosphorus. Phosphorus burden is more appropriately limited in pre-dialysis patients who are on low protein diets (~0.6 g/kg/day), whereas dialysis patients who require higher protein intake (~1.2 g/kg/day) are subject to a higher dietary phosphorus load. An effective and patient-friendly approach to reduce phosphorus intake without depriving patients of adequate proteins is to educate patients to avoid foods with high phosphorus relative to protein such as egg yolk and those with high amounts of phosphorus-based preservatives such as certain soft drinks and enhanced cheese and meat. Protein-rich foods should be prepared by boiling, which reduces phosphorus as well as sodium and potassium content, or by other types of cooking induced demineralization. The dose of phosphorus-binding therapy should be adjusted separately for the amount and absorbability of phosphorus in each meal. Dietician counselling to address the foregoing aspects of dietary phosphorus management is instrumental for achieving reduction of phosphorus load. PMID:23465504

  7. A Comparison of Alternative Strategies for Cost-Effective Water Quality Management in Lakes

    Science.gov (United States)

    Daniel Boyd Kramer; Stephen Polasky; Anthony Starfield; Brian Palik; Lynn Westphal; Stephanie Snyder; Pamela Jakes; Rachel Hudson; Eric Gustafson

    2006-01-01

    Roughly 45% of the assessed lakes in the United States are impaired for one or more reasons. Eutrophication due to excess phosphorus loading is common in many impaired lakes. Various strategies are available to lake residents for addressing declining lake water quality, including septic system upgrades and establishing riparian buffers. This study examines 25 lakes to...

  8. to Phosphorus Fertilization, Crop Sequence and Tillage Management

    Directory of Open Access Journals (Sweden)

    Xiaopeng Gao

    2012-01-01

    Full Text Available Field experiments were conducted at two locations in Manitoba, Canada, to determine the effect of crop rotation, phosphorus (P fertilization and tillage on grain yield and grain concentrations of Cd and Zn in durum wheat (Triticum durum L.. Compared to conventional tillage (CT, reduced tillage (RT management decreased grain Cd and increased grain yield and grain Zn in half of the site-years. The type of preceding crops of spring wheat-flax or canola-flax had little influence. Rate and timing of P application had little effect on grain Cd, but increasing P rate tended to decrease grain Zn. No interactive effect was detected among tested factors. Grain Zn was not related to grain Cd, but positively to other nutrients such as Fe, Mn, P, Ca, K, and Mg. Both grain Zn and Fe correlated positively with grain protein content, suggesting protein may represent a sink for micronutrients. The study suggested that the tillage management may have beneficial effects on both grain yield and quality. Phosphorus fertilizer can remain available for subsequent crops and high annual inputs in the crop sequence may decrease crop grain Zn. Understanding the environment is important in determining the impact of agricultural management on agronomic and nutrient traits.

  9. Performance management and cost effectiveness of public services : empirical evidence from Dutch municipalities

    NARCIS (Netherlands)

    de Groot, Hans; van Hulst, 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

  10. Cost Effectiveness of a Weight Management Program Implemented in the Worksite: Translation of Fuel Your Life.

    Science.gov (United States)

    Corso, Phaedra S; Ingels, Justin B; Padilla, Heather M; Zuercher, Heather; DeJoy, David M; Vandenberg, Robert J; Wilson, Mark G

    2018-04-18

    Conduct a cost-effectiveness analysis of the Fuel Your Life (FYL) program dissemination. Employees were recruited from three workplaces randomly assigned to one of the conditions: telephone coaching, small group coaching, and self-study. Costs were collected prospectively during the efficacy trial. The main outcome measures of interest were weight loss and quality-adjusted life years (QALYs). The phone condition was most costly ($601-$589/employee) and the self-study condition was least costly ($145-$143/employee). For weight loss, delivering FYL through the small group condition was no more effective, yet more expensive, than the self-study delivery. For QALYs, the group delivery of FYL was in an acceptable cost-effectiveness range ($22,400/QALY) relative to self-study (95% CI: $10,600/QALY - dominated). Prevention programs require adaptation at the local level and significantly affect the cost, effectiveness, and cost effectiveness of the program.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0.

  11. Cost-effectiveness of antibiotics for COPD management: observational analysis using CPRD data

    Directory of Open Access Journals (Sweden)

    Sarah J. Ronaldson

    2017-06-01

    Full Text Available It is often difficult to determine the cause of chronic obstructive pulmonary disease (COPD exacerbations, and antibiotics are frequently prescribed. This study conducted an observational cost-effectiveness analysis of prescribing antibiotics for exacerbations of COPD based on routinely collected data from patient electronic health records. A cohort of 45 375 patients aged 40 years or more who attended their general practice for a COPD exacerbation during 2000–2013 was identified from the Clinical Practice Research Datalink. Two groups were formed (“immediate antibiotics” or “no antibiotics” based on whether antibiotics were prescribed during the index general practice (GP consultation, with data analysed according to subsequent healthcare resource use. A cost-effectiveness analysis was undertaken from the perspective of the UK National Health Service, using a time horizon of 4 weeks in the base case. The use of antibiotics for COPD exacerbations resulted in cost savings and an improvement in all outcomes analysed; i.e. GP visits, hospitalisations, community respiratory team referrals, all referrals, infections and subsequent antibiotics prescriptions were lower for the antibiotics group. Hence, the use of antibiotics was dominant over no antibiotics. The economic analysis suggests that use of antibiotics for COPD exacerbations is a cost-effective alternative to not prescribing antibiotics for patients who present to their GP, and remains cost-effective when longer time horizons of 3 months and 12 months are considered. It would be useful for a definitive trial to be undertaken in this area to determine the cost-effectiveness of antibiotics for COPD exacerbations.

  12. Cost-effectiveness of antibiotics for COPD management: observational analysis using CPRD data.

    Science.gov (United States)

    Ronaldson, Sarah J; Raghunath, Anan; Torgerson, David J; Van Staa, Tjeerd

    2017-04-01

    It is often difficult to determine the cause of chronic obstructive pulmonary disease (COPD) exacerbations, and antibiotics are frequently prescribed. This study conducted an observational cost-effectiveness analysis of prescribing antibiotics for exacerbations of COPD based on routinely collected data from patient electronic health records. A cohort of 45 375 patients aged 40 years or more who attended their general practice for a COPD exacerbation during 2000-2013 was identified from the Clinical Practice Research Datalink. Two groups were formed ("immediate antibiotics" or "no antibiotics") based on whether antibiotics were prescribed during the index general practice (GP) consultation, with data analysed according to subsequent healthcare resource use. A cost-effectiveness analysis was undertaken from the perspective of the UK National Health Service, using a time horizon of 4 weeks in the base case. The use of antibiotics for COPD exacerbations resulted in cost savings and an improvement in all outcomes analysed; i.e. GP visits, hospitalisations, community respiratory team referrals, all referrals, infections and subsequent antibiotics prescriptions were lower for the antibiotics group. Hence, the use of antibiotics was dominant over no antibiotics. The economic analysis suggests that use of antibiotics for COPD exacerbations is a cost-effective alternative to not prescribing antibiotics for patients who present to their GP, and remains cost-effective when longer time horizons of 3 months and 12 months are considered. It would be useful for a definitive trial to be undertaken in this area to determine the cost-effectiveness of antibiotics for COPD exacerbations.

  13. Preoperative paravertebral blocks for the management of acute pain following mastectomy: a cost-effectiveness analysis.

    Science.gov (United States)

    Offodile, Anaeze C; Sheckter, Clifford C; Tucker, Austin; Watzker, Anna; Ottino, Kevin; Zammert, Martin; Padula, William V

    2017-10-01

    Preoperative paravertebral blocks (PPVBs) are routinely used for treating post-mastectomy pain, yet uncertainties remain about the cost-effectiveness of this modality. We aim to evaluate the cost-effectiveness of PPVBs at common willingness-to-pay (WTP) thresholds. A decision analytic model compared two strategies: general anesthesia (GA) alone versus GA with multilevel PPVB. For the GA plus PPVB limb, patients were subjected to successful block placement versus varying severity of complications based on literature-derived probabilities. The need for rescue pain medication was the terminal node for all postoperative scenarios. Patient-reported pain scores sourced from published meta-analyses measured treatment effectiveness. Costing was derived from wholesale acquisition costs, the Medicare fee schedule, and publicly available hospital charge masters. Charges were converted to costs and adjusted for 2016 US dollars. A commercial payer perspective was adopted. Incremental cost-effectiveness ratios (ICERs) were evaluated against WTP thresholds of $500 and $50,000 for postoperative pain control. The ICER for preoperative paravertebral blocks was $154.49 per point reduction in pain score. 15% variation in inpatient costs resulted in ICER values ranging from $124.40-$180.66 per pain point score reduction. Altering the probability of block success by 5% generated ICER values of $144.71-$163.81 per pain score reduction. Probabilistic sensitivity analysis yielded cost-effective trials 69.43% of the time at $500 WTP thresholds. Over a broad range of probabilities, PPVB in mastectomy reduces postoperative pain at an acceptable incremental cost compared to GA. Commercial payers should be persuaded to reimburse this technique based on convincing evidence of cost-effectiveness.

  14. Economic burden and cost-effective management of Clostridium difficile infections.

    Science.gov (United States)

    Heimann, S M; Cruz Aguilar, M R; Mellinghof, S; Vehreschild, M J G T

    2018-02-01

    Clostridium difficile infection (CDI) is the most important cause of healthcare-associated infectious diarrhea in industrialized countries. We performed a literature review of the overall economic burden of initial and recurrent CDI as well as of the cost-effectiveness of the various treatment strategies applied in these settings. Even though analysis of health economic data is complicated by the limited comparability of results, our review identified several internationally consistent results. Authors from different countries have shown that recurrent CDI disproportionally contributes to the overall economic burden of CDI and therefore offers considerable saving potential. Subsequent cost-effectiveness analyses almost exclusively identified fidaxomicin as the preferred treatment option for initial CDI and fecal microbiota transplant (FMT) for recurrent CDI. Among the various FMT protocols, optimum results were obtained using early colonoscopy-based FMT. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  15. Cost-effectiveness analysis of a patient-centered care model for management of psoriasis.

    Science.gov (United States)

    Parsi, Kory; Chambers, Cindy J; Armstrong, April W

    2012-04-01

    Cost-effectiveness analyses help policymakers make informed decisions regarding funding allocation of health care resources. Cost-effectiveness analysis of technology-enabled models of health care delivery is necessary to assess sustainability of novel online, patient-centered health care models. We sought to compare cost-effectiveness of conventional in-office care with a patient-centered, online model for follow-up treatment of patients with psoriasis. Cost-effectiveness analysis was performed from a societal perspective on a randomized controlled trial comparing a patient-centered online model with in-office visits for treatment of patients with psoriasis during a 24-week period. Quality-adjusted life expectancy was calculated using the life table method. Costs were generated from the original study parameters and national averages for salaries and services. No significant difference existed in the mean change in Dermatology Life Quality Index scores between the two groups (online: 3.51 ± 4.48 and in-office: 3.88 ± 6.65, P value = .79). Mean improvement in quality-adjusted life expectancy was not significantly different between the groups (P value = .93), with a gain of 0.447 ± 0.48 quality-adjusted life years for the online group and a gain of 0.463 ± 0.815 quality-adjusted life years for the in-office group. The cost of follow-up psoriasis care with online visits was 1.7 times less than the cost of in-person visits ($315 vs $576). Variations in travel time existed among patients depending on their distance from the dermatologist's office. From a societal perspective, the patient-centered online care model appears to be cost saving, while maintaining similar effectiveness to standard in-office care. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  16. Cost-effectiveness of wound management in France: pressure ulcers and venous leg ulcers.

    Science.gov (United States)

    Meaume, S; Gemmen, E

    2002-06-01

    This study set out to define realistic protocols of care for the treatment of chronic venous leg ulcers and pressure ulcers in France and, by developing cost-effectiveness models, to compare the different protocols of care for the two ulcer groups, enabling a calculation of direct medical costs per ulcer healed in a typical French health insurance plan. Clinical outcomes and some treatment patterns were obtained from published literature. Validations of different treatment patterns were developed using an expert consensus panel similar to the Delphi approach. Costs were calculated based on national averages and estimates from the UK and Germany. The models were used to measure costs per healed ulcer over a 12-week period. For both the pressure ulcer and venous leg ulcer models, three protocols of care were identified. For pressure ulcers and venous leg ulcers, the hydrocolloid DuoDERM (ConvaTec, also known as Granuflex in the UK and Varihesive in Germany) was most cost-effective in France. The combination of published data and expert consensus opinion is a valid technique, and in this case suggests that treating pressure ulcers and venous leg ulcers with hydrocolloid dressings is more cost-effective than treating them with saline gauze, in spite of the lower unit cost of the latter.

  17. Optimising the management of vaginal discharge syndrome in Bulgaria: cost effectiveness of four clinical algorithms with risk assessment.

    Science.gov (United States)

    Cornier, Nadine; Petrova, Elena; Cavailler, Philippe; Dentcheva, Rossitza; Terris-Prestholt, Fern; Janin, Arnaud; Ninet, Béatrice; Anguenot, Jean-Luc; Vassilakos, Pierre; Gerbase, Antonio; Mayaud, Philippe

    2010-08-01

    To evaluate the performance and cost effectiveness of the WHO recommendations of incorporating risk-assessment scores and population prevalence of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) into vaginal discharge syndrome (VDS) algorithms. Non-pregnant women presenting with VDS were recruited at a non-governmental sexual health clinic in Sofia, Bulgaria. NG and CT were diagnosed by PCR and vaginal infections by microscopy. Risk factors for NG/CT were identified in multivariable analysis. Four algorithms based on different combinations of behavioural factors, clinical findings and vaginal microscopy were developed. Performance of each algorithm was evaluated for detecting vaginal and cervical infections separately. Cost effectiveness was based on cost per patient treated and cost per case correctly treated. Sensitivity analysis explored the influence of NG/CT prevalence on cost effectiveness. 60% (252/420) of women had genital infections, with 9.5% (40/423) having NG/CT. Factors associated with NG/CT included new and multiple sexual partners in the past 3 months, symptomatic partner, childlessness and >or=10 polymorphonuclear cells per field on vaginal microscopy. For NG/CT detection, the algorithm that relied solely on behavioural risk factors was less sensitive but more specific than those that included speculum examination or microscopy but had higher correct-treatment rate and lower over-treatment rates. The cost per true case treated using a combination of risk factors, speculum examination and microscopy was euro 24.08. A halving and tripling of NG/CT prevalence would have approximately the inverse impact on the cost-effectiveness estimates. Management of NG/CT in Bulgaria was improved by the use of a syndromic approach that included risk scores. Approaches that did not rely on microscopy lost sensitivity but were more cost effective.

  18. Estimates of cost-effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema.

    Science.gov (United States)

    Hubble, Michael W; Richards, Michael E; Wilfong, Denise A

    2008-01-01

    To estimate the cost-effectiveness of continuous positive airway pressure (CPAP) in managing prehospital acute pulmonary edema in an urban EMS system. Using estimates from published reports on prehospital and emergency department CPAP, a cost-effectiveness model of implementing CPAP in a typical urban EMS system was derived from the societal perspective as well as the perspective of the implementing EMS system. To assess the robustness of the model, a series of univariate and multivariate sensitivity analyses was performed on the input variables. The cost of consumables, equipment, and training yielded a total cost of $89 per CPAP application. The theoretical system would be expected to use CPAP 4 times per 1000 EMS patients and is expected to save 0.75 additional lives per 1000 EMS patients at a cost of $490 per life saved. CPAP is also expected to result in approximately one less intubation per 6 CPAP applications and reduce hospitalization costs by $4075 per year for each CPAP application. Through sensitivity analyses the model was verified to be robust across a wide range of input variable assumptions. Previous studies have demonstrated the clinical effectiveness of CPAP in the management of acute pulmonary edema. Through a theoretical analysis which modeled the costs and clinical benefits of implementing CPAP in an urban EMS system, prehospital CPAP appears to be a cost-effective treatment.

  19. Hypocalcaemia following thyroidectomy for treatment of Graves' disease: implications for patient management and cost-effectiveness.

    Science.gov (United States)

    Hughes, O R; Scott-Coombes, D M

    2011-08-01

    No consensus exists on optimal treatment for Graves' disease once anti-thyroid medication fails to induce remission. Total thyroidectomy is a more cost-effective treatment than radioactive iodine or life-long anti-thyroid medication, but hypocalcaemia is an important complication, leading to longer hospital admissions and increased prescription costs. This study aimed to compare the relative risk of hypocalcaemia requiring medical treatment for patients with Graves' disease. Prospective cohort study of patients undergoing total thyroidectomy for Graves' disease and for multinodular goitre, calculating serum calcium levels 24-hours post-operatively and prescription rates. Mean corrected calcium concentrations 24 hours post-operatively were 2.05 mmol/l for Graves' disease patients and 2.14 mmol/l for multinodular goitre patients (p = 0.003). Biochemical hypocalcaemia developed in 92 per cent (n = 34) of Graves' disease patients and 71 per cent (n = 43) of multinodular goitre patients (p = 0.012). Graves' disease patients were more likely to be prescribed calcium supplementation pre-discharge (p = 0.037). Total thyroidectomy for Graves' disease carries an increased risk of hypocalcaemia at 24 hours, and of calcium supplementation pre-discharge. Graves' disease patients should be informed of the increased risk of hypocalcaemia associated with total thyroidectomy, and this risk must be factored into future cost-effectiveness analysis.

  20. Cost-effectiveness analysis of revised WHO guidelines for management of childhood pneumonia in 74 Countdown countries.

    Science.gov (United States)

    Zhang, Shanshan; Incardona, Beatrice; Qazi, Shamim A; Stenberg, Karin; Campbell, Harry; Nair, Harish

    2017-06-01

    Treatment of childhood pneumonia is a key priority in low-income countries, with substantial resource implications. WHO revised their guidelines for the management of childhood pneumonia in 2013. We estimated and compared the resource requirements, total direct medical cost and cost-effectiveness of childhood pneumonia management in 74 countries with high burden of child mortality (Countdown countries) using the 2005 and 2013 revised WHO guidelines. We constructed a cost model using a bottom up approach to estimate the cost of childhood pneumonia management using the 2005 and 2013 WHO guidelines from a public provider perspective in 74 Countdown countries. The cost of pneumonia treatment was estimated, by country, for year 2013, including costs of medicines and service delivery at three different management levels. We also assessed country-specific lives saved and disability adjusted life years (DALYs) averted due to pneumonia treated in children aged below five years. The cost-effectiveness of pneumonia treatment was estimated in terms of cost per DALY averted by fully implementing WHO treatment guidelines relative to no treatment intervention for pneumonia. Achieving full treatment coverage with the 2005 WHO guidelines was estimated to cost US$ 2.9 (1.9-4.2) billion compared to an estimated US$ 1.8 (0.8-3.0) billion for the revised 2013 WHO guidelines in these countries. Pneumonia management in young children following WHO treatment guidelines could save up to 39.8 million DALYs compared to a zero coverage scenario in the year 2013 in the 74 Countdown countries. The median cost-effectiveness ratio per DALY averted in 74 countries was substantially lower for the 2013 guidelines: US$ 26.6 (interquartile range IQR: 17.7-45.9) vs US$ 38.3 (IQR: US$ 26.2-86.9) per DALY averted for the 2005 guideline respectively. Child pneumonia management as detailed in standard WHO guidelines is a very cost-effective intervention. Implementation of the 2013 WHO guidelines is

  1. Cost-effectiveness of alternative management strategies for patients with solitary pulmonary nodules.

    Science.gov (United States)

    Gould, Michael K; Sanders, Gillian D; Barnett, Paul G; Rydzak, Chara E; Maclean, Courtney C; McClellan, Mark B; Owens, Douglas K

    2003-05-06

    Positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) is a potentially useful but expensive test to diagnose solitary pulmonary nodules. To evaluate the cost-effectiveness of strategies for pulmonary nodule diagnosis and to specifically compare strategies that did and did not include FDG-PET. Decision model. Accuracy and complications of diagnostic tests were estimated by using meta-analysis and literature review. Modeled survival was based on data from a large tumor registry. Cost estimates were derived from Medicare reimbursement and other sources. All adult patients with a new, noncalcified pulmonary nodule seen on chest radiograph. Patient lifetime. Societal. 40 clinically plausible combinations of 5 diagnostic interventions, including computed tomography, FDG-PET, transthoracic needle biopsy, surgery, and watchful waiting. Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. The cost-effectiveness of strategies depended critically on the pretest probability of malignancy. For patients with low pretest probability (26%), strategies that used FDG-PET selectively when computed tomography results were possibly malignant cost as little as 20 000 dollars per QALY gained. For patients with high pretest probability (79%), strategies that used FDG-PET selectively when computed tomography results were benign cost as little as 16 000 dollars per QALY gained. For patients with intermediate pretest probability (55%), FDG-PET strategies cost more than 220 000 dollars per QALY gained because they were more costly but only marginally more effective than computed tomography-based strategies. The choice of strategy also depended on the risk for surgical complications, the probability of nondiagnostic needle biopsy, the sensitivity of computed tomography, and patient preferences for time spent in watchful waiting. In probabilistic sensitivity analysis, FDG-PET strategies were cost saving or cost less than 100 000 dollars per QALY

  2. Cost-effectiveness of adding indoor residual spraying to case management in Afghan refugee settlements in Northwest Pakistan during a prolonged malaria epidemic

    DEFF Research Database (Denmark)

    Howard, Natasha; Guinness, Lorna; Rowland, Mark

    2017-01-01

    ’ or cost-effective using WHO and comparison thresholds. Conclusions: Adding IRS was cost-effective in this moderate endemicity, low mortality setting. It was more cost-effective when transmission was highest, becoming less so as transmission reduced. Because vivax was three times more common than......Introduction: Financing of malaria control for displaced populations is limited in scope and duration, making cost-effectiveness analyses relevant but difficult. This study analyses cost-effectiveness of adding prevention through targeted indoor residual spraying (IRS) to case management in Afghan.......g. cases and DALYs averted) were derived and incremental cost-effectiveness ratios (ICERs) for cases prevented and DALYs averted calculated. Population, treatment cost, women’s time, days of productivity lost, case fatality rate, cases prevented, and DALY assumptions were tested in sensitivity analysis...

  3. Management of frozen shoulder: a systematic review and cost-effectiveness analysis.

    Science.gov (United States)

    Maund, E; Craig, D; Suekarran, S; Neilson, Ar; Wright, K; Brealey, S; Dennis, L; Goodchild, L; Hanchard, N; Rangan, A; Richardson, G; Robertson, J; McDaid, C

    2012-01-01

    Frozen shoulder is condition in which movement of the shoulder becomes restricted. It can be described as either primary (idiopathic) whereby the aetiology is unknown, or secondary, when it can be attributed to another cause. It is commonly a self-limiting condition, of approximately 1 to 3 years' duration, though incomplete resolution can occur. To evaluate the clinical effectiveness and cost-effectiveness of treatments for primary frozen shoulder, identify the most appropriate intervention by stage of condition and highlight any gaps in the evidence. A systematic review was conducted. Nineteen databases and other sources including the Cumulative Index to Nursing and Allied Health (CINAHL), Science Citation Index, BIOSIS Previews and Database of Abstracts of Reviews of Effects (DARE) were searched up to March 2010 and EMBASE and MEDLINE up to January 2011, without language restrictions. MEDLINE, CINAHL and PsycINFO were searched in June 2010 for studies of patients' views about treatment. Randomised controlled trials (RCTs) evaluating physical therapies, arthrographic distension, steroid injection, sodium hyaluronate injection, manipulation under anaesthesia, capsular release or watchful waiting, alone or in combination were eligible for inclusion. Patients with primary frozen shoulder (with or without diabetes) were included. Quasi-experimental studies were included in the absence of RCTs and case series for manipulation under anaesthesia (MUA) and capsular release only. Full economic evaluations meeting the intervention and population inclusion criteria of the clinical review were included. Two researchers independently screened studies for relevance based on the inclusion criteria. One reviewer extracted data and assessed study quality; this was checked by a second reviewer. The main outcomes of interest were pain, range of movement, function and disability, quality of life and adverse events. The analysis comprised a narrative synthesis and pair-wise meta

  4. Implementation of a guideline for low back pain management in primary care: a cost-effectiveness analysis.

    Science.gov (United States)

    Becker, Annette; Held, Heiko; Redaelli, Marcus; Chenot, Jean F; Leonhardt, Corinna; Keller, Stefan; Baum, Erika; Pfingsten, Michael; Hildebrandt, Jan; Basler, Heinz-Dieter; Kochen, Michael M; Donner-Banzhoff, Norbert; Strauch, Konstantin

    2012-04-15

    Cost-effectiveness analysis alongside a cluster randomized controlled trial. To study the cost-effectiveness of 2 low back pain guideline implementation (GI) strategies. Several evidence-based guidelines on management of low back pain have been published. However, there is still no consensus on the effective implementation strategy. Especially studies on the economic impact of different implementation strategies are lacking. This analysis was performed alongside a cluster randomized controlled trial on the effectiveness of 2 GI strategies (physician education alone [GI] or physician education in combination with motivational counseling [MC] by practice nurses)--both compared with the postal dissemination of the guideline (control group, C). Sociodemographic data, pain characteristics, and cost data were collected by interview at baseline and after 6 and 12 months. low back pain-related health care costs were valued for 2004 from the societal perspective. For the cost analysis, 1322 patients from 126 general practices were included. Both interventions showed lower direct and indirect costs as well as better patient outcomes during follow-up compared with controls. In addition, both intervention arms showed superiority of cost-effectiveness to C. The effects attenuated when adjusting for differences of health care utilization prior to patient recruitment and for clustering of data. Trends in cost-effectiveness are visible but need to be confirmed in future studies. Researchers performing cost-evaluation studies should test for baseline imbalances of health care utilization data instead of judging on the randomization success by reviewing non-cost parameters like clinical data alone.

  5. A cost-effectiveness analysis of a proactive management strategy for the Sprint Fidelis recall: a probabilistic decision analysis model.

    Science.gov (United States)

    Bashir, Jamil; Cowan, Simone; Raymakers, Adam; Yamashita, Michael; Danter, Matthew; Krahn, Andrew; Lynd, Larry D

    2013-12-01

    The management of the recall is complicated by the competing risks of lead failure and complications that can occur with lead revision. Many of these patients are currently undergoing an elective generator change--an ideal time to consider lead revision. To determine the cost-effectiveness of a proactive management strategy for the Sprint Fidelis recall. We obtained detailed clinical outcomes and costing data from a retrospective analysis of 341 patients who received the Sprint Fidelis lead in British Columbia, where patients younger than 60 years were offered lead extraction when undergoing generator replacement. These population-based data were used to construct and populate a probabilistic Markov model in which a proactive management strategy was compared to a conservative strategy to determine the incremental cost per lead failure avoided. In our population, elective lead revisions were half the cost of emergent revisions and had a lower complication rate. In the model, the incremental cost-effectiveness ratio of proactive lead revision versus a recommended monitoring strategy was $12,779 per lead failure avoided. The proactive strategy resulted in 21 fewer failures per 100 patients treated and reduced the chance of an additional complication from an unexpected surgery. Cost-effectiveness analysis suggests that prospective lead revision should be considered when patients with a Sprint Fidelis lead present for pulse generator change. Elective revision of the lead is justified even when 25% of the population is operated on per year, and in some scenarios, it is both less costly and provides a better outcome. © 2013 Heart Rhythm Society Published by Heart Rhythm Society All rights reserved.

  6. Cost-Effective Mobile-Based Healthcare System for Managing Total Joint Arthroplasty Follow-Up.

    Science.gov (United States)

    Bitsaki, Marina; Koutras, George; Heep, Hansjoerg; Koutras, Christos

    2017-01-01

    Long-term follow-up care after total joint arthroplasty is essential to evaluate hip and knee arthroplasty outcomes, to provide information to physicians and improve arthroplasty performance, and to improve patients' health condition. In this paper, we aim to improve the communication between arthroplasty patients and physicians and to reduce the cost of follow-up controls based on mobile application technologies and cloud computing. We propose a mobile-based healthcare system that provides cost-effective follow-up controls for primary arthroplasty patients through questions about symptoms in the replaced joint, questionnaires (WOMAC and SF-36v2) and the radiological examination of knee or hip joint. We also perform a cost analysis for a set of 423 patients that were treated in the University Clinic for Orthopedics in Essen-Werden. The estimation of healthcare costs shows significant cost savings (a reduction of 63.67% for readmission rate 5%) in both the University Clinic for Orthopedics in Essen-Werden and the state of North Rhine-Westphalia when the mobile-based healthcare system is applied. We propose a mHealth system to reduce the cost of follow-up assessments of arthroplasty patients through evaluation of diagnosis, self-monitoring, and regular review of their health status.

  7. Price Endogeneity and Marginal Cost Effects on Incentive Compatible Stormwater Management Policies

    OpenAIRE

    Huber, Matthew C.; Willis, David B.; Hayes, John C.; Privette, Charles V., III

    2010-01-01

    Incentive based stormwater management policies offer the prospect of reducing urban stormwater runoff while increasing developer profits. An incentive compatible Stormwater Banking Program (SBP) is presented that allows developers to build at higher residential densities in exchange for including low impact stormwater Best Management Practices (BMPs) in the development’s stormwater management infrastructure. Price endogeneity presents itself when the smaller residential lots created by buildi...

  8. Cost-Effective Surgical Management of Liver Disease Amidst a Financial Crisis.

    Science.gov (United States)

    Arkadopoulos, Nikolaos; Gemenetzis, Georgios; Danias, Nikolaos; Kokoropoulos, Panagiotis; Koukopoulou, Ioanna; Bartsokas, Christos; Kostopanagiotou, Georgia; Smyrniotis, Vassilios

    2016-07-01

    Intraoperative use of specialized equipment and disposables contributes to the increasing cost of modern liver surgery. As a response to the recent severe financial crisis in our country we have employed a highly standardized protocol of liver resection that minimizes intraoperative and postoperative costs. Our goal is to evaluate cost-effectiveness of this protocol. We evaluated retrospectively all patients who underwent open hepatic resections for 4 years. All resections were performed by the same surgical team under selective hepatic vascular exclusion, i.e., occlusion of the hepatoduodenal ligament and the major hepatic veins, occasionally combined with extrahepatic ligation of the ipsilateral portal vein. Sharp parenchymal transection was performed with a scalpel and hemostasis was achieved with sutures without the use of energy devices. In each case we performed a detailed analysis of costs and surgical outcomes. Our cohort included 146 patients (median age 63 years). 113 patients were operated for primary or metastatic malignancies and 33 for benign lesions. Operating time was 121 ± 21 min (mean ± SD), estimated blood loss was 310 ± 159 ml (mean ± SD), and hospital stay was 7 ± 5 days (mean ± SD). Six patients required admission in the ICU postoperatively. 90-day mortality was 2.74 %, and 8.9 % of patients developed grade III/IV postoperative complications (Clavien-Dindo classification). Total in-hospital cost excluding physician fees was 6987.63 ± 3838.51 USD (mean ± SD). Our analysis suggests that, under pressing economic conditions, the proposed surgical protocol can significantly lessen the financial burden of liver surgery without compromising patient outcomes.

  9. On-site vs off-site management of environmental restoration waste: A cost effectiveness analysis

    International Nuclear Information System (INIS)

    Morse, M.A.; Aamodt, P.L.; Cox, W.B.

    1996-01-01

    The Sandia National Laboratories Environmental Restoration Project is expected to generate relatively large volumes of hazardous waste as a result of cleanup operations. These volumes will exceed the Laboratories existing waste management capacity. This paper presents four options for managing remediation wastes, including three alternatives for on-site waste management utilizing a corrective action management unit (CAMU). Costs are estimated for each of the four options based on current volumetric estimates of hazardous waste. Cost equations are derived for each of the options with the variables being waste volumes, the major unknowns in the analysis. These equations provide a means to update cost estimates as volume estimates change. This approach may be helpful to others facing similar waste management decisions

  10. Shaping Future Phosphorus Management Pathways by Understanding the Past and Present

    Science.gov (United States)

    Sustainable phosphorus (P) management in agricultural and urban ecosystems is necessary to ensure global food security and healthy aquatic ecosystems. Researchers and decision-makers alike need to understand how social, economic, political, and biophysical factors interact to cre...

  11. Managing agricultural phosphorus to minimize water quality impacts

    Directory of Open Access Journals (Sweden)

    Andrew Sharpley

    2016-02-01

    Full Text Available ABSTRACT Eutrophication of surface waters remains a major use-impairment in many countries, which, in fresh waters, is accelerated by phosphorus (P inputs from both point (e.g., municipal waste water treatment plants and nonpoint sources (e.g., urban and agricultural runoff. As point sources tend to be easier to identify and control, greater attention has recently focused on reducing nonpoint sources of P. In Brazil, agricultural productivity has increased tremendously over the last decade as a consequence, to a large extent, of increases in the use of fertilizer and improved land management. For instance, adoption of the “4R” approach (i.e., right rate, right time, right source, and right placement of P to fertilizer management can decrease P runoff. Additionally, practices that lessen the risk of runoff and erosion, such as reduced tillage and cover crops will also lessen P runoff. Despite these measures P can still be released from soil and fluvial sediment stores as a result of the prior 10 to 20 years’ management. These legacy sources can mask the water quality benefits of present-day conservation efforts. Future remedial efforts should focus on developing risk assessment indices and nonpoint source models to identify and target conservation measures and to estimate their relative effectiveness. New fertilizer formulations may more closely tailor the timing of nutrient release to plant needs and potentially decrease P runoff. Even so, it must be remembered that appropriate and timely inputs of fertilizers are needed to maintain agricultural productivity and in some cases, financial support might also be required to help offset the costs of expensive conservation measures.

  12. Water quality management and climate change mitigation: cost-effectiveness of joint implementation in the Baltic Sea region

    DEFF Research Database (Denmark)

    Nainggolan, Doan; Hasler, Berit; Andersen, Hans Estrup

    2018-01-01

    of contrasting strategies: single environmental objective management versus joint implementation strategy. The results show that implementing land-based measures with a sole focus on water quality (to meet the HELCOM's 2013 Baltic Sea Action Plan nutrient abatement targets) can produce climate change mitigation......This paper explores the scope for simultaneously managing nutrient abatement and climate change mitigation in the Baltic Sea (BS) region through the implementation of a selection of measures. The analysis is undertaken using a cost-minimisation model for the entire BS region, the BALTCOST model....... In the present research, the model has been extended to include greenhouse gas (GHG) emissions effects, enabling us to analyse the tradeoffs between cost-effective GHG and nutrient load reductions. We run the model for four different scenarios in order to compare the environmental and economic consequences...

  13. Current Law Limits the State Department's Authority to Manage Certain Overseas Properties Cost Effectively

    National Research Council Canada - National Science Library

    Ford, Jess

    2002-01-01

    The Department of State is the central manager for real estate at U.S. embassies and consulates and has the statutory authority to sell properties and use the sales proceeds to acquire and maintain other overseas properties...

  14. Phosphorus fertilizer and grazing management effects on phosphorus in runoff from dairy pastures.

    Science.gov (United States)

    Dougherty, Warwick J; Nicholls, Paul J; Milham, Paul J; Havilah, Euie J; Lawrie, Roy A

    2008-01-01

    Fertilizer phosphorus (P) and grazing-related factors can influence runoff P concentrations from grazed pastures. To investigate these effects, we monitored the concentrations of P in surface runoff from grazed dairy pasture plots (50 x 25 m) treated with four fertilizer P rates (0, 20, 40, and 80 kg ha(-1) yr(-1)) for 3.5 yr at Camden, New South Wales. Total P concentrations in runoff were high (0.86-11.13 mg L(-1)) even from the control plot (average 1.94 mg L(-1)). Phosphorus fertilizer significantly (P pasture biomass (P dairy pastures should be the maintenance of soil P at or near the agronomic optimum by the use of appropriate rates of P fertilizer.

  15. Cost-effectiveness of cardiovascular risk management by practice nurses in primary care

    NARCIS (Netherlands)

    Tiessen, Ans H.; Vermeulen, Karin M.; Broer, Jan; Smit, Andries J.; van der Meer, Klaas

    2013-01-01

    Background: Cardiovascular disease (CVD) is largely preventable and prevention expenditures are relatively low. The randomised controlled SPRING-trial (SPRING-RCT) shows that cardiovascular risk management by practice nurses in general practice with and without self-monitoring both decreases

  16. Farm-system modeling to evaluate environmental losses, profitability, and best management practice cost-effectiveness

    Science.gov (United States)

    To meet Chesapeake Bay Total Maximum Daily Load requirements for agricultural pollution, conservation districts and farmers are tasked with implementing best management practices (BMPs) that reduce farm losses of nutrients and sediment. The importance of the agricultural industry to the regional eco...

  17. Cost-Effectiveness of the Hepatitis C Self-Management Program

    Science.gov (United States)

    Groessl, Erik J.; Sklar, Marisa; Laurent, Diana D.; Lorig, Kate; Ganiats, Theodore G.; Ho, Samuel B.

    2017-01-01

    Background. Despite the emergence of new hepatitis C virus (HCV) antiviral medications, many people with chronic HCV know little about their disease, are at risk for transmitting HCV to others, and/or are not considered good treatment candidates. Self-management interventions can educate HCV-infected persons, improve their quality of life, and…

  18. Cost-effective energy management for hybrid electric heavy-duty truck including battery aging

    NARCIS (Netherlands)

    Pham, H.T.; Bosch, van den P.P.J.; Kessels, J.T.B.A.; Huisman, R.G.M.

    2013-01-01

    Battery temperature has large impact on battery power capability and battery life time. In Hybrid Electric Heavy-duty trucks (HEVs), the high-voltage battery is normally equipped with an active Battery Thermal Management System (BTMS) guaranteeing a desired battery life time. Since the BTMS can

  19. Use of fire hazard analysis to cost effectively manage facility modifications

    Energy Technology Data Exchange (ETDEWEB)

    Krueger, K., E-mail: kkruger@plcfire.com [PLC Fire Safety Solutions, Fredericton, NB (Canada); Cronk, R., E-mail: rcronk@plcfire.com [PLC Fire Safety Solutions, Mississauga, ON (Canada)

    2014-07-01

    In Canada, licenced Nuclear power facilities, or facilities that process, handle or store nuclear material are required by the Canadian Nuclear Safety Commission to have a change control process in place. These processes are in place to avoid facility modifications that could result in an increase in fire hazards, or degradation of fire protection systems. Change control processes can have a significant impact on budgets associated with plant modifications. A Fire Hazard Analysis (FHA) is also a regulatory requirement for licenced facilities in Canada. An FHA is an extensive evaluation of a facility's construction, nuclear safety systems, fire hazards, and fire protection features. This paper is being presented to outline how computer based data management software can help organize facilities' fire safety information, manage this information, and reduce the costs associated with preparation of FHAs as well as facilities' change control processes. (author)

  20. Cost-Effective Location Management for Mobile Agents on the Internet

    OpenAIRE

    Chien-Sheng Chen; Jiing-Dong Hwang; Chyuan-Der Lu; Ting-Yuan Yeh

    2015-01-01

    Many mobile agent system-related services and applications require interacting with a mobile agent by passing messages. However, an agent’s mobility raises several challenges in delivering messages to a mobile agent accurately. Consisting of tracking and message delivery phases, most mobile agent location management schemes create or receive many update messages and interaction messages to ensure the effectiveness of the schemes. In addition to downgrading the overall performance of a mobile ...

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

    Science.gov (United States)

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

    2016-03-01

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

  2. Waste management strategy for cost effective and environmentally friendly NPP decommissioning

    Energy Technology Data Exchange (ETDEWEB)

    Per Lidar; Arne Larsson [Studsvik Nuclear AB (ndcon partner), Nykoping (Sweden); Niklas Bergh; Gunnar Hedin [Westinghouse Electric Sweden AB (ndcon partner), Vasteraas (Sweden)

    2013-07-01

    Decommissioning of nuclear power plants generates large volumes of radioactive or potentially radioactive waste. The proper management of the dismantling waste plays an important role for the time needed for the dismantling phase and thus is critical to the decommissioning cost. An efficient and thorough process for inventorying, characterization and categorization of the waste provides a sound basis for the planning process. As part of comprehensive decommissioning studies for Nordic NPPs, Westinghouse has developed the decommissioning inventories that have been used for estimations of the duration of specific work packages and the corresponding costs. As part of creating the design basis for a national repository for decommissioning waste, the total production of different categories of waste packages has also been predicted. Studsvik has developed a risk based concept for categorization and handling of the generated waste using six different categories with a span from extremely small risk for radiological contamination to high level waste. The two companies have recently joined their skills in the area of decommissioning on selected market in a consortium named ndcon to further strengthen the proposed process. Depending on the risk for radiological contamination or the radiological properties and other properties of importance for waste management, treatment routes are proposed with well-defined and proven methods for on-site or off-site treatment, activity determination and conditioning. The system is based on a graded approach philosophy aiming for high confidence and sustainability, aiming for re-use and recycling where found applicable. The objective is to establish a process where all dismantled material has a pre-determined treatment route. These routes should through measurements, categorization, treatment, conditioning, intermediate storage and final disposal be designed to provide a steady, un-disturbed flow of material to avoid interruptions. Bottle

  3. Regional cost-effectiveness in transboundary water quality management for the Baltic Sea

    DEFF Research Database (Denmark)

    Hasler, Berit; Smart, James Christopher Rudd; Fonnesbech-Wulff, Anders

    In 2007 HELCOM launched a plan for transboundary management of the Baltic Sea. This plan, called the Baltic Sea Action Plan (BSAP), aims amongst other things, to reduce eutrophication in the different regions of the Baltic Sea by reducing incoming nutrient loads from all discharging drainage basins...... difficult to achieve, and that additional abatement measures are likely to be required to fulfil these targets. The minimised total cost of delivering the achievable load reductions across the 9 Baltic littoral countries is estimated to be 4.69 billion Euros, annually, with substantial differences...

  4. Waste management strategy for cost effective and environmentally friendly NPP decommissioning

    International Nuclear Information System (INIS)

    Per Lidar; Arne Larsson; Niklas Bergh; Gunnar Hedin

    2013-01-01

    Decommissioning of nuclear power plants generates large volumes of radioactive or potentially radioactive waste. The proper management of the dismantling waste plays an important role for the time needed for the dismantling phase and thus is critical to the decommissioning cost. An efficient and thorough process for inventorying, characterization and categorization of the waste provides a sound basis for the planning process. As part of comprehensive decommissioning studies for Nordic NPPs, Westinghouse has developed the decommissioning inventories that have been used for estimations of the duration of specific work packages and the corresponding costs. As part of creating the design basis for a national repository for decommissioning waste, the total production of different categories of waste packages has also been predicted. Studsvik has developed a risk based concept for categorization and handling of the generated waste using six different categories with a span from extremely small risk for radiological contamination to high level waste. The two companies have recently joined their skills in the area of decommissioning on selected market in a consortium named ndcon to further strengthen the proposed process. Depending on the risk for radiological contamination or the radiological properties and other properties of importance for waste management, treatment routes are proposed with well-defined and proven methods for on-site or off-site treatment, activity determination and conditioning. The system is based on a graded approach philosophy aiming for high confidence and sustainability, aiming for re-use and recycling where found applicable. The objective is to establish a process where all dismantled material has a pre-determined treatment route. These routes should through measurements, categorization, treatment, conditioning, intermediate storage and final disposal be designed to provide a steady, un-disturbed flow of material to avoid interruptions. Bottle

  5. Management features of the innovative development of the enterprise taking into account cost-effective use of resources

    Directory of Open Access Journals (Sweden)

    Babanova Yu.V.

    2017-01-01

    Full Text Available Modern business is developing in the conditions of innovation-driven economy in which science and technology are the basis of competitive ability and a productive force. Most of the managerial decisions are taken in the context of limited resources and high uncertainty, because they depend on many factors, the dynamics of which is not always possible to estimate with reasonable accuracy. In this article special method is presented, which allows you to formalize the process of management decision, in terms of innovative product development. This method includes matrix analysis and vector calculus. The purpose of this method and model is to develop a set of alternative options for the product development and the selection of the most cost effective projects based on the integration of consumer requirements, innovative product specifications and the manufacturing capability of the organization (initial conditions for the project realization.

  6. Upgrading Supply Chain Management Systems to Improve Availability of Medicines in Tanzania: Evaluation of Performance and Cost Effects.

    Science.gov (United States)

    Mwencha, Marasi; Rosen, James E; Spisak, Cary; Watson, Noel; Kisoka, Noela; Mberesero, Happiness

    2017-09-27

    To address challenges in public health supply chain performance, Tanzania invested in a national logistics management unit (LMU) and a national electronic logistics management information system (eLMIS). This evaluation examined the impact of those 2 key management upgrades approximately 1 year after they were introduced. We used a nonexperimental pre-post study design to compare the previous system with the upgraded management system. We collected baseline data from August to November 2013. We conducted round 1 of post-implementation data collection during April and May 2015, about 1 year after implementation of the upgrades. We evaluated key indicators of data use and reporting; supply chain management practices such as storage and supervision; supply chain performance including stock-out and expiry rates; and supply chain cost and savings. We analyzed the data using a range of techniques including statistical testing of baseline and round-1 results, and cost, cost-effectiveness, and return on investment analysis. The upgrades were associated with improvements in data use, accessibility, visibility, and transparency; planning, control, and monitoring; support for quantification; stock-out rates; stock-out duration; commodity expiry; and forecast error. The upgraded system was more costly, but it was also more efficient, particularly when adjusting for the performance improvements. The upgrades also generated substantial savings that defrayed some, but not all, of the investment costs. Upgrades to Tanzania's supply chain management systems created multiple and complex pathways to impact. One year after implementation, the LMU and eLMIS brought about performance improvements through better data use and through improvements in some, but not all, management practices. Furthermore, the upgrades-while not inexpensive-contributed to greater system efficiency and modest savings. © Mwencha et al.

  7. Integrated analysis of water quality parameters for cost-effective faecal pollution management in river catchments.

    Science.gov (United States)

    Nnane, Daniel Ekane; Ebdon, James Edward; Taylor, Huw David

    2011-03-01

    In many parts of the world, microbial contamination of surface waters used for drinking, recreation, and shellfishery remains a pervasive risk to human health, especially in Less Economically Developed Countries (LEDC). However, the capacity to provide effective management strategies to break the waterborne route to human infection is often thwarted by our inability to identify the source of microbial contamination. Microbial Source Tracking (MST) has potential to improve water quality management in complex river catchments that are either routinely, or intermittently contaminated by faecal material from one or more sources, by attributing faecal loads to their human or non-human sources, and thereby supporting more rational approaches to microbial risk assessment. The River Ouse catchment in southeast England (U.K.) was used as a model with which to investigate the integration and application of a novel and simple MST approach to monitor microbial water quality over one calendar year, thereby encompassing a range of meteorological conditions. A key objective of the work was to develop simple low-cost protocols that could be easily replicated. Bacteriophages (viruses) capable of infecting a human specific strain of Bacteroides GB-124, and their correlation with presumptive Escherichia coli, were used to distinguish sources of faecal pollution. The results reported here suggest that in this river catchment the principal source of faecal pollution in most instances was non-human in origin. During storm events, presumptive E. coli and presumptive intestinal enterococci levels were 1.1-1.2 logs higher than during dry weather conditions, and levels of the faecal indicator organisms (FIOs) were closely associated with increased turbidity levels (presumptive E. coli and turbidity, r = 0.43). Spatio-temporal variation in microbial water quality parameters was accounted for by three principal components (67.6%). Cluster Analysis, reduced the fourteen monitoring sites to six

  8. Studies on the cost-effective management of Alternaria blight of rapeseed-mustard (Brassica spp.

    Directory of Open Access Journals (Sweden)

    M.M. Khan

    2007-08-01

    Full Text Available Three systemic fungicides: Topsin-M (Thiophanate methyl, 70%WP, Ridomil MZ (Mancozeb, 64% + Metalaxyl, 8%WP, and Bavistin (Carbendazim, 50%WP alone and in combination with four non-systemic fungicides Captaf (Captan, 50%WP, Indofil M-45 (Mancozeb, 75%WP, Indofil Z-78 (Zineb, 75%WP, and Thiram (Thiram, 75%WP were evaluated both in vitro and in vivo for their effectiveness to manage Alternaria blight of rapeseedmustard caused by Alternaria brassicae. A pure culture of the pathogenic fungus was applied in the field at 2 g colonized sorghum seeds kg-1 soil. All the fungicides were evaluated for their efficacy at various concentrations, 50, 100, 150, 200 and 500 ppm, and were sprayed in the field at 0.2% a.i. l-1. All fungicides significantly reduced the severity of the disease but Ridomil MZ was most effective. Topsin-M at a concentration of 500 ppm was the most effective in reducing radial growth of the pathogenic fungi (74.2%. Ridomil MZ reduced disease severity by 32% and was followed in effectiveness by the combination Bavistin+Captaf (26.5%. Maximum yield was obtained in plots sprayed with Bavistin+Captaf (1198 kg ha-1 followed by Bavistin+Indofil Z-78 (1172 kg ha-1. It was worth noting that the highest net profit as well as the highest cost-benefit ratio was obtained with Bavistin+Indofil Z-78 (1:3.2, followed by Bavistin+Captaf (1:1.3.

  9. Cost effective management of duodenal ulcers in Uganda: interventions based on a series of seven cases.

    Science.gov (United States)

    Nzarubara, Gabriel R

    2005-03-01

    Our understanding of the cause and treatment of peptic ulcer disease has changed dramatically over the last couple of decades. It was quite common some years ago to treat chronic ulcers surgically. These days, the operative treatment is restricted to the small proportion of ulcer patients who have complications such as perforation. The author reports seven cases of perforated duodenal ulcers seen in a surgical clinic between 1995 and 2001. Recommendations on the criteria for selecting the appropriate surgical intervention for patients with perforated duodenal ulcer are given. To decide on the appropriate surgical interventions for patients with perforated duodenal ulcer. These are case series of 7 patients who presented with perforated duodenal ulcers without a history of peptic ulcer disease. Seven patients presented with perforated duodenal ulcer 72 hours after perforation in a specialist surgical clinic in Kampala were analyzed. Appropriate management based on these patients is suggested. These patients were initially treated in upcountry clinics for acute gastritis from either alcohol consumption or suspected food poisoning. There was no duodenal ulcer history. As a result, they came to specialist surgical clinic more than 72 hours after perforation. Diagnosis of perforated duodenal ulcer was made and they were operated using the appropriate surgical intervention. Diagnosis of hangovers and acute gastritis from alcoholic consumption or suspected food poisoning should be treated with suspicion because the symptoms and signs may mimic perforated peptic ulcer in "silent" chronic ulcers. The final decision on the appropriate surgical intervention for patients with perforated duodenal ulcer stratifies them into two groups: The previously fit patients who have relatively mild physiological compromise imposed on previously healthy organ system by the perforation can withstand the operative stress of definitive procedure. The Second category includes patients who are

  10. Efficient phosphorus management practices in the Everglades Agricultural Area

    Science.gov (United States)

    Bhadha, J. H.; Lang, T. A.; Daroub, S. H.; Alvarez, O.; Tootoonchi, M.; Capasso, J.

    2016-12-01

    In the 450,000 acres of the Everglades Agricultural Area (EAA) of South Florida, farming practices have long been mindful of phosphorus (P) management as it relates to sufficiency and efficiency of P utilization. Over two decades of P best management practices have resulted in 3001 metric-ton of P load reduction from the EAA to downstream ecosystems. During the summer, more than 50,000 acres of fallow sugarcane land is available for rice production. The net value of growing flooded rice in the EAA as a rotational crop with sugarcane far exceeds its monetary return. Soil conservation, improvement in tilth and P load reduction are only some of the benefits. With no P fertilizer applied, a two-year field trial on flooded rice showed improved outflow P concentrations by up to 40% as a result of particulate setting and plant P uptake. Harvested whole grain rice can effectively remove a significant amount of P from a rice field per growing season. In parts of the EAA where soils are sandy, the application of using locally derived organic amendments as potential P fertilizer has gained interest over the past few years. The use of local agricultural and urban organic residues as amendments in sandy soils of South Florida provide options to enhance soil properties and improve sugarcane yields, while reducing waste and harmful effects of agricultural production on the environment. A lysimeter study conducted to determine the effect of mill ash and three types of biochar (rice hulls, yard waste, horse bedding) on sugarcane yields, soil properties, and drainage water quality in sandy soils showed that mill ash and rice hull biochar increased soil TP, Mehlich 3-P (M3-P), and cation exchange capacity (CEC) compared to the control. TP and M3-P content remained constant after 9 months, CEC showed a significant increase over time with rich hull biochar addition. Future projects include the utilization of aquatic vegetation, such as chara and southern naiad as bio-filters in farm

  11. Cost-effectiveness analysis of FDG PET-CT in the management of pulmonary metastases from malignant melanoma

    Energy Technology Data Exchange (ETDEWEB)

    Krug, Bruno; Pirson, Anne-Sophie; Borght Thierry Vander (Nuclear Medicine Division, Mont-Godinne Univ. Hospital, Yvoir (Belgium)), E-mail: bruno.krug@uclouvain.be; Crott, Ralph (Public Health, Saint-Luc Univ. Hospital, Brussels (Belgium)); Roch, Isabelle (Public Health School, Univ. Catholique de Louvain, Brussels (Belgium)); Lonneux, Max (Nuclear Medicine Division, Saint-Luc Univ. Hospital, Brussels (Belgium)); Beguin, Claire (Medical Information and Statistics, Saint-Luc Univ. Hospital, Brussels (Belgium)); Baurain, Jean-Francois (Dept. of Oncology, Saint-Luc Univ. Hospital, Brussels (Belgium))

    2010-02-15

    Objectives. Most guidelines consider FDG PET-CT to detect occult extra-pulmonary disease prior to lung metastasectomy. A cost-effectiveness analysis, using a Markov model over a 10 year period, was performed to compare two different surveillance programs, either PET-CT or whole-body CT, in patients with suspected pulmonary metastasised melanoma. Methods. Data from published studies provided probabilities for the model. Complication and care costs were obtained from standardised administrative databases from 19 hospitals identified by DRG codes (reported in 2009 Euros). For the cost calculation of PET-CT we performed a microcosting analysis. All costs and benefits were yearly discounted at respectively 3% and 1.5%. Outcomes included life-months gained (LMG) and the number of futile surgeries avoided. Cost-effectiveness ratios were in Euros per LMG. Univariate and probabilistic sensitivity analyses addressed uncertainty in all model parameters. Results. The PET-CT strategy provided 86.29 LMG (95% CI: 81.50-90.88 LMG) at a discounted cost of Euro 3 974 (95% CI: Euro 1 339-12 303), while the conventional strategy provided 86.08 LMG (95% CI: 81.37-90.68 LMG) at a discounted cost of Euro 5 022 (95% CI: Euro 1 378-16 018). This PET-CT strategy resulted in a net saving of Euro 1 048 with a gain of 0.2 LMG. Based on PET-CT findings, 20% of futile surgeries could be avoided. Conclusion. Integrating PET-CT in the management of patients with high risk MM appears to be less costly and more accurate by avoiding futile thoracotomies in one of five patients as well as by providing a small survival benefit at 10 years

  12. Cost-Effective Pavement Performance Management of Indiana's Enhanced National Highway System through Strategic Modification of the Pavement Rehabilitation Treatment Trigger Values

    OpenAIRE

    Noureldin, Menna; Fricker, Jon D.; Sinha, Kumares C.

    2015-01-01

    Cost-Effective Pavement Performance Management of Indiana's Enhanced National Highway System through Strategic Modification of the Pavement Rehabilitation Treatment Trigger Values Presented during Session 3: Policy and Funding, moderated by Magdy Mikhail, at the 9th International Conference on Managing Pavement Assets (ICMPA9) in Alexandria, VA. Includes conference paper and PowerPoint slides.

  13. Integrated cost-effectiveness analysis of agri-environmental measures for water quality.

    Science.gov (United States)

    Balana, Bedru B; Jackson-Blake, Leah; Martin-Ortega, Julia; Dunn, Sarah

    2015-09-15

    This paper presents an application of integrated methodological approach for identifying cost-effective combinations of agri-environmental measures to achieve water quality targets. The methodological approach involves linking hydro-chemical modelling with economic costs of mitigation measures. The utility of the approach was explored for the River Dee catchment in North East Scotland, examining the cost-effectiveness of mitigation measures for nitrogen (N) and phosphorus (P) pollutants. In-stream nitrate concentration was modelled using the STREAM-N and phosphorus using INCA-P model. Both models were first run for baseline conditions and then their effectiveness for changes in land management was simulated. Costs were based on farm income foregone, capital and operational expenditures. The costs and effects data were integrated using 'Risk Solver Platform' optimization in excel to produce the most cost-effective combination of measures by which target nutrient reductions could be attained at a minimum economic cost. The analysis identified different combination of measures as most cost-effective for the two pollutants. An important aspect of this paper is integration of model-based effectiveness estimates with economic cost of measures for cost-effectiveness analysis of land and water management options. The methodological approach developed is not limited to the two pollutants and the selected agri-environmental measures considered in the paper; the approach can be adapted to the cost-effectiveness analysis of any catchment-scale environmental management options. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Assessment of the minimal available phosphorus needs of laying hens: Implications for phosphorus management strategies.

    Science.gov (United States)

    Jing, M; Zhao, S; Rogiewicz, A; Slominski, B A; House, J D

    2018-03-28

    The oversupply of dietary phosphorus (P) leads to increased feed costs and discharge of excessive P to the environment, thus directly impacting the sustainability of egg production practices. The present study was conducted to better define the minimal available P needs of laying hens. Fifty-six Lohmann white laying hens were individually caged and fed one of 7 diets with graded levels of available P (0.15, 0.20, 0.25, 0.30, 0.35, 0.40, or 0.45%) for 12 weeks. Records were maintained for body weight, feed intake, and egg production during the experimental period. Blood and egg samples were collected and digestibility studies conducted at wk 6 and 12 of the experiment. At the end of the experiment, tibia characteristics and expression of the P transporters in the small intestine and kidney were determined. Lowering dietary available P from 0.45 to 0.15% generally reduced plasma P concentrations (P data indicate that reducing dietary available P up to 0.15% is adequate to maintain health and performance of layers. As such, this minimal available P estimate should serve as a benchmark for the assessment of P contents of commercial laying hen rations, with the goal of enhancing the sustainability of egg production.

  15. Phosphorus fertilization in sugarcane cultivation under different soil managements

    OpenAIRE

    Sousa Junior, Paulo R. de; Brunharo, Caio A. C. G.; Furlani, Carlos E. A.; Prado, Renato de M.; Maldonado Júnior, Walter; Zerbato, Cristiano

    2017-01-01

    ABSTRACT Soil preparation along with its chemical adjustment is the most important step in sugarcane plantation, especially because it provides proper conditions for plant development. The objective of the present research was to evaluate sugarcane response to the application of different phosphorus doses and their location, associated with both minimum soil tillage and conventional soil tillage. The experiment was conducted in a split-split-plot randomized block design, where the main plots ...

  16. Cost-effectiveness analysis of a system-based approach for managing neonatal jaundice and preventing kernicterus in Ontario

    Science.gov (United States)

    Xie, Bin; da Silva, Orlando; Zaric, Greg

    2012-01-01

    OBJECTIVE: To evaluate the incremental cost-effectiveness of a system-based approach for the management of neonatal jaundice and the prevention of kernicterus in term and late-preterm (≥35 weeks) infants, compared with the traditional practice based on visual inspection and selected bilirubin testing. STUDY DESIGN: Two hypothetical cohorts of 150,000 term and late-preterm neonates were used to compare the costs and outcomes associated with the use of a system-based or traditional practice approach. Data for the evaluation were obtained from the case costing centre at a large teaching hospital in Ontario, supplemented by data from the literature. RESULTS: The per child cost for the system-based approach cohort was $176, compared with $173 in the traditional practice cohort. The higher cost associated with the system-based cohort reflects increased costs for predischarge screening and treatment and increased postdischarge follow-up visits. These costs are partially offset by reduced costs from fewer emergency room visits, hospital readmissions and kernicterus cases. Compared with the traditional approach, the cost to prevent one kernicterus case using the system-based approach was $570,496, the cost per life year gained was $26,279, and the cost per quality-adjusted life year gained was $65,698. CONCLUSION: The cost to prevent one kernicterus case using the system-based approach is much lower than previously reported in the literature. PMID:23277747

  17. Cost-effectiveness analysis of a system-based approach for managing neonatal jaundice and preventing kernicterus in Ontario.

    Science.gov (United States)

    Xie, Bin; da Silva, Orlando; Zaric, Greg

    2012-01-01

    To evaluate the incremental cost-effectiveness of a system-based approach for the management of neonatal jaundice and the prevention of kernicterus in term and late-preterm (≥35 weeks) infants, compared with the traditional practice based on visual inspection and selected bilirubin testing. Two hypothetical cohorts of 150,000 term and late-preterm neonates were used to compare the costs and outcomes associated with the use of a system-based or traditional practice approach. Data for the evaluation were obtained from the case costing centre at a large teaching hospital in Ontario, supplemented by data from the literature. The per child cost for the system-based approach cohort was $176, compared with $173 in the traditional practice cohort. The higher cost associated with the system-based cohort reflects increased costs for predischarge screening and treatment and increased postdischarge follow-up visits. These costs are partially offset by reduced costs from fewer emergency room visits, hospital readmissions and kernicterus cases. Compared with the traditional approach, the cost to prevent one kernicterus case using the system-based approach was $570,496, the cost per life year gained was $26,279, and the cost per quality-adjusted life year gained was $65,698. The cost to prevent one kernicterus case using the system-based approach is much lower than previously reported in the literature.

  18. Improvement in cost-effectiveness and customer satisfaction by a quality management system according to EN ISO 9001:2000.

    Science.gov (United States)

    Beholz, Sven; Konertz, Wolfgang

    2005-12-01

    The implementation of a quality management system (QMS) according to EN ISO 9001:2000 has proven to be possible for cardiac surgery departments. However, it remains unclear if a QMS can help to improve quality as indicated by cost-effectiveness and customer satisfaction. To control costs for medical goods and laboratory investigations an internal control system for the allocation of resources was implemented. Laboratory costs and medical goods per open heart procedure were investigated in the years 2000 to 2003. In terms of customer satisfaction, repeated questionnaire-based evaluation of referring physicians was obtained from 2001 to 2003 and the influence of repeated interventions on various aspects of communications was investigated. Costs of medical goods could be reduced by 6.1%, and for laboratory investigations by 35% per operation. Additionally, customer satisfaction could be increased efficiently with respect to accessibility and postoperative communication. By the introduction of a process based QMS, efficient control of the costs of medical goods and laboratory investigations could be achieved. Once a year repeat evaluation of satisfaction of advising physicians has proven to be a valuable tool in the process of continuous improvement.

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

    Science.gov (United States)

    Ohura, Takehiko; Sanada, Hiromi; Mino, Yoshio

    2004-01-01

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

  20. Agricultural phosphorus and water quality: sources, transport and management

    Directory of Open Access Journals (Sweden)

    A. SHARPLEY

    2008-12-01

    Full Text Available Freshwater eutrophication is usually controlled by inputs of phosphorus (P. To identify critical sources of P export from agricultural catchments we investigated hydrological and chemical factors controlling P export from a mixed land use (30% wooded, 50% cultivated, 20% pasture 39.5-ha catchment in east-central Pennsylvania, USA. Mehlich-3 extractable soil P, determined on a 30-m grid over the catchment, ranged from 7 to 788 mg kg-1. Generally, soils in wooded areas had low Mehlich-3 P (

  1. Cost-Effectiveness Analysis of Five Competing Strategies for the Management of Multiple Recurrent Community-Onset Clostridium difficile Infection in France

    OpenAIRE

    Baro, Emilie; Galperine, Tatiana; Denies, Fanette; Lannoy, Damien; Lenne, Xavier; Odou, Pascal; Guery, Benoit; Dervaux, Benoit

    2017-01-01

    Background Clostridium difficile infection (CDI) is characterized by high rates of recurrence, resulting in substantial health care costs. The aim of this study was to analyze the cost-effectiveness of treatments for the management of second recurrence of community-onset CDI in France. Methods We developed a decision-analytic simulation model to compare 5 treatments for the management of second recurrence of community-onset CDI: pulsed-tapered vancomycin, fidaxomicin, fecal microbiota transpl...

  2. Cost-effectiveness of adding indoor residual spraying to case management in Afghan refugee settlements in Northwest Pakistan during a prolonged malaria epidemic.

    Science.gov (United States)

    Howard, Natasha; Guinness, Lorna; Rowland, Mark; Durrani, Naeem; Hansen, Kristian S

    2017-10-01

    Financing of malaria control for displaced populations is limited in scope and duration, making cost-effectiveness analyses relevant but difficult. This study analyses cost-effectiveness of adding prevention through targeted indoor residual spraying (IRS) to case management in Afghan refugee settlements in Pakistan during a prolonged malaria epidemic. An intervention study design was selected, taking a societal perspective. Provider and household costs of vector control and case management were collected from provider records and community survey. Health outcomes (e.g. cases and DALYs averted) were derived and incremental cost-effectiveness ratios (ICERs) for cases prevented and DALYs averted calculated. Population, treatment cost, women's time, days of productivity lost, case fatality rate, cases prevented, and DALY assumptions were tested in sensitivity analysis. Malaria incidence peaked at 44/1,000 population in year 2, declining to 14/1,000 in year 5. In total, 370,000 malaria cases, 80% vivax, were diagnosed and treated and an estimated 67,988 vivax cases and 18,578 falciparum and mixed cases prevented. Mean annual programme cost per capita was US$0.56. The additional cost of including IRS over five years per case prevented was US$39; US$50 for vivax (US$43 in years 1-3, US$80 in years 4-5) and US$182 for falciparum (US$139 in years 1-3 and US$680 in years 4-5). Per DALY averted this was US$266 (US$220 in years 1-3 and US$486 in years 4-5) and thus 'highly cost-effective' or cost-effective using WHO and comparison thresholds. Adding IRS was cost-effective in this moderate endemicity, low mortality setting. It was more cost-effective when transmission was highest, becoming less so as transmission reduced. Because vivax was three times more common than falciparum and the case fatality rate was low, cost-effectiveness estimations for cases prevented appear reliable and more definitive for vivax malaria.

  3. Design, and participant enrollment, of a randomized controlled trial evaluating effectiveness and cost-effectiveness of a community-based case management intervention, for patients suffering from COPD

    DEFF Research Database (Denmark)

    Sørensen, Sabrina Storgaard; Pedersen, Kjeld Møller; Weinreich, Ulla Møller

    2015-01-01

    Background: Case management interventions are recommended to improve quality of care and reduce costs in chronic care, but further evidence on effectiveness and cost-effectiveness is needed. The objective of this study is the reporting of the design and participant enrollment of a randomized...... controlled trial, conducted to evaluate the effectiveness and cost-effectiveness of a community-based case management model for patients suffering from chronic obstructive pulmonary disease (COPD). With a focus on support for self-care and care coordination, the intervention was hypothesized to result...... patients were randomized into two groups: the case-managed group and the usual-care group. Participant characteristics were obtained at baseline, and measures on effectiveness and costs were obtained through questionnaires and registries within a 12-month follow-up period. In the forthcoming analysis...

  4. Cost-effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss.

    Science.gov (United States)

    Murugappan, Gayathree; Ohno, Mika S; Lathi, Ruth B

    2015-05-01

    To determine whether in vitro fertilization with preimplantation genetic screening (IVF/PGS) is cost effective compared with expectant management in achieving live birth for patients with unexplained recurrent pregnancy loss (RPL). Decision analytic model comparing costs and clinical outcomes. Academic recurrent pregnancy loss programs. Women with unexplained RPL. IVF/PGS with 24-chromosome screening and expectant management. Cost per live birth. The IVF/PGS strategy had a live-birth rate of 53% and a clinical miscarriage rate of 7%. Expectant management had a live-birth rate of 67% and clinical miscarriage rate of 24%. The IVF/PGS strategy was 100-fold more expensive, costing $45,300 per live birth compared with $418 per live birth with expectant management. In this model, IVF/PGS was not a cost-effective strategy for increasing live birth. Furthermore, the live-birth rate with IVF/PGS needs to be 91% to be cost effective compared with expectant management. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  5. Applying a private sector capitation model to the management of type 2 diabetes in the South African public sector: a cost-effectiveness analysis.

    Science.gov (United States)

    Volmink, Heinrich C; Bertram, Melanie Y; Jina, Ruxana; Wade, Alisha N; Hofman, Karen J

    2014-09-30

    Diabetes mellitus contributes substantially to the non-communicable disease burden in South Africa. The proposed National Health Insurance system provides an opportunity to consider the development of a cost-effective capitation model of care for patients with type 2 diabetes. The objective of the study was to determine the potential cost-effectiveness of adapting a private sector diabetes management programme (DMP) to the South African public sector. Cost-effectiveness analysis was undertaken with a public sector model of the DMP as the intervention and a usual practice model as the comparator. Probabilistic modelling was utilized for incremental cost-effectiveness ratio analysis with life years gained selected as the outcome. Secondary data were used to design the model while cost information was obtained from various sources, taking into account public sector billing. Modelling found an incremental cost-effectiveness ratio (ICER) of ZAR 8 356 (USD 1018) per life year gained (LYG) for the DMP against the usual practice model. This fell substantially below the Willingness-to-Pay threshold with bootstrapping analysis. Furthermore, a national implementation of the intervention could potentially result in an estimated cumulative gain of 96 997 years of life (95% CI 71 073 years - 113 994 years). Probabilistic modelling found the capitation intervention to be cost-effective, with an ICER of ZAR 8 356 (USD 1018) per LYG. Piloting the service within the public sector is recommended as an initial step, as this would provide data for more accurate economic evaluation, and would also allow for qualitative analysis of the programme.

  6. Modelling the Impact and Cost-Effectiveness of Biomarker Tests as Compared with Pathogen-Specific Diagnostics in the Management of Undifferentiated Fever in Remote Tropical Settings.

    Directory of Open Access Journals (Sweden)

    Yoel Lubell

    Full Text Available Malaria accounts for a small fraction of febrile cases in increasingly large areas of the malaria endemic world. Point-of-care tests to improve the management of non-malarial fevers appropriate for primary care are few, consisting of either diagnostic tests for specific pathogens or testing for biomarkers of host response that indicate whether antibiotics might be required. The impact and cost-effectiveness of these approaches are relatively unexplored and methods to do so are not well-developed.We model the ability of dengue and scrub typhus rapid tests to inform antibiotic treatment, as compared with testing for elevated C-Reactive Protein (CRP, a biomarker of host-inflammation. Using data on causes of fever in rural Laos, we estimate the proportion of outpatients that would be correctly classified as requiring an antibiotic and the likely cost-effectiveness of the approaches.Use of either pathogen-specific test slightly increased the proportion of patients correctly classified as requiring antibiotics. CRP testing was consistently superior to the pathogen-specific tests, despite heterogeneity in causes of fever. All testing strategies are likely to result in higher average costs, but only the scrub typhus and CRP tests are likely to be cost-effective when considering direct health benefits, with median cost per disability adjusted life year averted of approximately $48 USD and $94 USD, respectively.Testing for viral infections is unlikely to be cost-effective when considering only direct health benefits to patients. Testing for prevalent bacterial pathogens can be cost-effective, having the benefit of informing not only whether treatment is required, but also as to the most appropriate antibiotic; this advantage, however, varies widely in response to heterogeneity in causes of fever. Testing for biomarkers of host inflammation is likely to be consistently cost-effective despite high heterogeneity, and can also offer substantial reductions in

  7. Modelling the Impact and Cost-Effectiveness of Biomarker Tests as Compared with Pathogen-Specific Diagnostics in the Management of Undifferentiated Fever in Remote Tropical Settings.

    Science.gov (United States)

    Lubell, Yoel; Althaus, Thomas; Blacksell, Stuart D; Paris, Daniel H; Mayxay, Mayfong; Pan-Ngum, Wirichada; White, Lisa J; Day, Nicholas P J; Newton, Paul N

    2016-01-01

    Malaria accounts for a small fraction of febrile cases in increasingly large areas of the malaria endemic world. Point-of-care tests to improve the management of non-malarial fevers appropriate for primary care are few, consisting of either diagnostic tests for specific pathogens or testing for biomarkers of host response that indicate whether antibiotics might be required. The impact and cost-effectiveness of these approaches are relatively unexplored and methods to do so are not well-developed. We model the ability of dengue and scrub typhus rapid tests to inform antibiotic treatment, as compared with testing for elevated C-Reactive Protein (CRP), a biomarker of host-inflammation. Using data on causes of fever in rural Laos, we estimate the proportion of outpatients that would be correctly classified as requiring an antibiotic and the likely cost-effectiveness of the approaches. Use of either pathogen-specific test slightly increased the proportion of patients correctly classified as requiring antibiotics. CRP testing was consistently superior to the pathogen-specific tests, despite heterogeneity in causes of fever. All testing strategies are likely to result in higher average costs, but only the scrub typhus and CRP tests are likely to be cost-effective when considering direct health benefits, with median cost per disability adjusted life year averted of approximately $48 USD and $94 USD, respectively. Testing for viral infections is unlikely to be cost-effective when considering only direct health benefits to patients. Testing for prevalent bacterial pathogens can be cost-effective, having the benefit of informing not only whether treatment is required, but also as to the most appropriate antibiotic; this advantage, however, varies widely in response to heterogeneity in causes of fever. Testing for biomarkers of host inflammation is likely to be consistently cost-effective despite high heterogeneity, and can also offer substantial reductions in over-use of

  8. The Albufera Initiative for Biodiversity: a cost effective model for integrating science and volunteer participation in coastal protected area management

    NARCIS (Netherlands)

    Riddiford, N.J.; Veraart, J.A.; Férriz, I.; Owens, N.W.; Royo, L.; Honey, M.R.

    2014-01-01

    This paper puts forward a multi-disciplinary field project, set up in 1989 at the Parc Natural de s’Albufera in Mallorca, Balearic Islands, Spain, as an example of a cost effective model for integrating science and volunteer participation in a coastal protected area. Outcomes include the provision

  9. Optimizing best management practices to control anthropogenic sources of atmospheric phosphorus deposition to inland lakes.

    Science.gov (United States)

    Weiss, Lee; Thé, Jesse; Winter, Jennifer; Gharabaghi, Bahram

    2018-04-18

    Excessive phosphorus loading to inland freshwater lakes around the globe has resulted in nuisance plant growth along the waterfronts, degraded habitat for cold water fisheries, and impaired beaches, marinas and waterfront property. The direct atmospheric deposition of phosphorus can be a significant contributing source to inland lakes. The atmospheric deposition monitoring program for Lake Simcoe, Ontario indicates roughly 20% of the annual total phosphorus load (2010-2014 period) is due to direct atmospheric deposition (both wet and dry deposition) on the lake. This novel study presents a first-time application of the Genetic Algorithm (GA) methodology to optimize the application of best management practices (BMPs) related to agriculture and mobile sources to achieve atmospheric phosphorus reduction targets and restore the ecological health of the lake. The novel methodology takes into account the spatial distribution of the emission sources in the airshed, the complex atmospheric long-range transport and deposition processes, cost and efficiency of the popular management practices and social constraints related to the adoption of BMPs. The optimization scenarios suggest that the optimal overall capital investment of approximately $2M, $4M, and $10M annually can achieve roughly 3, 4 and 5 tonnes reduction in atmospheric P load to the lake, respectively. The exponential trend indicates diminishing returns for the investment beyond roughly $3M per year and that focussing much of this investment in the upwind, nearshore area will significantly impact deposition to the lake. The optimization is based on a combination of the lowest-cost, most-beneficial and socially-acceptable management practices that develops a science-informed promotion of implementation/BMP adoption strategy. The geospatial aspect to the optimization (i.e. proximity and location with respect to the lake) will help land managers to encourage the use of these targeted best practices in areas that

  10. Planned versus actual outcomes as a result of animal feeding operation decisions for managing phosphorus.

    Science.gov (United States)

    Cabot, Perry E; Nowak, Pete

    2005-01-01

    The paper explores how decisions made on animal feeding operations (AFOs) influence the management of manure and phosphorus. Variability among these decisions from operation to operation and from field to field can influence the validity of nutrient loss risk assessments. These assessments are based on assumptions that the decision outcomes regarding manure distribution will occur as they are planned. The discrepancy between planned versus actual outcomes in phosphorus management was explored on nine AFOs managing a contiguous set of 210 fields in south-central Wisconsin. A total of 2611 soil samples were collected and multiple interviews conducted to assign phosphorus index (PI) ratings to the fields. Spearman's rank correlation coefficients (r(S)) indicated that PI ratings were less sensitive to soil test phosphorus (STP) levels (r(S) = 0.378), universal soil loss equation (USLE) (r(S) = 0.261), ratings for chemical fertilizer application (r(S) = 0.185), and runoff class (r(S) = -0.089), and more sensitive to ratings for manure application (r(S) = 0.854). One-way ANOVA indicated that mean field STP levels were more homogenous than field PI ratings between AFOs. Kolmogorov-Smirnov (K-S) tests displayed several nonsignificant comparisons for cumulative distribution functions, S(x), of mean STP levels on AFO fields. On the other hand, the K-S tests of S(x) for PI ratings indicated that the majority of these S(x) functions were significantly different between AFOs at or greater than the 0.05 significance level. Interviews suggested multiple reasons for divergence between planned and actual outcomes in managing phosphorus, and that this divergence arises at the strategic, tactical, and operational levels of decision-making.

  11. A managed approach to achieve a safe, cost effective, and environmentally sound demolition of a plutonium-238 contaminated building

    International Nuclear Information System (INIS)

    Jaeger, Ralph R.; Geichman, Jack R.; Keener, Douglas E.; Farmer, Billy M.

    1992-01-01

    DOE's Mound Plant has the problem of demolishing a former plutonium-238 processing facility, the Special Metallurgical (SM) Building. The building is located within 200 feet of a major public road and golf course. Previous removal efforts on appendages to the building used the technique of tenting small segments and used labor intensive segment-by-segment removal with expendable hand tools. This approach was very slow and costly, but offered good environmental control of radioactive contamination. It was realized that this method, when applied to the entire structure of the building, would not only be very costly, but would also be of high risk to worker safety and worker exposure to contamination. The new approach to overcome these problems is to dismantle the building structure using a rotating grapple to hold sections of the building structure while a portable rotating shear cuts the steel beams into appropriate lengths for loading directly into large waste containers. By the former method, the cut jagged steel would be size reduced with hand tools and loaded into waste containers manually. The additional handling has a high probability of producing minor, yet potentially contaminated, skin lacerations. The shear and grapple method eliminates this hazard. To apply this safer and more cost effective technology, Mound had to assure that the method would be environmentally sound and that neither onsite workers or the general public would be exposed to radioactivity. The Annex was decontaminated to as low as reasonably possible and the contaminated interior painted. However, there were numerous areas where contamination could be trapped. Mound conducted a formal sampling of these areas and had the results modeled for potential release during demolition. The results of this sampling and modeling effort showed that the building could be dismantled using this technology without producing a harmful effect on the environment. Application of this managed approach to the

  12. Dairy heifer manure management, dietary phosphorus, and soil test P effects on runoff phosphorus.

    Science.gov (United States)

    Jokela, William E; Coblentz, Wayne K; Hoffman, Patrick C

    2012-01-01

    Manure application to cropland can contribute to runoff losses of P and eutrophication of surface waters. We conducted a series of three rainfall simulation experiments to assess the effects of dairy heifer dietary P, manure application method, application rate, and soil test P on runoff P losses from two successive simulated rainfall events. Bedded manure (18-21% solids) from dairy heifers fed diets with or without supplemental P was applied on a silt loam soil packed into 1- by 0.2-m sheet metal pans. Manure was either surface-applied or incorporated (Experiment 1) or surface-applied at two rates (Experiment 2) to supply 26 to 63 kg P ha. Experiment 3 evaluated runoff P from four similar nonmanured soils with average Bray P1-extractable P levels of 11, 29, 51, and 75 mg kg. We measured runoff quantity, total P (TP), dissolved reactive P (DRP), and total and volatile solids in runoff collected for 30 min after runoff initiation from two simulated rain events (70 mm h) 3 or 4 d apart. Manure incorporation reduced TP and DRP concentrations and load by 85 to 90% compared with surface application. Doubling the manure rate increased runoff DRP and TP concentrations an average of 36%. In the same experiment, P diet supplementation increased water-extractable P in manure by 100% and increased runoff DRP concentration threefold. Concentrations of solids, TP, and DRP in runoff from Rain 2 were 25 to 75% lower than from Rain 1 in Experiments 1 and 2. Runoff DRP from nonmanured soils increased quadratically with increasing soil test P. These results show that large reductions in P runoff losses can be achieved by incorporation of manure, avoiding unnecessary diet P supplementation, limiting manure application rate, and managing soils to prevent excessive soil test P levels. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  13. Transitions to sustainable management of phosphorus in Brazilian agriculture.

    Science.gov (United States)

    Withers, Paul J A; Rodrigues, Marcos; Soltangheisi, Amin; de Carvalho, Teotonio S; Guilherme, Luiz R G; Benites, Vinicius de M; Gatiboni, Luciano C; de Sousa, Djalma M G; Nunes, Rafael de S; Rosolem, Ciro A; Andreote, Fernando D; Oliveira, Adilson de; Coutinho, Edson L M; Pavinato, Paulo S

    2018-02-07

    Brazil's large land base is important for global food security but its high dependency on inorganic phosphorus (P) fertilizer for crop production (2.2 Tg rising up to 4.6 Tg in 2050) is not a sustainable use of a critical and price-volatile resource. A new strategic analysis of current and future P demand/supply concluded that the nation's secondary P resources which are produced annually (e.g. livestock manures, sugarcane processing residues) could potentially provide up to 20% of crop P demand by 2050 with further investment in P recovery technologies. However, the much larger legacy stores of secondary P in the soil (30 Tg in 2016 worth over $40 billion and rising to 105 Tg by 2050) could provide a more important buffer against future P scarcity or sudden P price fluctuations, and enable a transition to more sustainable P input strategies that could reduce current annual P surpluses by 65%. In the longer-term, farming systems in Brazil should be redesigned to operate profitably but more sustainably under lower soil P fertility thresholds.

  14. A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial.

    Science.gov (United States)

    Isetta, Valentina; Negrín, Miguel A; Monasterio, Carmen; Masa, Juan F; Feu, Nuria; Álvarez, Ainhoa; Campos-Rodriguez, Francisco; Ruiz, Concepción; Abad, Jorge; Vázquez-Polo, Francisco J; Farré, Ramon; Galdeano, Marina; Lloberes, Patricia; Embid, Cristina; de la Peña, Mónica; Puertas, Javier; Dalmases, Mireia; Salord, Neus; Corral, Jaime; Jurado, Bernabé; León, Carmen; Egea, Carlos; Muñoz, Aida; Parra, Olga; Cambrodi, Roser; Martel-Escobar, María; Arqué, Meritxell; Montserrat, Josep M

    2015-11-01

    Compliance with continuous positive airway pressure (CPAP) therapy is essential in patients with obstructive sleep apnoea (OSA), but adequate control is not always possible. This is clinically important because CPAP can reverse the morbidity and mortality associated with OSA. Telemedicine, with support provided via a web platform and video conferences, could represent a cost-effective alternative to standard care management. To assess the telemedicine impact on treatment compliance, cost-effectiveness and improvement in quality of life (QoL) when compared with traditional face-to-face follow-up. A randomised controlled trial was performed to compare a telemedicine-based CPAP follow-up strategy with standard face-to-face management. Consecutive OSA patients requiring CPAP treatment, with sufficient internet skills and who agreed to participate, were enrolled. They were followed-up at 1, 3 and 6 months and answered surveys about sleep, CPAP side effects and lifestyle. We compared CPAP compliance, cost-effectiveness and QoL between the beginning and the end of the study. A Bayesian cost-effectiveness analysis with non-informative priors was performed. We randomised 139 patients. At 6 months, we found similar levels of CPAP compliance, and improved daytime sleepiness, QoL, side effects and degree of satisfaction in both groups. Despite requiring more visits, the telemedicine group was more cost-effective: costs were lower and differences in effectiveness were not relevant. A telemedicine-based strategy for the follow-up of CPAP treatment in patients with OSA was as effective as standard hospital-based care in terms of CPAP compliance and symptom improvement, with comparable side effects and satisfaction rates. The telemedicine-based strategy had lower total costs due to savings on transport and less lost productivity (indirect costs). NCT01716676. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go

  15. Cost-effectiveness of manual therapy for the management of musculoskeletal conditions: a systematic review and narrative synthesis of evidence from randomized controlled trials.

    Science.gov (United States)

    Tsertsvadze, Alexander; Clar, Christine; Court, Rachel; Clarke, Aileen; Mistry, Hema; Sutcliffe, Paul

    2014-01-01

    The purpose of this study was to systematically review trial-based economic evaluations of manual therapy relative to other alternative interventions used for the management of musculoskeletal conditions. A comprehensive literature search was undertaken in major medical, health-related, science and health economic electronic databases. Twenty-five publications were included (11 trial-based economic evaluations). The studies compared cost-effectiveness and/or cost-utility of manual therapy interventions to other treatment alternatives in reducing pain (spinal, shoulder, ankle). Manual therapy techniques (e.g., osteopathic spinal manipulation, physiotherapy manipulation and mobilization techniques, and chiropractic manipulation with or without other treatments) were more cost-effective than usual general practitioner (GP) care alone or with exercise, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. Chiropractic manipulation was found to be less costly and more effective than alternative treatment compared with either physiotherapy or GP care in improving neck pain. Preliminary evidence from this review shows some economic advantage of manual therapy relative to other interventions used for the management of musculoskeletal conditions, indicating that some manual therapy techniques may be more cost-effective than usual GP care, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. However, at present, there is a paucity of evidence on the cost-effectiveness and/or cost-utility evaluations for manual therapy interventions. Further improvements in the methodological conduct and reporting quality of economic evaluations of manual therapy are warranted in order to facilitate adequate evidence-based decisions among policy makers, health care practitioners, and patients. Copyright © 2014 National University

  16. Real-Life Treatment Paradigms Show Adalimumab Is Cost-Effective for the Management of Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Candace L. Beilman

    2016-01-01

    Full Text Available Background. Adalimumab is effective for the maintenance of remission in patients with moderate-to-severe ulcerative colitis (UC. Currently, biologic therapies are used in cases where patients fail conventional medical therapies. If biologic therapies are not available, patients often choose to remain in an unwell state rather than undergo colectomy. Objective. The aim of the study was to evaluate the cost-effectiveness of adalimumab in patients with UC where adalimumab was readily available compared to not available. Methods. A previously validated Markov model was used to simulate disease progression of patients with UC who are corticosteroid-dependent and/or did not respond to thiopurine therapy. Utility scores and transition probabilities between health states were determined by using data from randomized controlled trials and real-life observational studies. Costs were obtained from the Ontario Case Costing Initiative and the Alberta Health Schedule of Medical Benefits. Results. The incremental cost-effectiveness ratios for readily available adalimumab treatment of UC were $40,000 and $59,000 per quality-adjusted life year, compared with ongoing medical therapy in an unwell state, at 5-year and 10-year treatment time horizons, respectively. Conclusion. Considering real-life patient preferences to avoid colectomy, adalimumab is cost-effective according to a willingness-to-pay threshold of $80,000 for treatment of UC.

  17. Cost effectiveness and value of information analyses of islet cell transplantation in the management of 'unstable' type 1 diabetes mellitus.

    Science.gov (United States)

    Wallner, Klemens; Shapiro, A M James; Senior, Peter A; McCabe, Christopher

    2016-04-09

    Islet cell transplantation is a method to stabilize type 1 diabetes patients with hypoglycemia unawareness and unstable blood glucose levels by reducing insulin dependency and protecting against severe hypoglycemia through restoring endogenous insulin secretion. This study analyses the current cost-effectiveness of this technology and estimates the value of further research to reduce uncertainty around cost-effectiveness. We performed a cost-utility analysis using a Markov cohort model with a mean patient age of 49 to simulate costs and health outcomes over a life-time horizon. Our analysis used intensive insulin therapy (IIT) as comparator and took the provincial healthcare provider perspective. Cost and effectiveness data for up to four transplantations per patient came from the University of Alberta hospital. Costs are expressed in 2012 Canadian dollars and effectiveness in quality-adjusted life-years (QALYs) and life years. To characterize the uncertainty around expected outcomes, we carried out a probabilistic sensitivity analysis within the Bayesian decision-analytic framework. We performed a value-of-information analysis to identify priority areas for future research under various scenarios. We applied a structural sensitivity analysis to assess the dependence of outcomes on model characteristics. Compared to IIT, islet cell transplantation using non-generic (generic) immunosuppression had additional costs of $150,006 ($112,023) per additional QALY, an average gain of 3.3 life years, and a probability of being cost-effective of 0.5 % (28.3 %) at a willingness-to-pay threshold of $100,000 per QALY. At this threshold the non-generic technology has an expected value of perfect information (EVPI) of $260,744 for Alberta. This increases substantially in cost-reduction scenarios. The research areas with the highest partial EVPI are costs, followed by natural history, and effectiveness and safety. Current transplantation technology provides substantial

  18. Irrigation management and phosphorus addition alter the abundance of carbon dioxide-fixing autotrophs in phosphorus-limited paddy soil.

    Science.gov (United States)

    Wu, Xiaohong; Ge, Tida; Yan, Wende; Zhou, Juan; Wei, Xiaomeng; Chen, Liang; Chen, Xiangbi; Nannipieri, Paolo; Wu, Jinshui

    2017-12-01

    In this study, we assessed the interactive effects of phosphorus (P) application and irrigation methods on the abundances of marker genes (cbbL, cbbM, accA and aclB) of CO2-fixing autotrophs. We conducted rice-microcosm experiments using a P-limited paddy soil, with and without the addition of P fertiliser (P-treated-pot (P) versus control pot (CK)), and using two irrigation methods, namely alternate wetting and drying (AWD) and continuous flooding (CF). The abundances of bacterial 16S rRNA, archaeal 16S rRNA, cbbL, cbbM, accA and aclB genes in the rhizosphere soil (RS) and bulk soil (BS) were quantified. The application of P significantly altered the soil properties and stimulated the abundances of Bacteria, Archaea and CO2-fixation genes under CF treatment, but negatively influenced the abundances of Bacteria and marker genes of CO2-fixing autotrophs in BS soils under AWD treatment. The response of CO2-fixing autotrophs to P fertiliser depended on the irrigation management method. The redundancy analysis revealed that 54% of the variation in the functional marker gene abundances could be explained by the irrigation method, P fertiliser and the Olsen-P content; however, the rhizosphere effect did not have any significant influence. P fertiliser application under CF was more beneficial in improving the abundance of CO2-fixing autotrophs compared to the AWD treatment; thus, it is an ideal irrigation management method to increase soil carbon fixation. © FEMS 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Systematic review of model-based analyses reporting the cost-effectiveness and cost-utility of cardiovascular disease management programs.

    Science.gov (United States)

    Maru, Shoko; Byrnes, Joshua; Whitty, Jennifer A; Carrington, Melinda J; Stewart, Simon; Scuffham, Paul A

    2015-02-01

    The reported cost effectiveness of cardiovascular disease management programs (CVD-MPs) is highly variable, potentially leading to different funding decisions. This systematic review evaluates published modeled analyses to compare study methods and quality. Articles were included if an incremental cost-effectiveness ratio (ICER) or cost-utility ratio (ICUR) was reported, it is a multi-component intervention designed to manage or prevent a cardiovascular disease condition, and it addressed all domains specified in the American Heart Association Taxonomy for Disease Management. Nine articles (reporting 10 clinical outcomes) were included. Eight cost-utility and two cost-effectiveness analyses targeted hypertension (n=4), coronary heart disease (n=2), coronary heart disease plus stoke (n=1), heart failure (n=2) and hyperlipidemia (n=1). Study perspectives included the healthcare system (n=5), societal and fund holders (n=1), a third party payer (n=3), or was not explicitly stated (n=1). All analyses were modeled based on interventions of one to two years' duration. Time horizon ranged from two years (n=1), 10 years (n=1) and lifetime (n=8). Model structures included Markov model (n=8), 'decision analytic models' (n=1), or was not explicitly stated (n=1). Considerable variation was observed in clinical and economic assumptions and reporting practices. Of all ICERs/ICURs reported, including those of subgroups (n=16), four were above a US$50,000 acceptability threshold, six were below and six were dominant. The majority of CVD-MPs was reported to have favorable economic outcomes, but 25% were at unacceptably high cost for the outcomes. Use of standardized reporting tools should increase transparency and inform what drives the cost-effectiveness of CVD-MPs. © The European Society of Cardiology 2014.

  20. Cost-Effectiveness Analysis of Five Competing Strategies for the Management of Multiple Recurrent Community-Onset Clostridium difficile Infection in France.

    Science.gov (United States)

    Baro, Emilie; Galperine, Tatiana; Denies, Fanette; Lannoy, Damien; Lenne, Xavier; Odou, Pascal; Guery, Benoit; Dervaux, Benoit

    2017-01-01

    Clostridium difficile infection (CDI) is characterized by high rates of recurrence, resulting in substantial health care costs. The aim of this study was to analyze the cost-effectiveness of treatments for the management of second recurrence of community-onset CDI in France. We developed a decision-analytic simulation model to compare 5 treatments for the management of second recurrence of community-onset CDI: pulsed-tapered vancomycin, fidaxomicin, fecal microbiota transplantation (FMT) via colonoscopy, FMT via duodenal infusion, and FMT via enema. The model outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY) among the 5 treatments. ICERs were interpreted using a willingness-to-pay threshold of €32,000/QALY. Uncertainty was evaluated through deterministic and probabilistic sensitivity analyses. Three strategies were on the efficiency frontier: pulsed-tapered vancomycin, FMT via enema, and FMT via colonoscopy, in order of increasing effectiveness. FMT via duodenal infusion and fidaxomicin were dominated (i.e. less effective and costlier) by FMT via colonoscopy and FMT via enema. FMT via enema compared with pulsed-tapered vancomycin had an ICER of €18,092/QALY. The ICER for FMT via colonoscopy versus FMT via enema was €73,653/QALY. Probabilistic sensitivity analysis with 10,000 Monte Carlo simulations showed that FMT via enema was the most cost-effective strategy in 58% of simulations and FMT via colonoscopy was favored in 19% at a willingness-to-pay threshold of €32,000/QALY. FMT via enema is the most cost-effective initial strategy for the management of second recurrence of community-onset CDI at a willingness-to-pay threshold of €32,000/QALY.

  1. Management of radioactive waste gases from PET radiopharmaceutical synthesis using cost effective capture systems integrated with a cyclotron safety system.

    Science.gov (United States)

    Stimson, D H R; Pringle, A J; Maillet, D; King, A R; Nevin, S T; Venkatachalam, T K; Reutens, D C; Bhalla, R

    2016-09-01

    The emphasis on the reduction of gaseous radioactive effluent associated with PET radiochemistry laboratories has increased. Various radioactive gas capture strategies have been employed historically including expensive automated compression systems. We have implemented a new cost-effective strategy employing gas capture bags with electronic feedback that are integrated with the cyclotron safety system. Our strategy is suitable for multiple automated 18 F radiosynthesis modules and individual automated 11 C radiosynthesis modules. We describe novel gas capture systems that minimize the risk of human error and are routinely used in our facility.

  2. Analysis of the efficacy and cost-effectiveness of best management practices for controlling sediment yield: A case study of the Joumine watershed, Tunisia.

    Science.gov (United States)

    Mtibaa, Slim; Hotta, Norifumi; Irie, Mitsuteru

    2018-03-01

    Soil erosion can be reduced through the strategic selection and placement of best management practices (BMPs) in critical source areas (CSAs). In the present study, the Soil Water Assessment Tool (SWAT) model was used to identify CSAs and investigate the effectiveness of different BMPs in reducing sediment yield in the Joumine watershed, an agricultural river catchment located in northern Tunisia. A cost-benefit analysis (CBA) was used to evaluate the cost-effectiveness of different BMP scenarios. The objective of the present study was to determine the most cost-effective management scenario for controlling sediment yield. The model performance for the simulation of streamflow and sediment yield at the outlet of the Joumine watershed was good and satisfactory, respectively. The model indicated that most of the sediment was originated from the cultivated upland area. About 34% of the catchment area consisted of CSAs that were affected by high to very high soil erosion risk (sediment yield >10t/ha/year). Contour ridges were found to be the most effective individual BMP in terms of sediment yield reduction. At the watershed level, implementing contour ridges in the CSAs reduced sediment yield by 59%. Combinations of BMP scenarios were more cost-effective than the contour ridges alone. Combining buffer strips (5-m width) with other BMPs depending on land slope (> 20% slope: conversion to olive orchards; 10-20% slope: contour ridges; 5-10% slope: grass strip cropping) was the most effective approach in terms of sediment yield reduction and economic benefits. This approach reduced sediment yield by 61.84% with a benefit/cost ratio of 1.61. Compared with the cost of dredging, BMPs were more cost-effective for reducing sediment loads to the Joumine reservoir, located downstream of the catchment. Our findings may contribute to ensure the sustainability of future conservation programs in Tunisian regions. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Cost-effectiveness analysis of telephone-based support for the management of pressure ulcers in people with spinal cord injury in India and Bangladesh.

    Science.gov (United States)

    Arora, M; Harvey, L A; Glinsky, J V; Chhabra, H S; Hossain, M S; Arumugam, N; Bedi, P K; Cameron, I D; Hayes, A J

    2017-08-15

    To determine from a societal perspective the cost-effectiveness and cost-utility of telephone-based support for management of pressure ulcers. Cost-effectiveness and cost-utility analysis of a randomised clinical trial. Tertiary centre in India and Bangladesh. An economic evaluation was conducted alongside a randomised clinical trial comparing 12 weeks of telephone-based support (intervention group) with usual care (control group). The analyses evaluated costs and health outcomes in terms of cm 2 reduction of pressure ulcers size and quality-adjusted life years (QALYs) gained. All costs were in Indian Rupees (INR) and then converted to US dollars (USD). The mean (95% confidence interval) between-group difference for the reduction in size of pressure ulcers was 0.53 (-3.12 to 4.32) cm 2 , favouring the intervention group. The corresponding QALYs were 0.027 (0.004-0.051), favouring the intervention group. The mean total cost per participant in the intervention group was INR 43 781 (USD 2460) compared to INR 42 561 (USD 2391) for the control group. The per participant cost of delivering the intervention was INR 2110 (USD 119). The incremental cost-effectiveness ratio was INR 2306 (USD 130) per additional cm 2 reduction in the size of the pressure ulcer and INR 44 915 (USD 2523) per QALY gained. In terms of QALYs, telephone-based support to help people manage pressure ulcers at home provides good value for money and has an 87% probability of being cost-effective, based on 3 times gross domestic product. Sensitivity analyses were performed using the overall cost data with and without productivity costs, and did not alter this conclusion.Spinal Cord advance online publication, 15 August 2017; doi:10.1038/sc.2017.87.

  4. Evaluation of the cost effectiveness of vesico-amniotic shunting in the management of congenital lower urinary tract obstruction (based on data from the PLUTO Trial.

    Directory of Open Access Journals (Sweden)

    Lavanya Diwakar

    Full Text Available OBJECTIVE: To determine the cost-effectiveness of in-utero percutaneous Vesico Amniotic Shunt (VAS in the management of fetal lower urinary tract obstruction (LUTO. DESIGN: Model based economic analysis using data from the randomised controlled arm of the PLUTO (percutaneous vesico-amniotic shunting for lower urinary tract obstruction trial. SETTING: Fetal medicine departments in United Kingdom, Ireland and Netherlands. POPULATION OR SAMPLE: Pregnant women with a male, singleton fetus with LUTO. METHODS: Costs and outcomes were prospectively collected in the trial; three separate base case analyses were performed using the intention to treat (ITT, per protocol and uniform prior methods. Deterministic and probabilistic sensitivity analyses were performed to explore data uncertainty. MAIN OUTCOME MEASURES: Survival at 28 days, 1 year and disease free survival at 1 year. RESULTS: VAS was more expensive but appeared to result in higher rates of survival compared with conservative management in patients with LUTO. Using ITT analysis the incremental cost effectiveness ratios based on outcomes of survival at 28 days, 1 year, or 1 morbidity-free year on the VAS arm were £ 15,506, £ 15,545, and £ 43,932, respectively. CONCLUSIONS: VAS is a more expensive option compared to the conservative approach in the management of individuals with LUTO. Data from the RCT suggest that VAS improves neonatal survival but does not result in significant improvements in morbidity. Our analysis concludes that VAS is not likely to be cost effective in the management of these patients given the NICE (National Institute of Health and Clinical Excellence cost threshold of £ 20,000 per QALY.

  5. Clearing invasive alien plants as a cost-effective strategy for water catchment management: The case of the Olifants river catchment, South Africa

    Directory of Open Access Journals (Sweden)

    Tshepo Morokong

    2016-12-01

    Full Text Available Invasive alien plants have a negative impact on ecosystem goods and services derived from ecosystems. Consequently, the aggressive spread of invasive alien plants (IAPs in the river catchments of South Africa is a major threat to, inter alia, water security. The Olifants River catchment is one such a catchment that is under pressure because of the high demand for water from mainly industrial sources and unsustainable land-use, which includes IAPs. This study considered the cost-effectiveness of clearing IAPs and compared these with the cost of a recently constructed dam. The methods used for data collection were semistructured interviews, site observation, desktop data analysis, and a literature review to assess the impact of IAPs on the catchment’s water supply. The outcomes of this study indicate that clearing invasive alien plants is a cost-effective intervention with a Unit Reference Value (URV of R1.44/m3, which compares very favourably with that of the De Hoop dam, the URV for which is R2.93/m3. These results suggest that clearing invasive alien plants is a cost-effective way of catchment management, as the opportunity cost of not doing so (forfeiting water to the value of R2.93/m3 is higher than that of protecting the investment in the dam.

  6. Cost effectiveness of paricalcitol versus cinacalcet with low-dose vitamin D for management of secondary hyperparathyroidism in haemodialysis patients in the USA.

    Science.gov (United States)

    Sharma, Amit; Marshall, Thomas S; Khan, Samina S; Johns, Beverly

    2014-02-01

    The IMPACT SHPT [Improved Management of Intact Parathyroid Hormone (iPTH) with Paricalcitol-Centered Therapy Versus Cinacalcet Therapy with Low-Dose Vitamin D in Hemodialysis Patients with Secondary Hyperparathyroidism] study compared the effectiveness of paricalcitol and cinacalcet in the management of secondary hyperparathyroidism in haemodialysis patients but did not report the costs or cost effectiveness of these treatments. The aim of this study was to compare the cost effectiveness of a paricalcitol-based regimen versus cinacalcet with low-dose vitamin D for management of secondary hyperparathyroidism in haemodialysis patients from a US payer perspective, using a 1-year time horizon. This was a post hoc cost-effectiveness analysis of data collected for US patients enrolled in the IMPACT SHPT study-a 28-week, randomized, open-label, phase 4, multinational study (ClinicalTrials.gov identifier: NCT00977080). Patients eligible for the IMPACT SHPT study were aged≥18 years with stage 5 chronic kidney disease, had been receiving maintenance haemodialysis three times weekly for at least 3 months before screening and were to continue haemodialysis during the study. Only US patients who reached the evaluation period (weeks 21-28) were included in this secondary analysis. US subjects in the IMPACT SHPT study were randomly assigned to receive intravenous paricalcitol, or oral cinacalcet plus fixed-dose intravenous doxercalciferol, for 28 weeks. Patients in the paricalcitol group could also receive supplemental cinacalcet for hypercalcaemia. The primary effectiveness endpoint in the IMPACT SHPT study was the proportion of subjects who achieved a mean intact parathyroid hormone (iPTH) level of 150-300 pg/mL during the evaluation period. In this secondary analysis, we estimated the incremental cost-effectiveness ratio (ICER), comparing paricalcitol-treated patients with cinacalcet-treated patients on the basis of this primary endpoint and several secondary endpoints

  7. Ward-based, nurse-led, outpatient chest tube management: analysis of impact, cost-effectiveness and patient safety.

    Science.gov (United States)

    Tcherveniakov, Peter; De Siqueira, Jonathan; Milton, Richard; Papagiannopoulos, Kostas

    2012-06-01

    Prolonged drainage and air leaks are recognized complications of elective and acute thoracic surgery and carry significant burden on inpatient stay and outpatient resources. Since 2007, we have run a ward-based, nurse-led clinic for patients discharged with a chest drain in situ. The aim of this study is to assess its cost-effectiveness and safety. We present a retrospective review of the activity of the clinic for a period of 12 months (November 2009-10). An analysis of the gathered data is performed, focusing specifically on the duration of chest tube indwelling, the indications, complications and cost efficiency. The nurse-led clinic was housed in the thoracic ward with no additional fixed costs. Seventy-four patients were reviewed (53 males, 21 females, mean age of 59) and subsequently discharged from the clinic in this time period, accounting for 149 care episodes. Thirty-three (45%) of the patients underwent a video-assisted thoracoscopic surgery procedure, 35 (47%) of them a thoracotomy and 7 (9%) had a bedside chest tube insertion. Following hospital discharge, the chest tubes were removed after a median of 14 days (range 1-82 days). Fifty-eight percent of the patients were reviewed because of a prolonged air leak, 26% for persistent fluid drainage and 16% due to prolonged drainage following evacuation of empyemas. For the care episodes analysed, we estimate that the clinic has generated an income of €24,899 for the department. Hourly staffing costs for the service are significantly lower compared with those of the traditional outpatient clinic: €15 vs. €114. Our results show that a dedicated chest tube monitoring clinic is a safe and efficient alternative to formal outpatient clinic review. It can lead to shorter hospital stays and is cost effective.

  8. Cost effectiveness of transcatheter aortic valve replacement compared to medical management in inoperable patients with severe aortic stenosis: Canadian analysis based on the PARTNER Trial Cohort B findings.

    Science.gov (United States)

    Hancock-Howard, Rebecca L; Feindel, Christopher M; Rodes-Cabau, Josep; Webb, John G; Thompson, Ann K; Banz, Kurt

    2013-01-01

    The only effective treatment for severe aortic stenosis (AS) is valve replacement. However, many patients with co-existing conditions are ineligible for surgical valve replacement, historically leaving medical management (MM) as the only option which has a poor prognosis. Transcatheter Aortic Valve Replacement (TAVR) is a less invasive replacement method. The objective was to estimate cost-effectiveness of TAVR via transfemoral access vs MM in surgically inoperable patients with severe AS from the Canadian public healthcare system perspective. A cost-effectiveness analysis of TAVR vs MM was conducted using a deterministic decision analytic model over a 3-year time horizon. The PARTNER randomized controlled trial results were used to estimate survival, utilities, and some resource utilization. Costs included the valve replacement procedure, complications, hospitalization, outpatient visits/tests, and home/nursing care. Resources were valued (2009 Canadian dollars) using costs from the Ontario Case Costing Initiative (OCCI), Ontario Ministry of Health and Long-Term Care and Ontario Drug Benefits Formulary, or were estimated using relative costs from a French economic evaluation or clinical experts. Costs and outcomes were discounted 5% annually. The effect of uncertainty in model parameters was explored in deterministic and probabilistic sensitivity analysis. The incremental cost-effectiveness ratio (ICER) was $32,170 per quality-adjusted life year (QALY) gained for TAVR vs MM. When the time horizon was shortened to 24 and 12 months, the ICER increased to $52,848 and $157,429, respectively. All other sensitivity analysis returned an ICER of less than $50,000/QALY gained. A limitation was lack of availability of Canadian-specific resource and cost data for all resources, leaving one to rely on clinical experts and data from France to inform certain parameters. Based on the results of this analysis, it can be concluded that TAVR is cost-effective compared to MM for the

  9. [Implementation and (cost-)effectiveness of case management for people with dementia and their informal caregivers: results of the COMPAS study].

    Science.gov (United States)

    van Mierlo, Lisa D; MacNeil-Vroomen, Janet; Meiland, Franka J M; Joling, Karlijn J; Bosmans, Judith E; Dröes, Rose Marie; Moll van Charante, Eric P; de Rooij, Sophia E J A; van Hout, Hein P J

    2016-12-01

    Different forms of case management for dementia have emerged over the past few years. In the COMPAS study (Collaborative dementia care for patients and caregivers study), two prominent Dutch case management forms were studied: the linkage and the integrated care form. Evaluation of the (cost)effectiveness of two dementia case management forms compared to usual care as well as factors that facilitated or impeded their implementation. A mixed methods design with a) a prospective, observational controlled cohort study with 2 years follow-up among 521 dyads of people with dementia and their primary informal caregiver with and without case management; b) interviews with 22 stakeholders on facilitating and impeding factors of the implementation and continuity of the two case management models. Outcome measures were severity and frequency of behavioural problems (NPI) for the person with dementia and mental health complaints (GHQ-12) for the informal caregiver, total met and unmet care needs (CANE) and quality adjusted life years (QALYs). Outcomes showed a better quality of life of informal caregivers in the integrated model compared to the linkage model. Caregivers in the control group reported more care needs than those in both case management groups. The independence of the case management provider in the integrated model facilitated the implementation, while the rivalry between multiple providers in the linkage model impeded the implementation. The costs of care were lower in the linkage model (minus 22 %) and integrated care model (minus 33 %) compared to the control group. The integrated care form was (very) cost-effective in comparison with the linkage form or no case management. The integrated care form is easy to implement.

  10. A review of the availability and cost effectiveness of chronic obstructive pulmonary disease (COPD) management interventions in rural Australia and New Zealand.

    Science.gov (United States)

    Brooke, Michelle E; Spiliopoulos, Nicolaos; Collins, Margaret

    2017-01-01

    Chronic obstructive pulmonary disease (COPD) is a chronic, progressive disease, which consumes a significant proportion of the Australian and New Zealand healthcare budget. Studies have shown that people living with COPD outside of urban areas have higher rates of hospitalisations. Two international reviews have demonstrated reduced hospital admissions and length of stay in people with COPD who participate in an integrated disease management program. However, most studies included in these reviews are in urban settings. The purpose of this review is to explore the type and cost-effectiveness of COPD management interventions located in rural or remote settings of Australia and New Zealand in order to inform planning and ongoing service development in the authors' local health district. Six databases and Google scholar were searched to find literature relating to the availability and cost-effectiveness of non-pharmaceutical interventions for the management of COPD in rural and remote areas of Australia and New Zealand. Two studies were found that met the inclusion criteria. Both studies had small sample sizes, were single intervention studies and showed a positive influence on variables such as number of hospital admissions and length of stay at 12 months post-intervention. However, because of the limited number of studies and the lack of homogeneity of interventions, no conclusions regarding availability and cost-effectiveness of COPD interventions in rural and remote areas of Australia and New Zealand could be drawn. Limited literature exists to inform planning and development of services for people with COPD living in rural and remote areas of Australia and New Zealand. Approximately 50% of pulmonary rehabilitation programs are situated in rural and remote locations in Australia and New Zealand. Outcomes from existing programs need to be reported in a consistent and coordinated manner to allow evaluation of health resource utilisation.

  11. Cost-effectiveness and Budget Impact of Routine Use of Fractional Exhaled Nitric Oxide Monitoring for the Management of Adult Asthma Patients in Spain.

    Science.gov (United States)

    Sabatelli, L; Seppälä, U; Sastre, J; Crater, G

    Fractional exhaled nitric oxide (FeNO) is a marker for type 2 airway inflammation. The objective of this study was to evaluate the cost-effectiveness and budget impact of FeNO monitoring for management of adult asthma in Spain. A cost-effectiveness analysis model was used to evaluate the effect on costs of adding FeNO monitoring to asthma management. Over a 1-year period, the model estimated the incremental cost per quality-adjusted life year and incremental number of exacerbations avoided when FeNO monitoring was added to standard guideline-driven asthma care compared with standard care alone. Univariate and multivariate sensitivity analyses were applied to explore uncertainty in the model. A budget impact model was used to examine the impact of FeNO monitoring on primary care costs across the Spanish health system. The results showed that adding FeNO to standard asthma care saved €62.53 per patient-year in the adult population and improved quality-adjusted life years by 0.026 per patient-year. The budget impact analysis revealed a potential net yearly saving of €129 million if FeNO monitoring had been used in primary care settings in Spain. The present economic model shows that adding FeNO to the treatment algorithm can considerably reduce costs and improve quality of life when used to manage asthma in combination with current treatment guidelines.

  12. Cost-effectiveness of providing patients with information on managing mild low-back symptoms in an occupational health setting

    Directory of Open Access Journals (Sweden)

    J. Rantonen

    2016-04-01

    Full Text Available Abstract Background Evidence shows that low back specific patient information is effective in sub-acute low back pain (LBP, but effectiveness and cost-effectiveness (CE of information in early phase symptoms is not clear. We assessed effectiveness and CE of patient information in mild LBP in the occupational health (OH setting in a quasi-experimental study. Methods A cohort of employees (N = 312, aged <57 with non-specific, mild LBP (Visual Analogue Scale between 10–34 mm was selected from the respondents of an employee survey (N = 2480; response rate 71 %. A random sample, representing the natural course of LBP (NC, N = 83; no intervention, was extracted as a control group. Remaining employees were invited (181 included, 47 declined, one excluded into a randomised controlled study with two 1:1 allocated parallel intervention arms (“Booklet”, N = 92; “Combined”, N = 89. All participants received the “Back Book” patient information booklet and the Combined also an individual verbal review of the booklet. Physical impairment (PHI, LBP, health care (HC utilisation, and all-cause sickness absence (SA were assessed at two years. CE of the interventions on SA days was analysed by using direct HC costs in one year, two years from baseline. Multiple imputation was used for missing values. Results Compared to NC, the Booklet reduced HC costs by 196€ and SA by 3.5 days per year. In 81 % of the bootstrapped cases the Booklet was both cost saving and effective on SA. Compared to NC, in the Combined arm, the figures were 107€, 0.4 days, and 54 %, respectively. PHI decreased in both interventions. Conclusions Booklet information alone was cost-effective in comparison to natural course of mild LBP. Combined information reduced HC costs. Both interventions reduced physical impairment. Mere booklet information is beneficial for employees who report mild LBP in the OH setting, and is also cost saving for the health care

  13. Cost-effectiveness of sibutramine in the LOSE Weight Study: evaluating the role of pharmacologic weight-loss therapy within a weight management program.

    Science.gov (United States)

    Malone, Daniel C; Raebel, Marsha A; Porter, Julie A; Lanty, Frances A; Conner, Douglas A; Gay, Elizabeth C; Merenich, John A; Vogel, Erin A

    2005-01-01

    the cost-effectiveness of drug therapy when used in conjunction with a weight management program (WMP) for treatment of obesity. The objective was to compare the cost-effectiveness of sibutramine (Meridia) plus a structured WMP versus only a structured WMP in both overweight and obese individuals. The core WMP was a physician-supervised, multidisciplinary program for which each enrollee paid $100 out of pocket. A cost-effectiveness analysis was performed based upon the results of a previously published randomized controlled trial conducted within a managed care organization. The target population for this study was obese or overweight persons. The perspective of the study was that of a managed care organization. The intervention consisted of subjects receiving a WMP with or without sibutramine. The primary outcomes of this study were (a) absolute change in body weight and percentage change in body weight over 12 months, (b) change in obesity-related and total medical costs from 12 months prior to enrollment through 12 months after enrollment, and (c) cost-effectiveness in terms of cost per pound of weight loss. All costs were adjusted to 2004 dollars using the respective components of the consumer price index for each medical service or medication. A total of 501 evaluable subjects were enrolled in the study, with 281 receiving sibutramine plus a structured WMP and 220 receiving only the structured WMP. The meanSD weight loss was significantly greater in the sibutramine (13.715.5 pounds, 4.8%) group than in the nondrug group (513.2 pounds, 2.2%) (P cost was a median increase of $408 for the sibutramine group compared with $31 for the nondrug group (P cost was a median $1,279 increase in the sibutramine group compared with $271 for the nondrug group (P cost by $44 per additional pound of weight loss (95% confidence interval, 42-46). Sensitivity analyses found that the results were sensitive to the price of sibutramine, whereas varying the cost of clinic visits did

  14. Negative pressure wound therapy literature review of efficacy, cost effectiveness, and impact on patients' quality of life in chronic wound management and its implementation in the United kingdom.

    Science.gov (United States)

    Othman, Diaa

    2012-01-01

    This is a paper reviewing the National Health Service (NHS) agenda in relation to the use of Negative Pressure Wound Therapy (NPWT) in chronic wound management and assesses the evidence behind it, its cost effectiveness and the outcome it has on patients' satisfaction and life style. Multiple studies over the last 10 years looking at clinical efficacy of NPWT with its cost effectiveness and the implementation of this service in the UK were reviewed. NPWT has showed a reasonable body of evidence to support its usage in chronic wounds with potential positive outcomes on finance and patients' satisfaction. However, the NHS system shows significant variations in the availability and implementation of this useful tool, depending on care providers and resources availabilities. The paper concluded that the NPWT can be a useful source of cutting down costs of chronic wound managements and saving money by its effect on expediting wound healing, which can address a part of the financial crises facing the NHS, however, has to be considered according to specific case needs. There should also be a national standard for the availability and indication of this tool to assure equal opportunities for different patients in different areas in the country.

  15. Negative Pressure Wound Therapy Literature Review of Efficacy, Cost Effectiveness, and Impact on Patients' Quality of Life in Chronic Wound Management and Its Implementation in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Diaa Othman

    2012-01-01

    Full Text Available This is a paper reviewing the National Health Service (NHS agenda in relation to the use of Negative Pressure Wound Therapy (NPWT in chronic wound management and assesses the evidence behind it, its cost effectiveness and the outcome it has on patients’ satisfaction and life style. Multiple studies over the last 10 years looking at clinical efficacy of NPWT with its cost effectiveness and the implementation of this service in the UK were reviewed. NPWT has showed a reasonable body of evidence to support its usage in chronic wounds with potential positive outcomes on finance and patients’ satisfaction. However, the NHS system shows significant variations in the availability and implementation of this useful tool, depending on care providers and resources availabilities. The paper concluded that the NPWT can be a useful source of cutting down costs of chronic wound managements and saving money by its effect on expediting wound healing, which can address a part of the financial crises facing the NHS, however, has to be considered according to specific case needs. There should also be a national standard for the availability and indication of this tool to assure equal opportunities for different patients in different areas in the country.

  16. Cost-Effectiveness Evaluation of a Novel Integrated Bite Case Management Program for the Control of Human Rabies, Haiti 2014-2015.

    Science.gov (United States)

    Undurraga, Eduardo A; Meltzer, Martin I; Tran, Cuc H; Atkins, Charisma Y; Etheart, Melissa D; Millien, Max F; Adrien, Paul; Wallace, Ryan M

    2017-06-01

    AbstractHaiti has the highest burden of rabies in the Western hemisphere, with 130 estimated annual deaths. We present the cost-effectiveness evaluation of an integrated bite case management program combining community bite investigations and passive animal rabies surveillance, using a governmental perspective. The Haiti Animal Rabies Surveillance Program (HARSP) was first implemented in three communes of the West Department, Haiti. Our evaluation encompassed all individuals exposed to rabies in the study area ( N = 2,289) in 2014-2015. Costs (2014 U.S. dollars) included diagnostic laboratory development, training of surveillance officers, operational costs, and postexposure prophylaxis (PEP). We used estimated deaths averted and years of life gained (YLG) from prevented rabies as health outcomes. HARSP had higher overall costs (range: $39,568-$80,290) than the no-bite-case-management (NBCM) scenario ($15,988-$26,976), partly from an increased number of bite victims receiving PEP. But HARSP had better health outcomes than NBCM, with estimated 11 additional annual averted deaths in 2014 and nine in 2015, and 654 additional YLG in 2014 and 535 in 2015. Overall, HARSP was more cost-effective (US$ per death averted) than NBCM (2014, HARSP: $2,891-$4,735, NBCM: $5,980-$8,453; 2015, HARSP: $3,534-$7,171, NBCM: $7,298-$12,284). HARSP offers an effective human rabies prevention solution for countries transitioning from reactive to preventive strategies, such as comprehensive dog vaccination.

  17. Cost-effectiveness of preventive case management for parents with a mental illness: a randomized controlled trial from three economic perspectives.

    Science.gov (United States)

    Wansink, Henny J; Drost, Ruben M W A; Paulus, Aggie T G; Ruwaard, Dirk; Hosman, Clemens M H; Janssens, Jan M A M; Evers, Silvia M A A

    2016-07-07

    The children of parents with a mental illness (COPMI) are at increased risk for developing costly psychiatric disorders because of multiple risk factors which threaten parenting quality and thereby child development. Preventive basic care management (PBCM) is an intervention aimed at reducing risk factors and addressing the needs of COPMI-families in different domains. The intervention may lead to financial consequences in the healthcare sector and in other sectors, also known as inter-sectoral costs and benefits (ICBs). The objective of this study was to assess the cost-effectiveness of PBCM from three perspectives: a narrow healthcare perspective, a social care perspective (including childcare costs) and a broad societal perspective (including all ICBs). Effects on parenting quality (as measured by the HOME) and costs during an 18-month period were studied in in a randomized controlled trial. Families received PBCM (n = 49) or care as usual (CAU) (n = 50). For all three perspectives, incremental cost-effectiveness ratios (ICERs) were calculated. Stochastic uncertainty in the data was dealt with using non-parametric bootstraps. Sensitivity analyses included calculating ICERs excluding cost outliers, and making an adjustment for baseline cost differences. Parenting quality improved in the PBCM group and declined in the CAU group, and PBCM was shown to be more costly than CAU. ICERs differ from 461 Euros (healthcare perspective) to 215 Euros (social care perspective) to 175 Euros (societal perspective) per one point improvement on the HOME T-score. The results of the sensitivity analyses, based on complete cases and excluding cost outliers, support the finding that the ICER is lower when adopting a broader perspective. The subgroup analysis and the analysis with baseline adjustments resulted in higher ICERs. This study is the first economic evaluation of family-focused preventive basic care management for COPMI in psychiatric and family services. The effects

  18. Cost-effectiveness of FDG-PET for the management of solitary pulmonary nodules: a decision analysis based on cost reimbursement in Germany

    International Nuclear Information System (INIS)

    Dietlein, M.; Weber, K.; Moka, D.; Theissen, P.; Schicha, H.; Gandjour, A.; Lauterbach, K.W.

    2000-01-01

    Management of solitary pulmonary nodules (SPNs) of up to 3 cm was modelled on decision analysis comparing ''wait and watch'', transthoracic needle biopsy (TNB), exploratory surgery and full-ring dedicated positron emission tomography (PET) using fluorine-18 2-fluorodeoxyglucose (FDG). The incremental cost-effectiveness ratios (ICERs) were calculated for the main risk group, a cohort of 62-year-old men, using first ''wait and watch'' and second exploratory surgery as the baseline strategy. Based on published data, the sensitivity and specificity of FDG-PET were estimated at 0.95 and 0.80 for detecting malignancy in SPNs and at 0.74 and 0.96 for detecting metastasis in normal-sized mediastinal lymph nodes. The costs quoted correspond to reimbursement in 1999 by the public health provider in Germany. Decision analysis modelling indicates the potential cost-effectiveness of the FDG-PET strategy for management of SPNs. Taking watchful waiting as the low-cost baseline strategy, the ICER of PET [3218 euros (EUR) per life year saved] was more favourable than that of exploratory surgery (4210 EUR/year) or that of TNB (6120 EUR/year). Changing the baseline strategy to exploratory surgery, the use of PET led to cost savings and additional life expectancy. This constellation was described by a negative ICER of -6912 EUR/year. The PET algorithm was cost-effective for risk and non-risk patients. However, the ICER of PET as the preferred strategy was sensitive to a hypothetical deterioration of any PET parameters by more than 0.07. To transfer the diagnostic efficacy from controlled studies to the routine user and to maintain the cost-effectiveness of this technology, obligatory protocols for data acquisitions would need to be defined. If the prevalence of SPNs is estimated at the USA level (52 per 100,000 individuals) and assuming that multiple strategies without PET are the norm, the overall costs of a newly implemented PET algorithm would be limited to far less than one EUR

  19. Relative cost-effectiveness of an extensively hydrolyzed casein formula containing the probiotic Lactobacillus rhamnosus GG in managing infants with cow's milk allergy in Italy

    Directory of Open Access Journals (Sweden)

    Guest JF

    2015-06-01

    Full Text Available Julian F Guest,1,2 Monica Panca,1 Olga Ovcinnikova,1 Rita Nocerino3 1CATALYST Health Economics Consultants, Northwood, Middlesex, UK; 2Faculty of Life Sciences and Medicine, King's College, London, UK; 3Department of Translational Medical Science, Pediatric Section, University of Naples 'Federico II', Naples, Italy Objective: To estimate the cost-effectiveness of using an extensively hydrolyzed casein formula (eHCF containing the probiotic Lactobacillus rhamnosus GG, (eHCF + LGG; Nutramigen LGG as first-line management for cow's milk allergy (CMA compared with eHCF alone, soy-based formulae (SBF, hydrolyzed rice formulae (HRF, and amino acid formulae (AAF in Italy, from the perspective of the Italian National Health Service (INHS and parents. Methods: Decision modeling was used to estimate the probability of infants developing tolerance to cow's milk by 18 months, based on an observational study dataset. The model also estimated the cost (at 2012/2013 prices of health care resource use funded by the INHS and formulae paid for by parents over 18 months after starting a formula, as well as the relative cost-effectiveness of each of the formulae. Results: The probability of developing tolerance to cow's milk by 18 months was higher among infants with either IgE-mediated or non-IgE-mediated allergy who were fed eHCF + LGG compared to those fed one of the other formulae. The total health care cost of initially feeding infants with eHCF + LGG was less than that of feeding infants with one of the other formulae. Hence, eHCF + LGG affords the greatest value for money to both the INHS and parents of infants with either IgE-mediated or non-IgE-mediated CMA. Conclusion: Using eHCF + LGG instead of eHCF, SBF, HRF, or an AAF for first-line management of newly diagnosed infants with CMA in Italy affords a cost-effective use of publicly funded resources, and is cost-effective from the parents' perspective, since it improves outcome for less cost. A randomized

  20. Nursing Management Minimum Data Set: Cost-Effective Tool To Demonstrate the Value of Nurse Staffing in the Big Data Science Era.

    Science.gov (United States)

    Pruinelli, Lisiane; Delaney, Connie W; Garciannie, Amy; Caspers, Barbara; Westra, Bonnie L

    2016-01-01

    There is a growing body of evidence of the relationship of nurse staffing to patient, nurse, and financial outcomes. With the advent of big data science and developing big data analytics in nursing, data science with the reuse of big data is emerging as a timely and cost-effective approach to demonstrate nursing value. The Nursing Management Minimum Date Set (NMMDS) provides standard administrative data elements, definitions, and codes to measure the context where care is delivered and, consequently, the value of nursing. The integration of the NMMDS elements in the current health system provides evidence for nursing leaders to measure and manage decisions, leading to better patient, staffing, and financial outcomes. It also enables the reuse of data for clinical scholarship and research.

  1. A Cost-Effectiveness Analysis of Reverse Total Shoulder Arthroplasty versus Hemiarthroplasty for the Management of Complex Proximal Humeral Fractures in the Elderly.

    Science.gov (United States)

    Osterhoff, Georg; O'Hara, Nathan N; D'Cruz, Jennifer; Sprague, Sheila A; Bansback, Nick; Evaniew, Nathan; Slobogean, Gerard P

    2017-03-01

    There is ongoing debate regarding the optimal surgical treatment of complex proximal humeral fractures in elderly patients. To evaluate the cost-effectiveness of reverse total shoulder arthroplasty (RTSA) compared with hemiarthroplasty (HA) in the management of complex proximal humeral fractures, using a cost-utility analysis. On the basis of data from published literature, a cost-utility analysis was conducted using decision tree and Markov modeling. A single-payer perspective, with a willingness-to-pay (WTP) threshold of Can$50,000 (Canadian dollars), and a lifetime time horizon were used. The incremental cost-effectiveness ratio (ICER) was used as the study's primary outcome measure. In comparison with HA, the incremental cost per quality-adjusted life-year gained for RTSA was Can$13,679. One-way sensitivity analysis revealed the model to be sensitive to the RTSA implant cost and the RTSA procedural cost. The ICER of Can$13,679 is well below the WTP threshold of Can$50,000, and probabilistic sensitivity analysis demonstrated that 92.6% of model simulations favored RTSA. Our economic analysis found that RTSA for the treatment of complex proximal humeral fractures in the elderly is the preferred economic strategy when compared with HA. The ICER of RTSA is well below standard WTP thresholds, and its estimate of cost-effectiveness is similar to other highly successful orthopedic strategies such as total hip arthroplasty for the treatment of hip arthritis. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  2. A framework model for investigating the export of phosphorus to surface waters in forested watersheds: Implications to management.

    Science.gov (United States)

    Santos, R M B; Sanches Fernandes, L F; Pereira, M G; Cortes, R M V; Pacheco, F A L

    2015-12-01

    The present study was developed in four sub-basins of rivers Cávado and Douro, located in the North of mainland Portugal. The goal was to identify main stressors as well as driving and attenuating processes responsible for the presence of phosphorus in masses of surface water in those catchments. To accomplish the goal, the basins were selected where a quality station was present at the outlet, the forest occupation was greater than 75% and the phosphorus concentrations have repeatedly exceeded the threshold for the good ecological status in the period 2000-2006. Further, in two basins the quality station was installed in a lotic (free-flow water) environment whereas in the other two was placed in a lentic (dammed water) environment. The ArcMap GIS-based software package was used for the spatial analysis of stressors and processes. The yields of phosphorus vary widely across the studied basins, from 0.2-30 kg·ha(-1)·yr(-1). The results point to post-fire soil erosion and hardwood clear cuttings as leading factors of phosphorus exports across the watersheds, with precipitation intensity being the key variable of erosion. However, yields can be attenuated by sediment deposition along the pathway from burned or managed areas to water masses. The observed high yields and concentrations of phosphorus in surface water encompass serious implications for water resources management in the basins, amplified in the lentic cases by potential release of phosphorus from lake sediments especially during the summer season. Therefore, a number of measures were proposed as regards wildfire combat, reduction of phosphorus exports after tree cuts, attenuation of soil erosion and improvement of riparian buffers, all with the purpose of preventing phosphorus concentrations to go beyond the regulatory good ecological status. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Efficacy and cost-effectiveness of a web-based and mobile stress-management intervention for employees: design of a randomized controlled trial.

    Science.gov (United States)

    Heber, Elena; Ebert, David Daniel; Lehr, Dirk; Nobis, Stephanie; Berking, Matthias; Riper, Heleen

    2013-07-15

    Work-related stress is associated with a variety of mental and emotional problems and can lead to substantial economic costs due to lost productivity, absenteeism or the inability to work. There is a considerable amount of evidence on the effectiveness of traditional face-to-face stress-management interventions for employees; however, they are often costly, time-consuming, and characterized by a high access threshold. Web-based interventions may overcome some of these problems yet the evidence in this field is scarce. This paper describes the protocol for a study that will examine the efficacy and cost-effectiveness of a web-based guided stress-management training which is based on problem solving and emotion regulation and aimed at reducing stress in adult employees. The study will target stressed employees aged 18 and older. A randomized controlled trial (RCT) design will be applied. Based on a power calculation of d=.35 (1-β of 80%, α = .05), 264 participants will be recruited and randomly assigned to either the intervention group or a six-month waitlist control group. Inclusion criteria include an elevated stress level (Cohen's Perceived Stress Scale-10 ≥ 22) and current employment. Exclusion criteria include risk of suicide or previously diagnosed psychosis or dissociative symptoms. The primary outcome will be perceived stress, and secondary outcomes include depression and anxiety. Data will be collected at baseline and seven weeks and six months after randomization. An extended follow up at 12 months is planned for the intervention group. Moreover, a cost-effectiveness analysis will be conducted from a societal perspective and will include both direct and indirect health care costs. Data will be analyzed on an intention-to-treat basis and per protocol. The substantial negative consequences of work-related stress emphasize the necessity for effective stress-management trainings. If the proposed internet intervention proves to be (cost-) effective, a

  4. Calibration of the APEX Model to Simulate Management Practice Effects on Runoff, Sediment, and Phosphorus Loss.

    Science.gov (United States)

    Bhandari, Ammar B; Nelson, Nathan O; Sweeney, Daniel W; Baffaut, Claire; Lory, John A; Senaviratne, Anomaa; Pierzynski, Gary M; Janssen, Keith A; Barnes, Philip L

    2017-11-01

    Process-based computer models have been proposed as a tool to generate data for Phosphorus (P) Index assessment and development. Although models are commonly used to simulate P loss from agriculture using managements that are different from the calibration data, this use of models has not been fully tested. The objective of this study is to determine if the Agricultural Policy Environmental eXtender (APEX) model can accurately simulate runoff, sediment, total P, and dissolved P loss from 0.4 to 1.5 ha of agricultural fields with managements that are different from the calibration data. The APEX model was calibrated with field-scale data from eight different managements at two locations (management-specific models). The calibrated models were then validated, either with the same management used for calibration or with different managements. Location models were also developed by calibrating APEX with data from all managements. The management-specific models resulted in satisfactory performance when used to simulate runoff, total P, and dissolved P within their respective systems, with > 0.50, Nash-Sutcliffe efficiency > 0.30, and percent bias within ±35% for runoff and ±70% for total and dissolved P. When applied outside the calibration management, the management-specific models only met the minimum performance criteria in one-third of the tests. The location models had better model performance when applied across all managements compared with management-specific models. Our results suggest that models only be applied within the managements used for calibration and that data be included from multiple management systems for calibration when using models to assess management effects on P loss or evaluate P Indices. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  5. Cost-effectiveness analysis of umeclidinium/vilanterol for the management of patients with moderate to very severe COPD using an economic model

    Directory of Open Access Journals (Sweden)

    Wilson MR

    2017-03-01

    Full Text Available Michele R Wilson,1 Jeetvan G Patel,2,3 Amber Coleman,2 Cheryl L McDade,1 Richard H Stanford,2 Stephanie R Earnshaw1 1RTI Health Solutions, Research Triangle Park, NC, USA; 2GSK, Research Triangle Park, NC, USA; 3Amgen Inc., Thousand Oaks, CA, USA Background: Bronchodilators such as long-acting muscarinic antagonists (LAMAs and long-acting β2-agonists (LABAs are central to the pharmacological management of COPD. Dual bronchodilation with umeclidinium/vilanterol (UMEC/VI; 62.5/25 µg is a novel LAMA/LABA combination approved for maintenance treatment for patients with COPD.Objective: The objective of this study was to assess the cost-effectiveness of maintenance treatment with UMEC/VI compared with tiotropium (TIO 18 µg, open dual LAMA + LABA treatment, or no long-acting bronchodilator treatment in patients with moderate to very severe COPD.Methods: A Markov model was developed to estimate the costs and outcomes associated with UMEC/VI treatment in patients with moderate to very severe COPD (GSK study number: HO-13-13411. Clinical efficacy, costs, utilities, and mortality obtained from the published literature were used as the model inputs. Costs are presented in US dollars based on 2015 prices. The model outputs are total costs, drug costs, other medical costs, number of COPD exacerbations, and quality-adjusted life-years (QALYs. Costs and outcomes were discounted at a 3% annual rate. Incremental cost-effectiveness ratios were calculated. One-way and probabilistic sensitivity analyses were conducted to assess the effects of changing parameters on the uncertainty of the results.Results: UMEC/VI treatment for moderate to very severe COPD was associated with lower lifetime medical costs ($82,344 compared with TIO ($88,822, open dual LAMA + LABA treatment ($114,442, and no long-acting bronchodilator ($86,751. Fewer exacerbations were predicted to occur with UMEC/VI treatment compared with no long-acting bronchodilator treatment. UMEC/VI provided

  6. Inspections - a cost effective approach

    International Nuclear Information System (INIS)

    Joseph, C.

    1981-01-01

    This paper describes a cost effective approach for inspections of Computerized Nuclear Materials Control and Accounting Systems (CNMCAS). Highlighted is the capability to conduct an inspection program via portable telephone terminals from off-site locations. The program can be applied to various materials management functions including materials control, quality assurance, and materials accounting. The system is designed to facilitate inspections by both external and internal groups

  7. Can arbuscular mycorrhiza and fertilizer management reduce phosphorus runoff from paddy fields?

    Science.gov (United States)

    Zhang, Shujuan; Wang, Li; Ma, Fang; Zhang, Xue; Li, Zhe; Li, Shiyang; Jiang, Xiaofeng

    2015-07-01

    Our study sought to assess how much phosphorus (P) runoff from paddy fields could be cut down by fertilizer management and inoculation with arbuscular mycorrhizal fungi. A field experiment was conducted in Lalin River basin, in the northeast China: six nitrogen-phosphorus-potassium fertilizer levels were provided (0, 20%, 40%, 60%, 80%, and 100% of the recommended fertilizer supply), with or without inoculation with Glomus mosseae. The volume and concentrations of particle P (PP) and dissolved P (DP) were measured for each runoff during the rice growing season. It was found that the seasonal P runoff, including DP and PP, under the local fertilization was 3.7 kg/ha, with PP, rather than DP, being the main form of P in runoff water. Additionally, the seasonal P runoff dropped only by 8.9% when fertilization decreased by 20%; rice yields decreased with declining fertilization. We also found that inoculation increased rice yields and decreased P runoff at each fertilizer level and these effects were lower under higher fertilization. Conclusively, while rice yields were guaranteed arbuscular mycorrhizal inoculation and fertilizer management would play a key role in reducing P runoff from paddy fields. Copyright © 2015. Published by Elsevier B.V.

  8. Improved Cost-effectiveness for Management of Chronic Heart Failure by Combined Home-based Intervention with Clinical Nursing Specialists

    Directory of Open Access Journals (Sweden)

    Yi-Lwun Ho

    2007-01-01

    Conclusion: The home- and clinic-based caring system is capable of decreasing adverse outcomes, most notably hospitalization and length of stay, and could trigger significant cost savings in the management of heart failure. [J Formos Med Assoc 2007;106(4:313-319

  9. Clinicians' adherence versus non adherence to practice guidelines in the management of patients with sarcoma: a cost-effectiveness assessment in two European regions

    Directory of Open Access Journals (Sweden)

    Perrier Lionel

    2012-03-01

    Full Text Available Abstract Background Although the management of sarcoma is improving, non adherence to clinical practice guidelines (CPGs remains high, mainly because of the low incidence of the disease and the variety of histological subtypes. Since little is known about the health economics of sarcoma, we undertook a cost-effectiveness analysis (within the CONnective TIssue CAncer NETwork, CONTICANET comparing costs and outcomes when clinicians adhered to CPGs and when they did not. Methods Patients studied had a histological diagnosis of sarcoma, were older than 15 years, and had been treated in the Rhône-Alpes region of France (in 2005/2006 or in the Veneto region of Italy (in 2007. Data collected retrospectively for the three years after diagnosis were used to determine relapse free survival and health costs (adopting the hospital's perspective and a microcosting approach. All costs were expressed in euros (€ at their 2009 value. A 4% annual discount rate was applied to both costs and effects. The incremental cost-effectiveness ratio (ICER was expressed as cost per relapse-free year gained when management was compliant with CPGs compared with when it was not. To capture uncertainty surrounding ICER, a probabilistic sensitivity analysis was performed based on a non-parametric bootstrap method. Results A total of 219 patients were included in the study. Compliance with CPGs was observed for 118 patients (54%. Average total costs reached 23,571 euros when treatment was in accordance with CPGs and 27,313 euros when it was not. In relation to relapse-free survival, compliance with CPGs strictly dominates non compliance, i.e. it is both less costly and more effective. Taking uncertainty into account, the probability that compliance with CPGs still strictly dominates was 75%. Conclusions Our findings should encourage physicians to increase their compliance with CPGs and healthcare administrators to invest in the implementation of CPGs in the management of

  10. Feeding strategies and manure management for cost-effective mitigation of greenhouse gas emissions from dairy farms in Wisconsin.

    Science.gov (United States)

    Dutreuil, M; Wattiaux, M; Hardie, C A; Cabrera, V E

    2014-09-01

    Greenhouse gas (GHG) emissions from dairy farms are a major concern. Our objectives were to assess the effect of mitigation strategies on GHG emissions and net return to management on 3 distinct farm production systems of Wisconsin. A survey was conducted on 27 conventional farms, 30 grazing farms, and 69 organic farms. The data collected were used to characterize 3 feeding systems scaled to the average farm (85 cows and 127ha). The Integrated Farm System Model was used to simulate the economic and environmental impacts of altering feeding and manure management in those 3 farms. Results showed that incorporation of grazing practices for lactating cows in the conventional farm led to a 27.6% decrease in total GHG emissions [-0.16kg of CO2 equivalents (CO2eq)/kg of energy corrected milk (ECM)] and a 29.3% increase in net return to management (+$7,005/yr) when milk production was assumed constant. For the grazing and organic farms, decreasing the forage-to-concentrate ratio in the diet decreased GHG emissions when milk production was increased by 5 or 10%. The 5% increase in milk production was not sufficient to maintain the net return; however, the 10% increase in milk production increased net return in the organic farm but not on the grazing farm. A 13.7% decrease in GHG emissions (-0.08kg of CO2eq/kg of ECM) was observed on the conventional farm when incorporating manure the day of application and adding a 12-mo covered storage unit. However, those same changes led to a 6.1% (+0.04kg of CO2eq/kg of ECM) and a 6.9% (+0.06kg of CO2eq/kg of ECM) increase in GHG emissions in the grazing and the organic farms, respectively. For the 3 farms, manure management changes led to a decrease in net return to management. Simulation results suggested that the same feeding and manure management mitigation strategies led to different outcomes depending on the farm system, and furthermore, effective mitigation strategies were used to reduce GHG emissions while maintaining

  11. Cost-Effectiveness of Clinical Pharmacy Education on Infection Management Among Patients with Chronic Kidney Disease in an Indonesian Hospital

    OpenAIRE

    Nasution, Azizah; Sulaiman, SA. Syed; Shafie, A.A

    2016-01-01

    Objectives This study evaluated the clinical and economic impacts of clinical pharmacy education (CPE) on infection management among patients with chronic kidney disease (CKD) stages 4 and 5 in Haji Adam Malik Hospital, Indonesia. Methods A quasi-experimental economic evaluation comparing CPE impact on 6-month CKD mortality was conducted on the basis of payer perspective. The experimental group (n = 63) received care by health care providers who were given CPE on drug-related probl...

  12. Advancing Cost-Effective Readiness by Improving the Supply Chain Management of Sparse, Intermittently-Demanded Parts

    Science.gov (United States)

    2015-03-26

    strategy and the actual measures they take/look at for management review decision support. Shaw, Meixell & Tuggle [31] recognize the lack of integrated...have proposed new performance measures and metrics that reflect the changes in markets and enterprise environments...” 5.1.2 Multiple Processes to...Petropoulos and V. Assimakopoulos, "An aggregate-disaggregate intermittent demand approach ( ADIDA ) to forecasting: an empirical proposition and analysis

  13. A Cost-effective and Emission-aware Power Management System for Ships with Integrated Full Electric Propulsion

    DEFF Research Database (Denmark)

    Kanellos, Fotis D.; Anvari-Moghaddam, Amjad; Guerrero, Josep M.

    2017-01-01

    The extensive exploitation of electric power in ships enables the development of more efficient and environmentally friendlier ships, as it allows for a more flexible ship power system operation and configuration. In this paper, an optimal power management method for ship electric power systems....... The proposed fuzzy-based particle swarm optimization (FPSO) algorithm aims at minimizing the operation cost, limiting the greenhouse gas (GHG) emissions and satisfying the technical and operational constraints of the ship....

  14. Catchment Models and Management Tools for diffuse Contaminants (Sediment, Phosphorus and Pesticides): DIFFUSE Project

    Science.gov (United States)

    Mockler, Eva; Reaney, Simeon; Mellander, Per-Erik; Wade, Andrew; Collins, Adrian; Arheimer, Berit; Bruen, Michael

    2017-04-01

    The agricultural sector is the most common suspected source of nutrient pollution in Irish rivers. However, it is also often the most difficult source to characterise due to its predominantly diffuse nature. Particulate phosphorus in surface water and dissolved phosphorus in groundwater are of particular concern in Irish water bodies. Hence the further development of models and indices to assess diffuse sources of contaminants are required for use by the Irish Environmental Protection Agency (EPA) to provide support for river basin planning. Understanding connectivity in the landscape is a vital component of characterising the source-pathway-receptor relationships for water-borne contaminants, and hence is a priority in this research. The DIFFUSE Project will focus on connectivity modelling and incorporation of connectivity into sediment, nutrient and pesticide risk mapping. The Irish approach to understanding and managing natural water bodies has developed substantially in recent years assisted by outputs from multiple research projects, including modelling and analysis tools developed during the Pathways and CatchmentTools projects. These include the Pollution Impact Potential (PIP) maps, which are an example of research output that is used by the EPA to support catchment management. The PIP maps integrate an understanding of the pollution pressures and mobilisation pathways and, using the source-pathways-receptor model, provide a scientific basis for evaluation of mitigation measures. These maps indicate the potential risk posed by nitrate and phosphate from diffuse agricultural sources to surface and groundwater receptors and delineate critical source areas (CSAs) as a means of facilitating the targeting of mitigation measures. Building on this previous research, the DIFFUSE Project will develop revised and new catchment managements tools focused on connectivity, sediment, phosphorus and pesticides. The DIFFUSE project will strive to identify the state

  15. The effectiveness and resilience of phosphorus management practices in the Lake Simcoe watershed, Ontario, Canada

    Science.gov (United States)

    Crossman, J.; Futter, M. N.; Palmer, M.; Whitehead, P. G.; Baulch, H. M.; Woods, D.; Jin, L.; Oni, S. K.; Dillon, P. J.

    2016-09-01

    Uncertainty surrounding future climate makes it difficult to have confidence that current nutrient management strategies will remain effective. This study used monitoring and modeling to assess current effectiveness (% phosphorus reduction) and resilience (defined as continued effectiveness under a changing climate) of best management practices (BMPs) within five catchments of the Lake Simcoe watershed, Ontario. The Integrated Catchment Phosphorus model (INCA-P) was used, and monitoring data were used to calibrate and validate a series of management scenarios. To assess current BMP effectiveness, models were run over a baseline period 1985-2014 with and without management scenarios. Climate simulations were run (2070-2099), and BMP resilience was calculated as the percent change in effectiveness between the baseline and future period. Results demonstrated that livestock removal from water courses was the most effective BMP, while manure storage adjustments were the least. Effectiveness varied between catchments, influenced by the dominant hydrological and nutrient transport pathways. Resilience of individual BMPs was associated with catchment sensitivity to climate change. BMPs were most resilient in catchments with high soil water storage capacity and small projected changes in frozen-water availability and in soil moisture deficits. Conversely, BMPs were less resilient in catchments with larger changes in spring melt magnitude and in overland flow proportions. Results indicated that BMPs implemented are not always those most suited to catchment flow pathways, and a more site-specific approach would enhance prospects for maintaining P reduction targets. Furthermore, BMP resilience to climate change can be predicted from catchment physical properties and present-day hydrochemical sensitivity to climate forcing.

  16. Prevalence and proposal for cost-effective management of the ciguatera risk in the Noumea fish market, New Caledonia (South Pacific).

    Science.gov (United States)

    Clua, Eric; Brena, Pierpaolo F; Lecasble, Côme; Ghnassia, Reine; Chauvet, Claude

    2011-11-01

    Ciguatera fish poisoning (CFP) is a common intoxication associated with the consumption of reef fish, which constitutes a critical issue for public health in many countries. The complexity of its epidemiology is responsible for the poor management of the risk in tropical fish markets. We used the example of the Noumea fish market in New Caledonia to develop a cost-effective methodology of assessing the CFP risk. We first used published reports and the knowledge of local experts to define a list of potentially poisonous local species, ranked by their ciguatoxic potential. Based on two 1-month surveys in the market, conducted in winters 2008 and 2009, we then calculated the consolidated ratio of biomass of potentially poisonous species vs. total biomass of fish sold on the market. The prevalence of high CFP-risk species in the market was 16.1% and 18.9% in 2008 and 2009, respectively. The most common high CFP risk species were groupers (serranids), king mackerels (scombrids), snappers (lutjanids), barracudas (sphyaraenids), emperors (lethrinids) and wrasses (labrids). The size (age) of the fish also plays a critical role in the potential ciguatoxic risk. According to proposals of average size thresholds provided by experts for high-risk species, we were also able to assess the additional risk induced by the sale of some large fish on the market. The data collected both from experts and from the market allowed us to develop a cost-effective proposal for improving the management of the CFP risk in this market. However, the successful implementation of any regulation aiming to ban some specific species and sizes from the market, with an acceptable economical impact, will require the improvement of the expertise in fish identification by public health officers and, ideally, the commitment of retailers. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. The CAMU Rule: A tool for implementing a protective, cost-effective remedy at the Fernald Environmental Management Project

    International Nuclear Information System (INIS)

    Dupuis-Nouille, E.M.; Goidell, L.C.; Strimbu, M.J.

    1995-01-01

    The Fernald Environmental Management Project (FEMP) is a former uranium processing facility currently under remediation pursuant to the Comprehensive Environmental Response, Compensation, and Liability Act as amended (CERCLA). Contamination at the FEMP consists of low-level radioactivity, hazardous substances, hazardous wastes and/or mixed wastes. Regulations promulgated under the Resource Conservation and Recovery Act as amended (RCRA) are evaluated as applicable or relevant and appropriate requirements (ARARs) for remediation of the FEMP. Historically, joint CERCLA-RCRA guidance dictated that hazardous waste could not be treated, or moved out of the designated area of contiguous contamination (AOC), without triggering land disposal restrictions (LDRs) or minimum technology requirements (MTRs). To avoid invoking these stringent requirements, in situ capping was chosen as the lower cost remedy at many sites, although on-site disposal and/or treatment of hazardous wastes would have been more protective. The Corrective Action Management Units (CAMUs) and Temporary Units (TUs) Final Rule [58 FR 8658, Vol. 58, No. 29, hereinafter the open-quotes CAMU Ruleclose quotes], promulgated on February 16, 1993, provides facilities regulated under RCRA corrective action authority with greater flexibility to move, treat, and dispose of wastes on site without triggering LDRs or MTRs, thereby encouraging application of innovative technologies and more protective remedies. The waste acceptance criteria for the on-site disposal facility is based on site-specific considerations including the mobility of the contaminants through the underlying site geology and the protectiveness of the engineered liners. Application of the open-quotes CAMU Ruleclose quotes allows for disposition in the on-site facility based on these technical considerations rather than on regulatory classifications

  18. Cost-effectiveness analysis of umeclidinium/vilanterol for the management of patients with moderate to very severe COPD using an economic model.

    Science.gov (United States)

    Wilson, Michele R; Patel, Jeetvan G; Coleman, Amber; McDade, Cheryl L; Stanford, Richard H; Earnshaw, Stephanie R

    2017-01-01

    Bronchodilators such as long-acting muscarinic antagonists (LAMAs) and long-acting β 2 -agonists (LABAs) are central to the pharmacological management of COPD. Dual bronchodilation with umeclidinium/vilanterol (UMEC/VI; 62.5/25 μg) is a novel LAMA/LABA combination approved for maintenance treatment for patients with COPD. The objective of this study was to assess the cost-effectiveness of maintenance treatment with UMEC/VI compared with tiotropium (TIO) 18 μg, open dual LAMA + LABA treatment, or no long-acting bronchodilator treatment in patients with moderate to very severe COPD. A Markov model was developed to estimate the costs and outcomes associated with UMEC/VI treatment in patients with moderate to very severe COPD (GSK study number: HO-13-13411). Clinical efficacy, costs, utilities, and mortality obtained from the published literature were used as the model inputs. Costs are presented in US dollars based on 2015 prices. The model outputs are total costs, drug costs, other medical costs, number of COPD exacerbations, and quality-adjusted life-years (QALYs). Costs and outcomes were discounted at a 3% annual rate. Incremental cost-effectiveness ratios were calculated. One-way and probabilistic sensitivity analyses were conducted to assess the effects of changing parameters on the uncertainty of the results. UMEC/VI treatment for moderate to very severe COPD was associated with lower lifetime medical costs ($82,344) compared with TIO ($88,822), open dual LAMA + LABA treatment ($114,442), and no long-acting bronchodilator ($86,751). Fewer exacerbations were predicted to occur with UMEC/VI treatment compared with no long-acting bronchodilator treatment. UMEC/VI provided an 0.11 and 0.25 increase in QALYs compared with TIO and no long-acting bronchodilator treatment, and as such, dominated these cost-effectiveness analyses. Sensitivity analyses confirmed that the results were robust. The results from this model suggest that UMEC/VI treatment would be dominant

  19. Phosphorus flux due to Atlantic salmon (Salmo salar) in an oligotrophic upland stream: effects of management and demography

    Science.gov (United States)

    Keith H. Nislow; John D. Armstrong; Simon. McKelvey

    2004-01-01

    Little is known concerning the role of Atlantic salmon (Salmo salar) in the transport of nutrients to and from river systems. We used demographic data from the River Bran, an oligotrophic river in Scotland, UK, to construct a budget for the transport of phosphorus (P) and applied it to investigate the effects of management strategies and demographic...

  20. The phosphorus footprint of China's food chain: implications for food security, natural resource management, and environmental quality

    NARCIS (Netherlands)

    Wang, F.; Sims, J.T.; Ma, L.; Ma, W.; Dou, Z.; Zhang, F.

    2011-01-01

    Efficient use of phosphorus (P) for producing food, preventing water pollution, and managing a dwindling rock P reserve are major challenges for China. We analyzed P stocks and flows in the Chinese food chain to identify where P use efficiency can be improved, where P leaks to the environment, and

  1. Nitrogen and phosphorus budgets for the Yucatán littoral: An approach for groundwater management.

    Science.gov (United States)

    Arandacirerol, Nancy; Comín, Francisco; Herrera-Silveira, Jorge

    2011-01-01

    Human activities have altered the balance of ecosystems to the detriment of natural environments. Eutrophication is a serious risk in Yucatán, a state in the eastern peninsula of México where groundwater supplies the only freshwater to a karst shelf environment. While economic development in Yucatán is increasing, environmental awareness is lagging, and efficient waste treatment systems are lacking. To assess potential nitrogen and phosphorus inputs into the coastal zone of Yucatán, we analyzed government reports and the chemical composition of groundwater and aquaculture wastewater. Swine, poultry, and tourism are revealed as the main continental nutrient sources, while groundwater with high nitrate concentrations is the principal coastal nutrient source, a pattern similar to other river discharges around the world. This study demonstrates that environmental risk management practices must be implemented in the Yucatán region to protect groundwater quality.

  2. Phosphorus cycles of forest and upland grassland ecosystems and some effects of land management practices.

    Science.gov (United States)

    Harrison, A F

    The distribution of phosphorus capital and net annual transfers of phosphorus between the major components of two unfertilized phosphorus-deficient UK ecosystems, an oak--ash woodland in the Lake District and an Agrostis-Festuca grassland in Snowdonia (both on acid brown-earth soils), have been estimted in terms of kg P ha--1. In both ecosystems less than 3% of the phosphorus, totalling 1890 kg P ha--1 and 3040 kg P ha--1 for the woodland and grassland, respectively, is contained in the living biomass and half that is below ground level. Nearly all the phosphorus is in the soil matrix. Although the biomass phosphorus is mostly in the vegetation, the soil fauna and vegetation is slower (25%) than in the grassland vegetatation (208%). More than 85% of the net annual vegetation uptake of phosphorus from the soil is returned to the soil, mainly in organic debris, which in the grassland ecosystem is more than twice as rich in phosphorus (0.125% P) as in the woodland ecosystem (0.053% P). These concentrations are related to the rates of turnover (input/P content) of phosphorus in the litter layer on the soil surface; it is faster in the grassland (460%) than in the woodland (144%). In both cycles plant uptake of phosphorus largely depends on the release of phosphorus through decomposition of the organic matter returned to soil. In both the woodland and the grassland, the amount of cycling phosphorus is potentially reduced by its immobilization in tree and sheep production and in undecomposed organic matter accumulating in soil. It is assumed that the reductions are counterbalanced by the replenishment of cycling phosphorus by (i) some mineralization of organically bound phosphorus in the mineral soil, (ii) the income in rainfall and aerosols not being effectively lost in soil drainage waters and (iii) rock weathering. The effects of the growth of conifers and sheep grazing on the balance between decomposition and accumulation of organic matter returned to soil are

  3. An evaluation of the cost-effectiveness of booklet-based self-management of dizziness in primary care, with and without expert telephone support

    Directory of Open Access Journals (Sweden)

    King Debbie

    2009-12-01

    Full Text Available Abstract Background Dizziness is a very common symptom that often leads to reduced quality of life, anxiety and emotional distress, loss of fitness, lack of confidence in balance, unsteadiness and an increased risk of falling. Most dizzy patients are managed in primary care by reassurance and medication to suppress symptoms. Trials have shown that chronic dizziness can be treated effectively in primary care using a self-help booklet to teach patients vestibular rehabilitation exercises that promote neurological adaptation and skill and confidence in balance. However, brief support from a trained nurse was provided in these trials, and this model of managing dizzy patients has not been taken up due to a lack of skills and resources in primary care. The aim of this trial is to evaluate two new alternative models of delivery that may be more feasible and cost-effective. Methods/Design In a single blind two-centre pragmatic controlled trial, we will randomise 330 patients from 30 practices to a self-help booklet with telephone support from a vestibular therapist, b self-help booklet alone, c routine medical care. Symptoms, disability, handicap and quality of life will be assessed by validated questionnaires administered by post at baseline, immediately post-treatment (3 months, and at one year follow-up. The study is powered to test our primary hypothesis, that the self-help booklet with telephone support will be more effective than routine care. We will also explore the effectiveness of the booklet without any support, and calculate the costs of treatment in each arm. Discussion If our trial indicates that patients can cost-effectively manage their dizziness in primary care, then it can be easily rolled out to relieve the symptoms of the many patients in primary care who currently have chronic, untreated, disabling dizziness. Treatment in primary care may reduce the development of psychological and physical sequelae that cause handicap and require

  4. Controlling Eutrophication in A Mediterranean Shallow Reservoir by Phosphorus Loading Reduction: The Need for an Integrated Management Approach

    Science.gov (United States)

    Zaragüeta, Mikel; Acebes, Pablo

    2017-04-01

    Increased nutrient enrichment in Mediterranean standing waters has enhanced the risk of being affected by cyanobacterial blooms. Because phosphorus abatement is shaped as a crucial strategy for controlling eutrophication, this study introduces a structural thinking, experiential learning laboratory with animation dynamic model elaborated for Cazalegas Reservoir (Spain) to assess the feasibility of implementing a set of internal and external control measures and hydromorphological adjustments to meet the goal of oligotrophication. This shallow reservoir is another case where recurrent eutrophication has led to reach annual mean total phosphorus concentrations (0.16 ± 0.08 mg total phosphorus/L) over the threshold of current water policies, triggering cyanobacterial growth up to undesirable levels in summer time (approximately 50,000 cells/mL). Modeling results showed that (i) after upgrading water treatment in the main tributary, (ii) applying a lanthanum-modified bentonite into the water column and sediment, and (iii) increasing reservoir water level, in-lake P concentrations and cyanobacterial abundance decreased in an 88% (below 0.01 mg total phosphorus/L) and 84% (below 6000 cells/mL), respectively in the most critical periods. However, the constraints of the proposed management strategies are associated with their costs of implementation and the time span for a stable trophic recovery of the reservoir. In that end, integrated management approaches are aimed to be adopted by water managers to reach adequate ecological status of freshwater bodies.

  5. Optimal Management Strategies for Primary HPV Testing for Cervical Screening: Cost-Effectiveness Evaluation for the National Cervical Screening Program in Australia.

    Science.gov (United States)

    Simms, Kate T; Hall, Michaela; Smith, Megan A; Lew, Jie-Bin; Hughes, Suzanne; Yuill, Susan; Hammond, Ian; Saville, Marion; Canfell, Karen

    2017-01-01

    Several countries are implementing a transition to HPV testing for cervical screening in response to the introduction of HPV vaccination and evidence indicating that HPV screening is more effective than cytology. In Australia, a 2017 transition from 2-yearly conventional cytology in 18-20 to 69 years to 5-yearly primary HPV screening in 25 to 74 years will involve partial genotyping for HPV 16/18 with direct referral to colposcopy for this higher risk group. The objective of this study was to determine the optimal management of women positive for other high-risk HPV types (not 16/18) ('OHR HPV'). We used a dynamic model of HPV transmission, vaccination, natural history and cervical screening to determine the optimal management of women positive for OHR HPV. We assumed cytology triage testing was used to inform management in this group and that those with high-grade cytology would be referred to colposcopy and those with negative cytology would receive 12-month surveillance. For those with OHR HPV and low-grade cytology (considered to be a single low-grade category in Australia incorporating ASC-US and LSIL), we evaluated (1) the 20-year risk of invasive cervical cancer assuming this group are referred for 12-month follow-up vs. colposcopy, and compared this to the risk in women with low-grade cytology under the current program (i.e. an accepted benchmark risk for 12-month follow-up in Australia); (2) the population-level impact of the whole program, assuming this group are referred to 12-month surveillance vs. colposcopy; and (3) the cost-effectiveness of immediate colposcopy compared to 12-month follow-up. Evaluation was performed both for HPV-unvaccinated cohorts and cohorts offered vaccination (coverage ~72%). The estimated 20-year risk of cervical cancer is ≤1.0% at all ages if this group are referred to colposcopy vs. ≤1.2% if followed-up in 12 months, both of which are lower than the ≤2.6% benchmark risk in women with low-grade cytology in the current

  6. Managing phosphorus export from golf courses using industrial byproducts as filter materials

    Science.gov (United States)

    Golf courses, and in particular the tees, fairways, and putting greens, are vulnerable to loss of phosphorus (P) as dissolved reactive P (DRP) through sandy, porous grass rooting media and subsurface tile drainage. Excess levels of phosphorus (P) in surface waters promotes eutrophication, which in t...

  7. Exploring nutrient management options to increase nitrogen and phosphorus use efficiencies in food production of China

    NARCIS (Netherlands)

    Wang, Mengru; Ma, Lin; Strokal, Maryna; Chu, Yanan; Kroeze, Carolien

    2018-01-01

    Low nitrogen (NUE) and phosphorus (PUE) use efficiencies in food production in China result in large losses of nitrogen (N) and phosphorus (P) to the environment. The Chinese government formulated policies to increase the NUEs and PUEs. Recent policies aim for zero growth in synthetic fertilizer

  8. Cost Effectiveness Analysis of Different Management Strategies between Best Supportive Care and Second-line Chemotherapy for Platinum-resistant or Refractory Ovarian Cancer.

    Science.gov (United States)

    Luealon, Phanida; Khempech, Nipon; Vasuratna, Apichai; Hanvoravongchai, Piya; Havanond, Piyalamporn

    2016-01-01

    There is no standard treatment for patients with platinum-resistant or refractory epithelial ovarian cancer. Single agent chemotherapies have evidence of more efficacy and less toxicity than combination therapy. Most are very expensive, with appreciable toxicity and minimal survival. Since it is difficult to make comparison between outcomes, economic analysis of single-agent chemotherapy regimens and best supportive care may help to make decisions about an appropriate management for the affected patients. To evaluate the cost effectiveness of second-line chemotherapy compared with best supportive care for patients with platinum-resistant or refractory epithelial ovarian cancer. A Markov model was used to estimate the effectiveness and total costs associated with treatments. The hypothetical patient population comprised women aged 55 with platinum-resistant or refractory epithelial ovarian cancer. Four types of alternative treatment options were evaluated: 1) gemcitabine followed by BSC; 2) pegylated liposomal doxorubicin (PLD) followed by BSC; 3) gemcitabine followed by topotecan; and 4) PLD followed by topotecan. Baseline comparator of alternative treatments was BSC. Time horizon of the analysis was 2 years. Health care provider perspective and 3% discount rate were used to determine the costs of medical treatment in this study. Quality-adjusted life-years (QALY) were used to measure the treatment effectiveness. Treatment effectiveness data were derived from the literature. Costs were calculated from unit cost treatment of epithelial ovarian cancer patients at various stages of disease in King Chulalongkorn Memorial Hospital (KCMH) in the year 2011. Parameter uncertainty was tested in probabilistic sensitivity analysis by using Monte Carlo simulation. One-way sensitivity analysis was used to explore each variable's impact on the uncertainty of the results. Approximated life expectancy of best supportive care was 0.182 years and its total cost was 26,862 Baht. All

  9. A simple, cost-effective emitter for controlled release of fish pheromones: development, testing, and application to management of the invasive sea lamprey

    Science.gov (United States)

    Wagner, Michael C.; Hanson, James E.; Meckley, Trevor D.; Johnson, Nicholas; Bals, Jason D.

    2018-01-01

    Semiochemicals that elicit species-specific attraction or repulsion have proven useful in the management of terrestrial pests and hold considerable promise for control of nuisance aquatic species, particularly invasive fishes. Because aquatic ecosystems are typically large and open, use of a semiochemical to control a spatially dispersed invader will require the development of a cost-effective emitter that is easy to produce, environmentally benign, inexpensive, and controls the release of the semiochemical without altering its structure. We examined the release properties of five polymers, and chose polyethylene glycol (PEG) as the best alternative. In a series of laboratory and field experiments, we examined the response of the invasive sea lamprey to PEG, and to a partial sex pheromone emitted from PEG that has proven effective as a trap bait to capture migrating sea lamprey prior to spawning. Our findings confirm that the sea lamprey does not behaviorally respond to PEG, and that the attractant response to the pheromone component was conserved when emitted from PEG. Further, we deployed the pheromone-PEG emitters as trap bait during typical control operations in three Great Lakes tributaries, observing similar improvements in trap performance when compared to a previous study using mechanically pumped liquid pheromone. Finally, the polymer emitters tended to dissolve unevenly in high flow conditions. We demonstrate that housing the emitter stabilizes the dissolution rate at high water velocity. We conclude the performance characteristics of PEG emitters to achieve controlled-release of a semiochemical are sufficient to recommend its use in conservation and management activities related to native and invasive aquatic organisms.

  10. Downstream approaches to phosphorus management in agricultural landscapes: regional applicability and use.

    Science.gov (United States)

    Kröger, R; Dunne, E J; Novak, J; King, K W; McLellan, E; Smith, D R; Strock, J; Boomer, K; Tomer, M; Noe, G B

    2013-01-01

    This review provides a critical overview of conservation practices that are aimed at improving water quality by retaining phosphorus (P) downstream of runoff genesis. The review is structured around specific downstream practices that are prevalent in various parts of the United States. Specific practices that we discuss include the use of controlled drainage, chemical treatment of waters and soils, receiving ditch management, and wetlands. The review also focuses on the specific hydrology and biogeochemistry associated with each of those practices. The practices are structured sequentially along flowpaths as you move through the landscape, from the edge-of-field, to adjacent aquatic systems, and ultimately to downstream P retention. Often practices are region specific based on geology, cropping practices, and specific P related problems and thus require a right practice, and right place mentality to management. Each practice has fundamental P transport and retention processes by systems that can be optimized by management with the goal of reducing downstream P loading after P has left agricultural fields. The management of P requires a system-wide assessment of the stability of P in different biogeochemical forms (particulate vs. dissolved, organic vs. inorganic), in different storage pools (soil, sediment, streams etc.), and under varying biogeochemical and hydrological conditions that act to convert P from one form to another and promote its retention in or transport out of different landscape components. There is significant potential of hierarchically placing practices in the agricultural landscape and enhancing the associated P mitigation. But an understanding is needed of short- and long-term P retention mechanisms within a certain practice and incorporating maintenance schedules if necessary to improve P retention times and minimize exceeding retention capacity. Copyright © 2012 Elsevier B.V. All rights reserved.

  11. Phosphorus management in cropping systems of the Paris Basin: From farm to regional scale.

    Science.gov (United States)

    Le Noë, Julia; Garnier, Josette; Billen, Gilles

    2018-01-01

    The sustainability of phosphorus (P) fertilization in cropping systems is an important issue because P resources on earth are limited and excess P in soils can lead to ecological damage such as eutrophication. Worldwide, there is an increasing interest in organic farming (OF) due to its good environmental performance. However, organic cropping systems are suspected of generating negative P budgets, which questions their ability to provide sustainable P management. The design of agricultural systems at a broader scale also largely influences the shape of the P cycle and the possibility of its recycling to cropland. In this context, the aim of this study was to assess the relative influence of (i) OF versus conventional farming (CF) practices and (ii) the structure of agro-food systems at the regional scale, on P cycling and availability on cropland. For this purpose, we examined P budgets and soil P status of 14 organic and conventional cropping systems in commercial farms located in the Paris Basin. Available P was analyzed using two different methods: resin P and Olsen P. The results revealed no significant differences between CF and OF in available P stocks. Phosphorus budgets were always negative and significantly lower in CF systems, indicating that P was mined from soil reserves. In parallel, we estimated P budgets over cropland in all French regions for two distinct periods, 2004-2014 and 1970-1981, and showed that specialized intensive cropping systems in the Paris Basin led to a high, positive P budget in the latter period. However, this trend was reversed in the 2004-2014 period due to a sharp reduction of the mineral fertilizer application rate. The shift from very high P budgets to much lower and sometimes negative P budgets would not be a threat for agriculture due to the current high level of Olsen P in these regions, which was consistent with our measurements at the plot scale. Overall, these results suggest that OF would not lead to more P deficiency

  12. A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia.

    Science.gov (United States)

    Livingston, Gill; Kelly, Lynsey; Lewis-Holmes, Elanor; Baio, Gianluca; Morris, Stephen; Patel, Nishma; Omar, Rumana Z; Katona, Cornelius; Cooper, Claudia

    2014-06-01

    of life (DEMQOL-Proxy-U scores) and developed a new cost-effectiveness model. We included 160 out of 1916 papers screened. Supervised person-centred care, communication skills (SES = -1.8 to -0.3) or modified dementia care mapping (DCM) with implementing plans (SES = -1.4 to -0.6) were all efficacious at reducing clinically significant agitation in care home residents, both immediately and up to 6 months afterwards. In care home residents, during interventions but not at follow-up, activities (SES = -0.8 to -0.6) and music therapy (SES = -0.8 to -0.5) by protocol reduced mean levels of agitation; sensory intervention (SES = -1.3 to -0.6) reduced mean and clinically significant symptoms. Advantages were not demonstrated with 'therapeutic touch' or individualised activity. Aromatherapy and light therapy did not show clinical effectiveness. Training family carers in behavioural or cognitive interventions did not decrease severe agitation. The few studies reporting activities of daily living or quality-of-life outcomes found no improvement, even when agitation had improved. We identified two health economic studies. Costs of interventions which significantly impacted on agitation were activities, £80-696; music therapy, £13-27; sensory interventions, £3-527; and training paid caregivers in person-centred care or communication skills with or without behavioural management training and DCM, £31-339. Among the 11 interventions that were evaluated using the Cohen-Mansfield Agitation Inventory (CMAI), the incremental cost per unit reduction in CMAI score ranged from £162 to £3480 for activities, £4 for music therapy, £24 to £143 for sensory interventions, and £6 to £62 for training paid caregivers in person-centred care or communication skills with or without behavioural management training and DCM. Health and social care costs ranged from around £7000 over 3 months in people without clinically significant agitation symptoms to around £15

  13. Exercise and self-management for people with chronic knee, hip or lower back pain: a cluster randomised controlled trial of clinical and cost-effectiveness. Study protocol.

    Science.gov (United States)

    Walsh, Nicola; Cramp, Fiona; Palmer, Shea; Pollock, Jon; Hampson, Lisa; Gooberman-Hill, Rachael; Green, Colin; Jones, Louise; Phillips, Sonia; Johnson, Liz; Hurley, Mike

    2013-12-01

    Chronic musculoskeletal pain and osteoarthritis can significantly limit the functional independence of individuals, and given that 25% of the population experience these problems, the socioeconomic impact is immense. Exercise and self-management have proven benefits for these conditions, but most trials tailor interventions for specific joints. Epidemiological data demonstrates that many older people with degenerative joint problems experience pain and functional difficulty in other joints, seeking further healthcare input when these present. Managing multiple joint presentations simultaneously could potentially reduce the need for repeat visits to healthcare professionals as advice is frequently the same for differing site presentations. This single-blind cluster randomised controlled trial will determine the clinical and cost-effectiveness of an exercise and self-management intervention delivered to people over-50 with either hip, knee or lower back pain, compared to 'standard' GP care. A qualitative analysis will also establish the acceptability of the intervention. 352 people with chronic degenerative musculoskeletal pain of the hip, knee or lower back will be recruited from primary care. GP surgeries will be randomised to either the intervention or control arms. Participants in the intervention arm will receive a 6-week group exercise and self-management programme facilitated by a physiotherapist in primary care. Participants allocated to the control arm will continue under 'standard' GP care. The primary outcome measure is the Dysfunction Index of the Short Musculoskeletal Functional Assessment (SMFA). Individual patient responses will be modelled using a mixed effects linear regression, allowing for the clustering effects. Resource use and related intervention costs will be estimated and broader resource use data will be collected using a version of the Client Service Receipt Inventory adapted for musculoskeletal relevance. In addition, a cost

  14. Cost-effectiveness of alternative strategies for the initial medical management of non-ST elevation acute coronary syndrome: systematic review and decision-analytical modelling.

    Science.gov (United States)

    Robinson, M; Palmer, S; Sculpher, M; Philips, Z; Ginnelly, L; Bowens, A; Golder, S; Alfakih, K; Bakhai, A; Packham, C; Cooper, N; Abrams, K; Eastwood, A; Pearman, A; Flather, M; Gray, D; Hall, A

    2005-07-01

    as part of the initial medical management of all non-ST elevation ACS was the optimal choice, with an incremental cost-effectiveness ratio (ICER) of 5738 pounds per quality-adjusted life-year (QALY) compared with no use of GPAs. Stochastic analysis showed that if the health service is willing to pay 10,000 pounds per additional QALY, the probability of this strategy being cost-effective was around 82%, increasing to 95% at a threshold of 50,000 pounds per QALY. A sensitivity analysis including an additional strategy of using GPAs as part of initial medical management only in patients at particular high risk (as defined by age, ST depression or diabetes) showed that this additional strategy was yet more cost-effective, with an ICER of 3996 pounds per QALY compared with no treatment with GPA. Value of information analysis suggested that there was considerable merit in additional research to reduce the level of uncertainty in the optimal decision. At a threshold of 10,000 pounds per QALY, the maximum potential value of such research in the base case was calculated as 12.7 million pounds per annum for the UK as a whole. Taking account of the greater uncertainty in the sensitivity analyses including clopidogrel, this figure was increased to approximately 50 million pounds. This study suggests the use of GPAs in all non-ST elevation ACS patients as part of their initial medical management. Sensitivity analysis showed that virtually all of the benefit could be realised by treating only high-risk patients. Further clarification of the optimum role of GPAs in the UK NHS depends on the availability of further high-quality observational and trial data. Value of information analysis derived from the model suggests that a relatively large investment in such research may be worthwhile. Further research should focus on the identification of the characteristics of patients who benefit most from GPAs as part of medical management, the comparison of GPAs with clopidogrel as an adjunct

  15. Cost effectiveness of radon mitigation in Canada

    International Nuclear Information System (INIS)

    Letourneau, E.G.; Krewski, D.; Zielinski, J.M.; McGregor, R.G.

    1992-01-01

    This paper examines the cost effectiveness of comprehensive strategies for reducing exposure to radon gas in indoor air in Canadian homes. The analysis is conducted within the context of a general framework for risk management programme evaluation which includes well-known evaluation techniques such as cost effectiveness and cost-benefit analyses as special cases. Based on this analysis, it is clear that any comprehensive programme to reduce exposure to environmental radon will be extremely expensive, and may not be justifiable in terms of health impact, particularly when considered in relation to other public health programmes. Testing of homes at the point of sale and installing sub-slab suction equipment to reduce exposure to indoor radon where necessary appears to be a relatively cost-effective radon mitigation strategy. In general, radon mitigation was found to be most cost effective in cities with relatively high levels of radon. (author)

  16. Fit-for-purpose phosphorus management: do riparian buffers qualify in catchments with sandy soils?

    Science.gov (United States)

    Weaver, David; Summers, Robert

    2014-05-01

    Hillslope runoff and leaching studies, catchment-scale water quality measurements and P retention and release characteristics of stream bank and catchment soils were used to better understand reasons behind the reported ineffectiveness of riparian buffers for phosphorus (P) management in catchments with sandy soils from south-west Western Australia (WA). Catchment-scale water quality measurements of 60 % particulate P (PP) suggest that riparian buffers should improve water quality; however, runoff and leaching studies show 20 times more water and 2 to 3 orders of magnitude more P are transported through leaching than runoff processes. The ratio of filterable reactive P (FRP) to total P (TP) in surface runoff from the plots was 60 %, and when combined with leachate, 96 to 99 % of P lost from hillslopes was FRP, in contrast with 40 % measured as FRP at the large catchment scale. Measurements of the P retention and release characteristics of catchment soils (bank soil (bank soils suggest that catchment soils contain more P, are more P saturated and are significantly more likely to deliver FRP and TP in excess of water quality targets than stream bank soils. Stream bank soils are much more likely to retain P than contribute P to streams, and the in-stream mixing of FRP from the landscape with particulates from stream banks or stream beds is a potential mechanism to explain the change in P form from hillslopes (96 to 99 % FRP) to large catchments (40 % FRP). When considered in the context of previous work reporting that riparian buffers were ineffective for P management in this environment, these studies reinforce the notion that (1) riparian buffers are unlikely to provide fit-for-purpose P management in catchments with sandy soils, (2) most P delivered to streams in sandy soil catchments is FRP and travels via subsurface and leaching pathways and (3) large catchment-scale water quality measurements are not good indicators of hillslope P mobilisation and transport

  17. POEM is a cost-effective procedure: cost-utility analysis of endoscopic and surgical treatment options in the management of achalasia.

    Science.gov (United States)

    Miller, Heidi J; Neupane, Ruel; Fayezizadeh, Mojtaba; Majumder, Arnab; Marks, Jeffrey M

    2017-04-01

    Achalasia is a rare motility disorder of the esophagus. Treatment is palliative with the goal of symptom remission and slowing the progression of the disease. Treatment options include per oral endoscopic myotomy (POEM), laparoscopic Heller myotomy (LM) and endoscopic treatments such as pneumatic dilation (PD) and botulinum toxin type A injections (BI). We evaluate the economics and cost-effectiveness of treating achalasia. We performed cost analysis for POEM, LM, PD and BI at our institution from 2011 to 2015. Cost of LM was set to 1, and other procedures are presented as percentage change. Cost-effectiveness was calculated based on cost, number of interventions required for optimal results for dilations and injections and efficacy reported in the current literature. Incremental cost-effectiveness ratio was calculated by a cost-utility analysis using quality-adjusted life year gained, defined as a symptom-free year in a patient with achalasia. Average number of interventions required was 2.3 dilations or two injections for efficacies of 80 and 61 %, respectively. POEM cost 1.058 times the cost of LM, and PD and BI cost 0.559 and 0.448 times the cost of LM. Annual cost per cure over a period of 4 years for POEM, and LM were consistently equivalent, trending the same as PD although this has a lower initial cost. The cost per cure of BI remains stable over 3 years and then doubles. The cost-effectiveness of POEM and LM is equivalent. Myotomy, either surgical or endoscopic, is more cost-effective than BI due to high failure rates of the economical intervention. When treatment is being considered BI should be utilized in patients with less than 2-year life expectancy. Pneumatic dilations are cost-effective and are an acceptable approach to treatment of achalasia, although myotomy has a lower relapse rate and is cost-effective compared to PD after 2 years.

  18. Comparative study of balloon and metal olive dilators for endoscopic management of benign anastomotic rectal strictures: clinical and cost-effectiveness outcomes.

    Science.gov (United States)

    Xinopoulos, Dimitrios; Kypreos, Dimitrios; Bassioukas, Stefanos P; Korkolis, Dimitrios; Mavridis, Konstantinos; Scorilas, Andreas; Dimitroulopoulos, Dimitrios; Loukou, Argyro; Paraskevas, Emmanouel

    2011-03-01

    Postoperative anastomotic strictures frequently complicate colorectal resection. Currently, various endoscopic techniques are being employed in their management, but the establishment of an optimal therapeutic strategy is still pending. The purpose of our study is to compare through-the-scope (TTS) balloon dilators versus Eder-Puestow metal olive dilators in the treatment of postoperative benign rectal strictures, considering the clinical outcome and cost-effectiveness of each method. A total of 39 patients with benign anastomotic rectal stenosis were retrospectively studied. In group A, 15 patients underwent dilation with Eder-Puestow metal olives, while in group B 19 patients were treated by means of TTS balloon dilators. The technical and clinical success of dilation, complications, number of repeated sessions required, disease-free time intervals, and the overall cost of each procedure were evaluated. Dilations were technically successful in all patients. No major complications occurred in either group. The number of dilations needed, rate of stricture recurrence, and duration of stenosis-free time intervals were not statistically significantly different between the two groups. Both methods proved more effective in older patients, given the greater number of dilations required in younger patients of both groups and higher frequency of stricture relapse in younger balloon-dilated patients (median 64.00 years) compared with older ones (median 75.00 years) (p = 0.001). An indisputable advantage of the Eder-Puestow technique, compared with TTS balloon dilators, is the low cost of equipment (median 22.30 compared with 680 , respectively; p Puestow bougies or TTS balloon dilators. However, metal olivary tips seem to surpass balloon dilators when considering the obvious economical benefits of the first method.

  19. Spleen hydatidosis treated by hemi-splenectomy: A low-morbidity, cost-effective management by a recently improved surgical technique.

    Science.gov (United States)

    Costi, Renato; Castro Ruiz, Carolina; Zarzavadjian le Bian, Alban; Scerrati, Daniele; Santi, Caterina; Violi, Vincenzo

    2015-08-01

    Splenic hydatidosis is a rare condition and is usually managed by total splenectomy, which is associated to various complications, including overwhelming post-splenectomy sepsis and thrombosis. Probably due to supposed technical difficulties, the partial splenectomy is rarely performed being often unknown to physicians, infectious disease specialists and surgeons. Demographic, clinical and surgical data were collected of four consecutive patients undergoing partial (or hemi-) splenectomy using an original, recently improved technique as a treatment for polar splenic hydatid cyst. The procedure implies a selective vascular ligation, a mechanical stapler-assisted section and haemostatic agents (Surgicel(®)) application on the cutting surface. Three patients were treated by laparotomy (including one affected by both liver and spleen localizations) whereas the last one was approached laparoscopically. Partial splenectomy operative time reached 74 min (range: 60-94 min) and blood loss was 8 ml (range: 5-10 ml). Hospital stay was 5.6 days (range: 5-7 days). At a mean follow-up of 20 months (range: 12-36 months), outcomes were uneventful. Partial splenectomy for hydatidosis is effective and safe. Physicians and surgeons should be aware of such an easy-to-catch option when dealing with benign splenic conditions, such as parasitic cysts. Cost-effectiveness, low morbidity and the possible prevention of splenectomy-related infectious complications should plead in favor of this technique in developing countries, where hydatidosis is endemic and post-splenectomy drugs and vaccines may be lacking. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  20. Cost-Effectiveness Analysis of Microscopic and Endoscopic Transsphenoidal Surgery Versus Medical Therapy in the Management of Microprolactinoma in the United States.

    Science.gov (United States)

    Jethwa, Pinakin R; Patel, Tapan D; Hajart, Aaron F; Eloy, Jean Anderson; Couldwell, William T; Liu, James K

    2016-03-01

    Although prolactinomas are treated effectively with dopamine agonists, some have proposed curative surgical resection for select cases of microprolactinomas to avoid life-long medical therapy. We performed a cost-effectiveness analysis comparing transsphenoidal surgery (either microsurgical or endoscopic) and medical therapy (either bromocriptine or cabergoline) with decision analysis modeling. A 2-armed decision tree was created with TreeAge Pro Suite 2012 to compare upfront transsphenoidal surgery versus medical therapy. The economic perspective was that of the health care third-party payer. On the basis of a literature review, we assigned plausible distributions for costs and utilities to each potential outcome, taking into account medical and surgical costs and complications. Base-case analysis, sensitivity analysis, and Monte Carlo simulations were performed to determine the cost-effectiveness of each strategy at 5-year and 10-year time horizons. In the base-case scenario, microscopic transsphenoidal surgery was the most cost-effective option at 5 years from the time of diagnosis; however, by the 10-year time horizon, endoscopic transsphenoidal surgery became the most cost-effective option. At both time horizons, medical therapy (both bromocriptine and cabergoline) were found to be more costly and less effective than transsphenoidal surgery (i.e., the medical arm was dominated by the surgical arm in this model). Two-way sensitivity analysis demonstrated that endoscopic resection would be the most cost-effective strategy if the cure rate from endoscopic surgery was greater than 90% and the complication rate was less than 1%. Monte Carlo simulation was performed for endoscopic surgery versus microscopic surgery at both time horizons. This analysis produced an incremental cost-effectiveness ratio of $80,235 per quality-adjusted life years at 5 years and $40,737 per quality-adjusted life years at 10 years, implying that with increasing time intervals, endoscopic

  1. Modeling diffuse phosphorus emissions to assist in best management practice designing

    Science.gov (United States)

    Kovacs, Adam; Zessner, Matthias; Honti, Mark; Clement, Adrienne

    2010-05-01

    A diffuse emission modeling tool has been developed, which is appropriate to support decision-making in watershed management. The PhosFate (Phosphorus Fate) tool allows planning best management practices (BMPs) in catchments and simulating their possible impacts on the phosphorus (P) loads. PhosFate is a simple fate model to calculate diffuse P emissions and their transport within a catchment. The model is a semi-empirical, catchment scale, distributed parameter and long-term (annual) average model. It has two main parts: (a) the emission and (b) the transport model. The main input data of the model are digital maps (elevation, soil types and landuse categories), statistical data (crop yields, animal numbers, fertilizer amounts and precipitation distribution) and point information (precipitation, meteorology, soil humus content, point source emissions and reservoir data). The emission model calculates the diffuse P emissions at their source. It computes the basic elements of the hydrology as well as the soil loss. The model determines the accumulated P surplus of the topsoil and distinguishes the dissolved and the particulate P forms. Emissions are calculated according to the different pathways (surface runoff, erosion and leaching). The main outputs are the spatial distribution (cell values) of the runoff components, the soil loss and the P emissions within the catchment. The transport model joins the independent cells based on the flow tree and it follows the further fate of emitted P from each cell to the catchment outlets. Surface runoff and P fluxes are accumulated along the tree and the field and in-stream retention of the particulate forms are computed. In case of base flow and subsurface P loads only the channel transport is taken into account due to the less known hydrogeological conditions. During the channel transport, point sources and reservoirs are also considered. Main results of the transport algorithm are the discharge, dissolved and sediment

  2. Reducing phosphorus loss in tile water with managed drainage in a claypan soil.

    Science.gov (United States)

    Nash, Patrick R; Nelson, Kelly A; Motavalli, Peter P; Nathan, Manjula; Dudenhoeffer, Chris

    2015-03-01

    Installing subsurface tile drain systems in poorly drained claypan soils to improve corn ( L.) yields could potentially increase environmental phosphorus (P) loss through the tile drainage system. The objectives of the study were to quantify the average concentration and loss of ortho-P in tile drain water from a claypan soil and to determine whether managed subsurface drainage (MD) could reduce ortho-P loss in tile water compared with free subsurface drainage (FD). Flow-weighted ortho-P concentration in the tile water was significantly lower with MD (0.09 mg L) compared with that of FD (0.15 mg L). Ortho-P loss in the tile water of this study was reduced with MD (36 g ha) by 80% compared with FD (180 g ha). Contrary to previous research, reduced ortho-P loss observed over the 4-yr study was not solely due to the reduced amount of water drained annually (63%) with MD compared with FD. During the spring period, when flow was similar between MD and FD, the concentration of ortho-P in the tile water generally was lower with MD compared with FD, which resulted in significantly less ortho-P loss with MD. We speculate that MD's ability to conserve water during the dry summer months increased corn's uptake of water and P, which reduced the amount of P available for leaching loss in the subsequent springs. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  3. Effect of water management and silicon on germination, growth, phosphorus and arsenic uptake in rice.

    Science.gov (United States)

    Zia, Zahida; Bakhat, Hafiz Faiq; Saqib, Zulfiqar Ahmad; Shah, Ghulam Mustafa; Fahad, Shah; Ashraf, Muhammad Rizwan; Hammad, Hafiz Mohkum; Naseem, Wajid; Shahid, Muhammad

    2017-10-01

    Silicon (Si) is the 2nd most abundant element in soil which is known to enhance stress tolerance in wide variety of crops. Arsenic (As), a toxic metalloid enters into the human food chain through contaminated water and food or feed. To alleviate the deleterious effect of As on human health, it is a need of time to find out an effective strategy to reduce the As accumulation in the food chain. The experiments were conducted during September-December 2014, and 2016 to optimize Si concentration for rice (Oryza sativa L.) exposed to As stress. Further experiment were carried out to evaluate the effect of optimum Si on rice seed germination, seedling growth, phosphorus and As uptake in rice plant. During laboratory experiment, rice seeds were exposed to 150 and 300µM As with and without 3mM Si supplementation. Results revealed that As application, decreased the germination up to 40-50% as compared to control treatment. Arsenic stress also significantly (P management, significantly (P˂0.05) affected the plant growth, Si and As concentrations in the plant. Arsenic uptake was relatively less under aerobic conditions. The maximum As concentration (9.34 and 27.70mgkg DW -1 in shoot and root, respectively) was found in plant treated with 300µM As in absence of Si under anaerobic condition. Similarly, anaerobic condition resulted in higher As uptake in the plants. The study demonstrated that aerobic cultivation is suitable to decrease the As uptake and in rice exogenous Si supply is beneficial to decrease As uptake under both anaerobic and aerobic conditions. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Drainage water management combined with cover crop enhances reduction of soil phosphorus loss.

    Science.gov (United States)

    Zhang, T Q; Tan, C S; Zheng, Z M; Welacky, T; Wang, Y T

    2017-05-15

    Integrating multiple practices for mitigation of phosphorus (P) loss from soils may enhance the reduction efficiency, but this has not been studied as much as individual ones. A four-year study was conducted to determine the effects of cover crop (CC) (CC vs. no CC, NCC) and drainage water management (DWM) (controlled drainage with sub-irrigation, CDS, vs. regular free tile drainage, RFD) and their interaction on P loss through both surface runoff (SR) and tile drainage (TD) water in a clay loam soil of the Lake Erie region. Cover crop reduced SR flow volume by 32% relative to NCC, regardless of DWM treatment. In contrast, CC increased TD flow volume by 57 and 9.4% with CDS and RFD, respectively, compared to the corresponding DWM treatment with NCC. The total (SR+TD) field water discharge volumes were comparable amongst all the treatments. Cover crop reduced flow-weighted mean (FWM) concentrations of particulate P (PP) by 26% and total P (TP) by 12% in SR, while it didn't affect the FWM dissolved reactive P (DRP) concentration, regardless of DWM treatments. Compared with RFD, CDS reduced FWM DRP concentration in TD water by 19%, while CC reduced FWM PP and TP concentrations in TD by 21 and 17%, respectively. Total (SR+TD) soil TP loss was the least with CDS-CC followed by RFD-CC, CDS-NCC, and RFD-NCC. Compared with RFD-NCC, currently popular practice in the region, total TP loss was reduced by 23% with CDS-CC. The CDS-CC system can be an effective practice to ultimately mitigate soil P loading to water resource. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Gedanken Experiments in Educational Cost Effectiveness

    Science.gov (United States)

    Brudner, Harvey J.

    1978-01-01

    Discusses the effectiveness of cost determining techniques in education. The areas discussed are: education and management; cost-effectiveness models; figures of merit determination; and the implications as they relate to the areas of audio-visual and computer educational technology. (Author/GA)

  6. Assessment of soil phosphorus status and management of phosphatic fertilisers to optimise crop production

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2002-02-01

    Phosphorus (P) is an essential plant nutrient, and its deficiency in soils severely restricts crop yields. Tropical and subtropical soils are predominantly acidic and often extremely deficient in phosphorus. Moreover most of these soils possess a high phosphate sorption capacity. Strongly sorbed or fixed phosphate is unavailable for plant uptake. Therefore, substantial P inputs are required for optimum plant growth and adequate food and fiber production. Manufactured water-soluble P fertilizers, like superphosphates, are the commonest P inputs. However, in most developing countries these P fertilizers are not produced locally but are imported, and their supplies to resource-poor farmers in rural areas are limited. Many phosphate-bearing mineral deposits exist worldwide. Several developing countries with P-deficient tropical acid soils have important phosphate rock deposits, that is the raw material for the production of P fertilizers. Thus, under certain soil and climatic conditions, direct application of phosphate rocks (PRs) is an agronomically and economically sound alternative to the use of expensive superphosphates. In spite of extensive research on the application of PR to acid soils in temperate regions, there is scant information on the potential of local PR sources in tropical and subtropical regions. Phosphate rocks vary widely in their mineralogical, chemical and physical properties and consequently in their reactivity and agronomic potential. It is, therefore, necessary to assess the relative agronomic effectiveness of the indigenous and imported PRs using the commercially available superphosphate as a reference. Also, changes in the soil available P when amended with PR products and water-soluble P fertilizers need to be properly monitored with suitable soil P testing methods for the provision of adequate P fertilizer recommendations. During the 1980's, some local PR sources were evaluated in the FAO Fertilizer Programme. The idea of a project on PR

  7. Assessment of soil phosphorus status and management of phosphatic fertilisers to optimise crop production

    International Nuclear Information System (INIS)

    2002-02-01

    Phosphorus (P) is an essential plant nutrient, and its deficiency in soils severely restricts crop yields. Tropical and subtropical soils are predominantly acidic and often extremely deficient in phosphorus. Moreover most of these soils possess a high phosphate sorption capacity. Strongly sorbed or fixed phosphate is unavailable for plant uptake. Therefore, substantial P inputs are required for optimum plant growth and adequate food and fiber production. Manufactured water-soluble P fertilizers, like superphosphates, are the commonest P inputs. However, in most developing countries these P fertilizers are not produced locally but are imported, and their supplies to resource-poor farmers in rural areas are limited. Many phosphate-bearing mineral deposits exist worldwide. Several developing countries with P-deficient tropical acid soils have important phosphate rock deposits, that is the raw material for the production of P fertilizers. Thus, under certain soil and climatic conditions, direct application of phosphate rocks (PRs) is an agronomically and economically sound alternative to the use of expensive superphosphates. In spite of extensive research on the application of PR to acid soils in temperate regions, there is scant information on the potential of local PR sources in tropical and subtropical regions. Phosphate rocks vary widely in their mineralogical, chemical and physical properties and consequently in their reactivity and agronomic potential. It is, therefore, necessary to assess the relative agronomic effectiveness of the indigenous and imported PRs using the commercially available superphosphate as a reference. Also, changes in the soil available P when amended with PR products and water-soluble P fertilizers need to be properly monitored with suitable soil P testing methods for the provision of adequate P fertilizer recommendations. During the 1980's, some local PR sources were evaluated in the FAO Fertilizer Programme. The idea of a project on PR

  8. Assessment of soil phosphorus status and management of phosphatic fertilizers to optimise crop production

    International Nuclear Information System (INIS)

    2002-03-01

    Phosphorus (P) is an essential plant nutrient, and its deficiency in soils severely restricts crop yields. Tropical and subtropical soils are predominantly acidic and often extremely deficient in phosphorus. Moreover most of these soils possess a high phosphate sorption capacity. Strongly sorbed or fixed phosphate is unavailable for plant uptake. Therefore, substantial P inputs are required for optimum plant growth and adequate food and fiber production. Manufactured water-soluble P fertilizers, like superphosphates, are the commonest P inputs. However, in most developing countries these P fertilizers are not produced locally but are imported, and their supplies to resource-poor farmers in rural areas are limited. Many phosphate-bearing mineral deposits exist worldwide. Several developing countries with P-deficient tropical acid soils have important phosphate rock deposits, that is the raw material for the production of P fertilizers. Thus, under certain soil and climatic conditions, direct application of phosphate rocks (PRs) is an agronomically and economically sound alternative to the use of expensive superphosphates. In spite of extensive research on the application of PR to acid soils in temperate regions, there is scant information on the potential of local PR sources in tropical and subtropical regions. Phosphate rocks vary widely in their mineralogical, chemical and physical properties and consequently in their reactivity and agronomic potential. It is, therefore, necessary to assess the relative agronomic effectiveness of the indigenous and imported PRs using the commercially available superphosphate as a reference. Also, changes in the soil available P when amended with PR products and water-soluble P fertilizers need to be properly monitored with suitable soil P testing methods for the provision of adequate P fertilizer recommendations. During the 1980's, some local PR sources were evaluated in the FAO Fertilizer Programme. The idea of a project on PR

  9. Long-term grassland management effects on soil Phosphorus status on rewetted Histosols

    Science.gov (United States)

    Heller, Sebastian; Müller, Jürgen; Kayser, Manfred

    2017-04-01

    Since the Neolithic Period, the cultivation of wetlands has played a significant role for the settlement of Humans northwest Germany. A continuing drainage of the wetlands over the centuries and an intensified soil cultivation during the last decades has caused irreversible peat degradation and led to fundamental changes in the landscape. Nowadays, almost 70 % of the 4345 km2 peatland of Lower Saxony is altered by agriculture. For the revitalization of wetland ecosystems, permanent rewetting is an integral component to preserve the functions of organic soils and achieve resilient, speciesrich wetlands. However, permanent rewetting measures are not always feasible. In our study area at the Osterfeiner Moor, a fen located in the Dümmer lowlands near Osnabrück, intensive forage cropping areas were converted into extensive permanent grasslands accompanied by temporary rewetting during winter. This management practice combined with zero fertilization and a low mowing and grazing intensity aims at mitigating mineralisation of peat layers and creating a habitat for endangered meadow bird species. In this semi-natural ecosystem soil phosphorus (P) dynamics play a crucial role. However, longterm research results on P availability of degraded and rewetted fens are still lacking. Thus, we investigated the interaction of different grassland uses and P dynamics in the soil. We described P depletion of the topsoil over a time scale of 17 years after the implementation of restoration measures. Our study site comprises of 180 ha protected grassland divided into 52 management plots. According to the management system, we divided the plots into meadows, pastures and combinations of cutting and grazing. The soils in our study area can be characterised as drained organic soils, WRB: Rheic Sapric Histosols (Drainic), with drastic degradation properties through moorsh forming processes. Plant-available P (double lactate extraction method: PDL) was analysed from representative topsoil

  10. Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort - The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care).

    Science.gov (United States)

    Maru, Shoko; Byrnes, Joshua; Carrington, Melinda J; Chan, Yih-Kai; Thompson, David R; Stewart, Simon; Scuffham, Paul A

    2015-12-15

    To assess the long-term cost-effectiveness of two multidisciplinary management programs for elderly patients hospitalized with chronic heart failure (CHF) and how it is influenced by patient characteristics. A trial-based analysis was conducted alongside a randomized controlled trial of 280 elderly patients with CHF discharged to home from three Australian tertiary hospitals. Two interventions were compared: home-based intervention (HBI) that involved home visiting with community-based care versus specialized clinic-based intervention (CBI). Bootstrapped incremental cost-utility ratios were computed based on quality-adjusted life-years (QALYs) and total healthcare costs. Cost-effectiveness acceptability curves were constructed based on incremental net monetary benefit (NMB). We performed multiple linear regression to explore which patient characteristics may impact patient-level NMB. During median follow-up of 3.2 years, HBI was associated with slightly higher QALYs (+0.26 years per person; p=0.078) and lower total healthcare costs (AU$ -13,100 per person; p=0.025) mainly driven by significantly reduced duration of all-cause hospital stay (-10 days; p=0.006). At a willingness-to-pay threshold of AU$ 50,000 per additional QALY, the probability of HBI being better-valued was 96% and the incremental NMB of HBI was AU$ 24,342 (discounted, 5%). The variables associated with increased NMB were HBI (vs. CBI), lower Charlson Comorbidity Index, no hyponatremia, fewer months of HF, fewer prior HF admissions <1 year and a higher patient's self-care confidence. HBI's net benefit further increased in those with fewer comorbidities, a lower self-care confidence or no hyponatremia. Compared with CBI, HBI is likely to be cost-effective in elderly CHF patients with significant comorbidity. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Effect of water management, tillage options and phosphorus status on arsenic uptake in rice.

    Science.gov (United States)

    Talukder, A S M H M; Meisner, C A; Sarkar, M A R; Islam, M S

    2011-05-01

    High arsenic (As) concentrations in soil may lead to elevated concentrations of arsenic in agricultural products. Field experiments were conducted to examine the effects of water management (WM) and Phosphorus (P) rates on As uptake, rice growth, yield and yield attributes of winter (boro) and monsoon (aman) rice in an As contaminated soil-water at Gobindagonj, Gaibandha, Bangladesh in 2004 and 2005. Significantly, the highest average grain yields (6.88±0.07 t ha(-1) in boro 6.38±0.06 t ha(-1) in aman) were recorded in permanent raised bed (PRB; aerobic WM: Eh=+360 mV) plus 100% P amendment. There was a 12% yield increase over conventional till on flat (CTF; anaerobic WM: Eh=-56 mV) at the same P level. In boro, the As content in grain and As content in straw were about 3 and 6 times higher in CTF compared to PRB, respectively. The highest total As content (0.646±0.01 ppm in grain and 10.93±0.19 ppm in straw) was recorded under CTF, and the lowest total As content (0.247±0.01 and 1.554±0.09 ppm in grain and straw, respectively) was recorded under PRB (aerobic WM). The results suggest that grain and straw As are closely associated in boro rice. The furrow irrigation approach of the PRB treatments consistently reduced irrigation input by 29-31% for boro and 27-30% for aman rice relative to CTF treatments in 2004 and 2005, respectively, thus reducing the amount of As added to the soil from the As-contaminated irrigation water. Yearly, 30% less As was deposited to the soil compared to CTF system through irrigation water during boro season. High As concentrations in grain and straw in rice grown using CTF in the farmers' field, and the fact that using PRB reduced grain As concentrations to value less than half of the proposed food hygiene standard. Copyright © 2010 Elsevier Inc. All rights reserved.

  12. Atmospheric Deposition of Phosphorus to the Everglades: Concepts, Constraints, and Published Deposition Rates for Ecosystem Management

    Directory of Open Access Journals (Sweden)

    Garth W. Redfield

    2002-01-01

    Full Text Available This paper summarizes concepts underlying the atmospheric input of phosphorus (P to ecosystems, published rates of P deposition, measurement methods, and approaches to future monitoring and research. P conveyed through the atmosphere can be a significant nutrient source for some freshwater and marine ecosystems. Particle sources and sinks at the land-air interface produce variation in P deposition from the atmosphere across temporal and spatial scales. Natural plant canopies can affect deposition rates by changing the physical environment and surface area for particle deposition. Land-use patterns can alter P deposition rates by changing particle concentrations in the atmosphere. The vast majority of P in dry atmospheric deposition is conveyed by coarse (2.5 to 10 μm and giant (10 to 100 μm particles, and yet these size fractions represent a challenge for long-term atmospheric monitoring in the absence of accepted methods for routine sampling. Most information on P deposition is from bulk precipitation collectors and wet/dry bucket sampling, both with questionable precision and accuracy. Most published annual rates of P deposition are gross estimates derived from bulk precipitation sampling in locations around the globe and range from about 5 to well over 100 mg P m–2 year–1, although most inland ecosystems receive between 20 and 80 mg P m–2 year–1. Rates below 30 mg P m–2 year–1 are found in remote areas and near coastlines. Intermediate rates of 30 to 50 mg P m–2 year–1 are associated with forests or mixed land use, and rates of 50 to 100 mg P m–2 year–1 or more are often recorded from urban or agricultural settings. Comparison with other methods suggests that these bulk precipitation estimates provide crude boundaries around actual P deposition rates for various land uses. However, data screening cannot remove all positive bias caused by contamination of bucket or bulk collectors. As a consequence, continued sampling

  13. Controlling Healthcare Costs: Just Cost Effectiveness or "Just" Cost Effectiveness?

    Science.gov (United States)

    Fleck, Leonard M

    2018-04-01

    Meeting healthcare needs is a matter of social justice. Healthcare needs are virtually limitless; however, resources, such as money, for meeting those needs, are limited. How then should we (just and caring citizens and policymakers in such a society) decide which needs must be met as a matter of justice with those limited resources? One reasonable response would be that we should use cost effectiveness as our primary criterion for making those choices. This article argues instead that cost-effectiveness considerations must be constrained by considerations of healthcare justice. The goal of this article will be to provide a preliminary account of how we might distinguish just from unjust or insufficiently just applications of cost-effectiveness analysis to some healthcare rationing problems; specifically, problems related to extraordinarily expensive targeted cancer therapies. Unconstrained compassionate appeals for resources for the medically least well-off cancer patients will be neither just nor cost effective.

  14. Cost-effectiveness analysis of the national implementation of integrated community case management and community-based health planning and services in Ghana for the treatment of malaria, diarrhoea and pneumonia.

    Science.gov (United States)

    Escribano Ferrer, Blanca; Hansen, Kristian Schultz; Gyapong, Margaret; Bruce, Jane; Narh Bana, Solomon A; Narh, Clement T; Allotey, Naa-Korkor; Glover, Roland; Azantilow, Naa-Charity; Bart-Plange, Constance; Sagoe-Moses, Isabella; Webster, Jayne

    2017-07-05

    Ghana has developed two main community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia: the integrated community case management (iCCM) and the community-based health planning and services (CHPS). The aim of the study was to assess the cost-effectiveness of these strategies under programme conditions. A cost-effectiveness analysis was conducted. Appropriate diagnosis and treatment given was the effectiveness measure used. Appropriate diagnosis and treatment data was obtained from a household survey conducted 2 and 8 years after implementation of iCCM in the Volta and Northern Regions of Ghana, respectively. The study population was carers of children under-5 years who had fever, diarrhoea and/or cough in the last 2 weeks prior to the interview. Costs data was obtained mainly from the National Malaria Control Programme (NMCP), the Ministry of Health, CHPS compounds and from a household survey. Appropriate diagnosis and treatment of malaria, diarrhoea and suspected pneumonia was more cost-effective under the iCCM than under CHPS in the Volta Region, even after adjusting for different discount rates, facility costs and iCCM and CHPS utilization, but not when iCCM appropriate treatment was reduced by 50%. Due to low numbers of carers visiting a CBA in the Northern Region it was not possible to conduct a cost-effectiveness analysis in this region. However, the cost analysis showed that iCCM in the Northern Region had higher cost per malaria, diarrhoea and suspected pneumonia case diagnosed and treated when compared to the Volta Region and to the CHPS strategy in the Northern Region. Integrated community case management was more cost-effective than CHPS for the treatment of malaria, diarrhoea and suspected pneumonia when utilized by carers of children under-5 years in the Volta Region. A revision of the iCCM strategy in the Northern Region is needed to improve its cost-effectiveness. Long-term financing

  15. Assessment of the cost-effectiveness and clinical outcomes of a fourth-generation synchronous telehealth program for the management of chronic cardiovascular disease.

    Science.gov (United States)

    Ho, Yi-Lwun; Yu, Jiun-Yu; Lin, Yen-Hung; Chen, Ying-Hsien; Huang, Ching-Chang; Hsu, Tse-Pin; Chuang, Pao-Yu; Hung, Chi-Sheng; Chen, Ming-Fong

    2014-06-10

    Telehealth programs are a growing field in the care of patients. The evolution of information technology has resulted in telehealth becoming a fourth-generation synchronous program. However, long-term outcomes and cost-effectiveness analysis of fourth-generation telehealth programs have not been reported in patients with chronic cardiovascular diseases. We conducted this study to assess the clinical outcomes and cost-effectiveness of a fourth-generation synchronous telehealth program for patients with chronic cardiovascular diseases. We retrospectively analyzed 575 patients who had joined a telehealth program and compared them with 1178 patients matched for sex, age, and Charlson comorbidity index. The program included: (1) instant transmission of biometric data, (2) daily telephone interview, and (3) continuous decision-making support. Data on hospitalization, emergency department (ED) visits, and medical costs were collected from the hospital's database and were adjusted to the follow-up months. The mean age was 64.5 years (SD 16.0). The mean number of monthly ED visits (mean 0.06 SD 0.13 vs mean 0.09 SD 0.23, P<.001), hospitalizations (mean 0.05 SD 0.12 vs mean 0.11 SD 0.21, P<.001), length of hospitalization (mean 0.77 days SD 2.78 vs mean 1.4 SD 3.6, P<.001), and intensive care unit admissions (mean 0.01 SD 0.07 vs mean 0.036 SD 0.14, P<.001) were lower in the telehealth group. The monthly mean costs of ED visits (mean US$20.90 SD 66.60 vs mean US$37.30 SD 126.20, P<.001), hospitalizations (mean US$386.30 SD 1424.30 vs mean US$878.20 SD 2697.20, P<.001), and all medical costs (mean US$587.60 SD 1497.80 vs mean US$1163.60 SD 3036.60, P<.001) were lower in the telehealth group. The intervention costs per patient were US$224.80 per month. Multivariate analyses revealed that age, telehealth care, and Charlson index were the independent factors for ED visits, hospitalizations, and length of hospitalization. A bootstrap method revealed the dominant cost-effectiveness

  16. Describing the characteristics, treatment pathways, outcomes, and costs of people with persistent noncancer pain managed by community pain clinics and generating an indicative estimate of cost-effectiveness: feasibility study protocol

    Directory of Open Access Journals (Sweden)

    AlAujan S

    2016-05-01

    Full Text Available Shiekha AlAujan,1 Saja AlMazrou,1 Roger D Knaggs,1,2 Rachel A Elliott11Division for Social Research in Medicines and Health, The School of Pharmacy, University of Nottingham, Nottingham, UK; 2Pharmacy Department and Pain Management Service, Nottingham University Hospitals NHS Trust, Nottingham, UKBackground: Low back pain (LBP and fibromyalgia (FM, also known as chronic widespread pain (CWP, are highly prevalent chronic painful conditions that have substantial impact on patients, health care systems, and society. Diagnosis is complex and management strategies are associated with various levels of evidence for effectiveness and cost-effectiveness. Multidisciplinary pain services have been shown to be effective in some settings and therefore are recommended by clinical practice guidelines as a rational treatment option to manage these patients. Knowing that these services are resource intensive, evidence is needed to demonstrate their cost-effectiveness. This study aims to describe the management of patients with LBP and FM in two community pain clinics to derive an indicative estimate of cost-effectiveness compared with standard practice.Methods: This is a prospective observational multicenter study, using patient-level data. The data from this study will be combined with modelling of the long-term economic impact of community pain clinics in treating people with LBP and FM. Newly referred patients with LBP and FM who provide written consent will be included. We will collect data on functional disability, pain intensity, quality of life, and health resource utilization. Follow-up data at the 3- and 6-month points will be collected by patient-completed questionnaires and health care contact diaries. Health care resource use from diaries will be compared with patient electronic records to assess the agreement between these recording methods. Patient cohort characteristics, treatment pathways, resource use, and outcomes derived from this study will

  17. Management of the first in vitro fertilization cycle for unexplained infertility: a cost-effectiveness analysis of split in vitro fertilization-intracytoplasmic sperm injection.

    Science.gov (United States)

    Vitek, Wendy S; Galárraga, Omar; Klatsky, Peter C; Robins, Jared C; Carson, Sandra A; Blazar, Andrew S

    2013-11-01

    To determine the cost-effectiveness of split IVF-intracytoplasmic sperm injection (ICSI) for the treatment of couples with unexplained infertility. Adaptive decision model. Academic infertility clinic. A total of 154 couples undergoing a split IVF-ICSI cycle and a computer-simulated cohort of women IVF. Modeling insemination method in the first IVF cycle as all IVF, split IVF-ICSI, or all ICSI, and adapting treatment based on fertilization outcomes. Live birth rate, incremental cost-effectiveness ratio (ICER). In a single cycle, all IVF is preferred as the ICER of split IVF-ICSI or all ICSI ($58,766) does not justify the increased live birth rate (3%). If two cycles are needed, split IVF/ICSI is preferred as the increased cumulative live birth rate (3.3%) is gained at an ICER of $29,666. In a single cycle, all IVF was preferred as the increased live birth rate with split IVF-ICSI and all ICSI was not justified by the increased cost per live birth. If two IVF cycles are needed, however, split IVF/ICSI becomes the preferred approach, as a result of the higher cumulative live birth rate compared with all IVF and the lesser cost per live birth compared with all ICSI. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  18. Animal-based agriculture, phosphorus management and water quality in Brazil: options for the future

    OpenAIRE

    Shigaki Francirose; Sharpley Andrew; Prochnow Luís Ignácio

    2006-01-01

    Eutrophication has become a major threat to water quality in the U.S., Europe, and Australasia. In most cases, freshwater eutrophication is accelerated by increased inputs of phosphorus (P), of which agricultural runoff is now a major contributor, due to intensification of crop and animal production systems since the early 1990s'. Once little information is available on the impacts of Brazilian agriculture in water quality, recent changes in crop and animal production systems in Brazil were e...

  19. Long-term clinical benefit and cost-effectiveness of an 8-week multimodal knee osteoarthritis management program incorporating intra-articular sodium hyaluronate (Hyalgan® injections

    Directory of Open Access Journals (Sweden)

    Miller LE

    2017-05-01

    Full Text Available Larry E Miller,1 Michael J Sloniewsky,2 Thomas E Gibbons,3 Janice G Johnston,4 Kent D Vosler,4 Saad Nasir5 1Miller Scientific Consulting, Inc., Asheville, NC, 2RMG Holding, Inc., Florence, 3Doctors Care, PA, Columbia, SC, 4Arrowhead Health Centers, Glendale, AZ, 5Fidia Pharma USA Inc., Parsippany, NJ, USA Background: Given the poor long-term effectiveness of focused nonsurgical knee osteoarthritis (OA treatments, alternative therapies are needed for patients who have unsuccessfully exhausted nonsurgical options.Methods: A telephone interview was conducted in patients who participated in a single 8-week multimodal knee OA treatment program (mean follow-up: 3.7 years, range: 2.7–4.9 years. The program consisted of five intra-articular knee injections of sodium hyaluronate (Hyalgan®, with each injection given 1 week apart, structured physical therapy, knee bracing, and patient education. Clinical outcomes included knee pain severity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC subscores, current medication use, and history of total knee arthroplasty. Base-case, subgroup, and sensitivity analyses were conducted to determine the incremental cost-effectiveness ratio (ICER of the treatment program with comparisons made to historical literature controls undergoing usual care. Results: A total of 218 patients (54% provided long-term follow-up data. Knee pain severity decreased 60% and WOMAC subscores decreased 33%–42% compared to baseline (all p<0.001. Total knee arthroplasty was performed in 22.8% (81/356 of knees during follow-up. The treatment program was highly cost-effective compared to usual care with a base-case ICER of $6,000 per quality-adjusted life year (QALY. Results of subgroup analyses, one-way deterministic sensitivity analyses, and second-order probabilistic sensitivity analyses resulted in ICERs ranging from $3,996 to $10,493 per QALY. The percentage of simulations with an ICER below willingness

  20. Evaluation and management of the impact of land use change on the nitrogen and phosphorus load delivered to surface waters: the export coefficient modelling approach

    Science.gov (United States)

    Johnes, P. J.

    1996-09-01

    A manageable, relatively inexpensive model was constructed to predict the loss of nitrogen and phosphorus from a complex catchment to its drainage system. The model used an export coefficient approach, calculating the total nitrogen (N) and total phosphorus (P) load delivered annually to a water body as the sum of the individual loads exported from each nutrient source in its catchment. The export coefficient modelling approach permits scaling up from plot-scale experiments to the catchment scale, allowing application of findings from field experimental studies at a suitable scale for catchment management. The catchment of the River Windrush, a tributary of the River Thames, UK, was selected as the initial study site. The Windrush model predicted nitrogen and phosphorus loading within 2% of observed total nitrogen load and 0.5% of observed total phosphorus load in 1989. The export coefficient modelling approach was then validated by application in a second research basin, the catchment of Slapton Ley, south Devon, which has markedly different catchment hydrology and land use. The Slapton model was calibrated within 2% of observed total nitrogen load and 2.5% of observed total phosphorus load in 1986. Both models proved sensitive to the impact of temporal changes in land use and management on water quality in both catchments, and were therefore used to evaluate the potential impact of proposed pollution control strategies on the nutrient loading delivered to the River Windrush and Slapton Ley.

  1. Acupuncture's Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management-White Paper 2017.

    Science.gov (United States)

    Fan, Arthur Yin; Miller, David W; Bolash, Bonnie; Bauer, Matthew; McDonald, John; Faggert, Sarah; He, Hongjian; Li, Yong Ming; Matecki, Amy; Camardella, Lindy; Koppelman, Mel Hopper; Stone, Jennifer A M; Meade, Lindsay; Pang, John

    2017-11-01

    The United States (U.S.) is facing a national opioid epidemic, and medical systems are in need of non-pharmacologic strategies that can be employed to decrease the public's opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture's cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, and neonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.

  2. A three-group study, internet-based, face-to-face based and standard- management after acute whiplash associated disorders (WAD – choosing the most efficient and cost-effective treatment: study protocol of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Bring Annika

    2009-07-01

    Full Text Available Abstract Background The management of Whiplash Associated Disorders is one of the most complicated challenges with high expenses for the health care system and society. There are still no general guidelines or scientific documentation to unequivocally support any single treatment for acute care following whiplash injury. The main purpose of this study is to try a new behavioural medicine intervention strategy at acute phase aimed to reduce the number of patients who have persistent problems after the whiplash injury. The goal is also to identify which of three different interventions that is most cost-effective for patients with Whiplash Associated Disorders. In this study we are controlling for two factors. First, the effect of behavioural medicine approach is compared with standard care. Second, the manner in which the behavioural medicine treatment is administered, Internet or face-to-face, is evaluated in it's effectiveness and cost-effectiveness. Methods/Design The study is a randomized, prospective, experimental three-group study with analyses of cost-effectiveness up to two-years follow-up. Internet – based programme and face-to-face group treatment programme are compared to standard-treatment only. Patient follow-ups take place three, six, twelve and 24 months, that is, short-term as well as long-term effects are evaluated. Patients will be enrolled via the emergency ward during the first week after the accident. Discussion This new self-help management will concentrate to those psychosocial factors that are shown to be predictive in long-term problems in Whiplash Associated Disorders, i.e. the importance of self-efficacy, fear of movement, and the significance of catastrophizing as a coping strategy for restoring and sustaining activities of daily life. Within the framework of this project, we will develop, broaden and evaluate current physical therapy treatment methods for acute Whiplash Associated Disorders. The project will

  3. Will the Oxygen-Phosphorus Paradigm Persist? - Expert Views of the Future of Management and Restoration of Eutrophic Lakes

    Science.gov (United States)

    Nygrén, Nina A.; Tapio, Petri; Horppila, Jukka

    2017-11-01

    In the age of climate change, the demand and lack of pure water challenges many communities. Substantial amount of effort is put in every year to manage and restore degraded lakes while the long-term effects of those efforts are only poorly known or monitored. Oxygenation, or aeration, is used extensively for the restoration of eutrophic lakes, although many studies question whether this process improves the status of the lakes in the long-term. The desired effect of oxygenation is based on paradigmatic theories that, in the light of recent literature, might not be adequate when long-term improvements are sought. This article canvasses expert views on the feasibility of the `oxygen-phosphorus paradigm' as well as the future of the management and restoration of eutrophic lakes, based on an international, two-rounded, expert panel survey (Delphi study), employing 200 freshwater experts from 33 nationalities, contacted at three conferences on the topic. The conclusion is that the oxygen-phosphorus paradigm seems to be rather persistent. The experts considered oxygenation to be a valid short-term lake restoration method, but not without harmful side-effects. In addition, experts' low level of trust in the adequacy of the scientific knowledge on the effects of restorations and in the use of the scientific knowledge as a basis of choice of restoration methods, could be signs of a paradigm shift towards an outlook emphasizing more effective catchment management over short-term restorations. The expert panel also anticipated that reducing external nutrient loads from both point and diffuse sources will succeed in the future.

  4. Cost effectiveness analysis in radiopharmacy

    International Nuclear Information System (INIS)

    Carpentier, N.; Verbeke, S.; Ducloux, T.

    1999-01-01

    Objective: to evaluate the cost effectiveness of radiopharmaceuticals and their quality control. Materials and methods: this retrospective study was made in the Nuclear Medicine Department of the University Hospital of Limoges. Radiopharmaceutical costs were obtained with adding the price of the radiotracer, the materials, the equipments, the labour, the running expenses and the radioisotope. The costs of quality control were obtained with adding the price of labour, materials, equipments, running expenses and the cost of the quality control of 99m Tc eluate. Results: during 1998, 2106 radiopharmaceuticals were prepared in the Nuclear Medicine Department. The mean cost effectiveness of radiopharmaceutical was 1430 francs (846 to 4260). The mean cost effectiveness of quality control was 163 francs (84 to 343). The rise of the radiopharmaceutical cost induced by quality control was 11%. Conclusion: the technical methodology of quality control must be mastered to optimize the cost of this operation. (author)

  5. Phosphorus management and its utilization by berseem (Trifolium alexandrinum L.) and residual effect on forage crops

    International Nuclear Information System (INIS)

    Sinha, M.N.; Rai, R.K.

    1990-01-01

    Placement of phosphorus even to a broadcast sown crop like berseem helped in boosting up 10 per cent higher forage production over the conventional practice of broadcast application of phosphatic fertilizer without altering the normal practice of sowing broadcast. Likewise, P from fertilizer source and its utilization by the crop increased substantially and were higher in favour of placement of P. Closer the rows of phosphorus placement, greater was the recovery of applied P. The yield of forage increased with the increase in the level of P ranging from 75 to 225 kg P 2 O 5 /ha and the optimum dose was 173 kg P 2 O 5 /ha while the utilization of P decreased with increase in levels. There was enormous response to residual P after berseem and the residual forage yield increased with increase in P levels. A fertilized cereal crop after berseem was in no way better than unfertilized crop after berseem from productivity point of view. (author). 11 refs., 5 tabs

  6. Decision-tree sensitivity analysis for cost-effectiveness of whole-body FDG PET in the management of patients with non-small-cell lung carcinoma in Japan

    International Nuclear Information System (INIS)

    Kosuda, Shigeru; Kobayashi, Hideo; Kusano, Shoichi; Ichihara, Kiyoshi; Watanabe, Masazumi

    2002-01-01

    Whole-body 2-fluoro-2-D-[ 18 F]deoxyglucose[FDG] positron emission tomography (WB-PET) may be more cost-effective than chest PET because WB-PET does not require conventional imaging (CI) for extrathoracic staging. The cost-effectiveness of WB-PET for the management of Japanese patients with non-small-cell lung carcinoma (NSCLC) was assessed. Decision-tree sensitivity analysis was designed, based on the two competing strategies of WB-PET vs. CI. WB-PET was assumed to have a sensitivity and specificity for detecting metastases, of 90% to 100% and CI of 80% to 90%. The prevalences of M1 disease were 34% and 20%. On thousand patients suspected of having NSCLC were simulated in each strategy. We surveyed the relevant literature for the choice of variables. Expected cost saving (CS) and expected life expectancy (LE) for NSCLC patients were calculated. The WB-PET strategy yielded an expected CS of $951 US to $1,493 US per patient and an expected LE of minus 0.0246 years to minus 0.0136 years per patient for the 71.4% NSCLC and 34% M1 disease prevalence at our hospital. PET avoided unnecessary bronchoscopies and thoracotomies for incurable and benign disease. Overall, the CS for each patient was $833 US to $2,010 US at NSCLC prevalences ranging from 10% to 90%. The LE of the WB-PET strategy was similar to that of the CI strategy. The CS and LE minimally varied in the two situations of 34% and 20% M1 disease prevalence. The introduction of a WB-PET strategy in place of CI for managing NSCLC patients is potentially cost-effective in Japan. (author)

  7. Working with Farmers to Reduce Phosphorus in Lake Champlain

    Science.gov (United States)

    EPA researchers are working with Vermont small dairy farmers to explore whether pasture-based rotational grazing can be a viable, cost-effective, option for small farms to help to reduce phosphorus loadings to the lake.

  8. Cost-effectiveness of monitoring free flaps.

    Science.gov (United States)

    Subramaniam, Shiva; Sharp, David; Jardim, Christopher; Batstone, Martin D

    2016-06-01

    Methods of free flap monitoring have become more sophisticated and expensive. This study aims to determine the cost of free flap monitoring and examine its cost effectiveness. We examined a group of patients who had had free flaps to the head and neck over a two-year period, and combined these results with costs obtained from business managers and staff. There were 132 free flaps with a success rate of 99%. The cost of monitoring was Aus $193/flap. Clinical monitoring during this time period cost Aus$25 476 and did not lead to the salvage of any free flaps. Cost equivalence is reached between monitoring and not monitoring only at a failure rate of 15.8%. This is to our knowledge the first study to calculate the cost of clinical monitoring of free flaps, and to examine its cost-effectiveness. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. All rights reserved.

  9. Efficacy and cost-effectiveness of a specialist depression service versus usual specialist mental health care to manage persistent depression: a randomised controlled trial.

    Science.gov (United States)

    Morriss, Richard; Garland, Anne; Nixon, Neil; Guo, Boliang; James, Marilyn; Kaylor-Hughes, Catherine; Moore, Richard; Ramana, Rajini; Sampson, Christopher; Sweeney, Timothy; Dalgleish, Tim

    2016-09-01

    Persistent moderate or severe unipolar depression is common and expensive to treat. Clinical guidelines recommend combined pharmacotherapy and psychotherapy. Such treatments can take up to 1 year to show an effect, but no trials of suitable duration have been done. We investigated the efficacy and cost-effectiveness of outpatient-based, specialist depression services (SDS) versus treatment as usual (TAU) on depression symptoms and function. We did a multicentre, single-blind, patient-level, parallel, randomised controlled trial (RCT), as part of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) study, in three mental health outpatient settings in England. Eligible participants were in secondary care, were older than 18 years, had unipolar depression (with a current major depressive episode, a 17-item Hamilton Depression Rating Scale [HDRS17] score of ≥16, and a Global Assessment of Function [GAF] score of ≤60), and had not responded to 6 months or more of treatment for depression. Randomisation was stratified by site with allocation conveyed to a trial administrator, with research assessors masked to outcome. Patients were randomised (1:1) using a computer-generated pseudo-random code with random permuted blocks of varying sizes of two, four, or six to either SDS (collaborative care approach between psychiatrists and cognitive behavioural therapists for 12 months, followed by graduated transfer of care up to 15 months) or to the TAU group. Intention-to-treat primary outcome measures were changes in HDRS17 and GAF scores between baseline and 6, 12, and 18 months' follow-up. We will separately publish follow-up outcomes for months 24 and 36. Clinical efficacy and cost-effectiveness were examined from health and social care persp ectives at 18 months, as recommended by the National Institute for Health and Care Excellence. This trial is registered at ClinicalTrials.gov (NCT01047124) and the

  10. Historical clinical and economic consequences of anemia management in patients with end-stage renal disease on dialysis using erythropoietin stimulating agents versus routine blood transfusions: a retrospective cost-effectiveness analysis.

    Science.gov (United States)

    Naci, Huseyin; de Lissovoy, Gregory; Hollenbeak, Christopher; Custer, Brian; Hofmann, Axel; McClellan, William; Gitlin, Matthew

    2012-01-01

    To determine whether Medicare's decision to cover routine administration of erythropoietin stimulating agents (ESAs) to treat anemia of end-stage renal disease (ESRD) has been a cost-effective policy relative to standard of care at the time. The authors used summary statistics from the actual cohort of ESRD patients receiving ESAs between 1995 and 2004 to create a simulated patient cohort, which was compared with a comparable simulated cohort assumed to rely solely on blood transfusions. Outcomes modeled from the Medicare perspective included estimated treatment costs, life-years gained, and quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratio (ICER) was calculated relative to the hypothetical reference case of no ESA use in the transfusion cohort. Sensitivity of the results to model assumptions was tested using one-way and probabilistic sensitivity analyses. Estimated total costs incurred by the ESRD population were $155.47B for the cohort receiving ESAs and $155.22B for the cohort receiving routine blood transfusions. Estimated QALYs were 2.56M and 2.29M, respectively, for the two groups. The ICER of ESAs compared to routine blood transfusions was estimated as $873 per QALY gained. The model was sensitive to a number of parameters according to one-way and probabilistic sensitivity analyses. This model was counter-factual as the actual comparison group, whose anemia was managed via transfusion and iron supplements, rapidly disappeared following introduction of ESAs. In addition, a large number of model parameters were obtained from observational studies due to the lack of randomized trial evidence in the literature. This study indicates that Medicare's coverage of ESAs appears to have been cost effective based on commonly accepted levels of willingness-to-pay. The ESRD population achieved substantial clinical benefit at a reasonable cost to society.

  11. Guiding phosphorus stewardship for multiple ecosystem services

    Science.gov (United States)

    Phosphorus is vital to agricultural production and water quality regulation. While the role of phosphorus in agriculture and water quality has been studied for decades, the benefits of sustainable phosphorus use and management for society due to its downstream impacts on multiple ecosystem services...

  12. Cost-effective analysis of PET application in NSCLC

    International Nuclear Information System (INIS)

    Gu Aichun; Liu Jianjun; Sun Xiaoguang; Shi Yiping; Huang Gang

    2006-01-01

    Objective: To evaluate the cost-effectiveness of PET and CT application for diagnosis of non-small cell lung cancer (NSCLC) in China. Methods: Using decision analysis method the diagnostic efficiency of PET and CT for diagnosis of NSCLC in china was analysed. And also the value of cost for accurate diagnosis (CAD), cost for accurate staging (CAS) and cost for effective therapy (CAT) was calculated. Results: (1) For the accurate diagnosis, CT was much more cost-effective than PET. (2) For the accurate staging, CT was still more cost-effective than PET. (3) For the all over diagnostic and therapeutic cost, PET was more cost-effective than CT. (4) The priority of PET to CT was for the diagnosis of stage I NSCLC. Conclusion: For the management of NSCLC patient in China, CT is more cost-effective for screening, whereas PET for clinical staging and monitoring therapeutic effect. (authors)

  13. Cost-effectiveness of preventive case management for parents with a mental illness: A randomized controlled trial from three economic perspectives

    NARCIS (Netherlands)

    Wansink, H.J.; Drost, R.M.W.A.; Paulus, A.T.G.; Ruwaard, D.; Hosman, C.M.H.; Janssens, J.M.A.M.; Evers, S.M.A.A.

    2016-01-01

    Background: The children of parents with a mental illness (COPMI) are at increased risk for developing costly psychiatric disorders because of multiple risk factors which threaten parenting quality and thereby child development. Preventive basic care management (PBCM) is an intervention aimed at

  14. Setting Up the Next Generation Biofeedback Program for Stress and Anxiety Management for College Students: A Simple and Cost-Effective Approach

    Science.gov (United States)

    Ratanasiripong, Paul; Sverduk, Kevin; Hayashino, Diane; Prince, Judy

    2010-01-01

    The increasing prevalence of stress and anxiety on college campuses along with limited resources and budget reductions for many campuses has prompted the need for innovative approaches to help students effectively manage their stress and anxiety. With college students becoming more and more technology-savvy, the authors present an innovative…

  15. A cost-effectiveness analysis of fistula treatment in the abdominal region using a new integrated fistula and wound management system

    DEFF Research Database (Denmark)

    Keiding, Hans; Skovgaard, Rasmus

    2008-01-01

    OBJECTIVE: To evaluate wear time and costs of a new fistula and wound management system (FWMS) compared to standard fistula treatments. METHODS: Data were collected from 22 patients with an abdominal fistula recruited from 5 sites in the United States. This economic evaluation was based on a cost...

  16. Sustainable Land Use, Soil Protection and Phosphorus Management from a Cross-National Perspective

    Directory of Open Access Journals (Sweden)

    Jessica Stubenrauch

    2018-06-01

    Full Text Available The scarcity of phosphorus (P is a global concern that is not restricted to western industrialized nations. Until now, most countries in the world are highly dependent on importing mineral P fertilizers for agriculture. The industrialized nation of Germany, the emerging economy of Costa Rica, and the developing country of Nicaragua are examined with regard to their legislation in the field of environmental protection and agriculture, in particular with regard to soil protection and fertilizer law. Based on the structure of agriculture in each country, control weaknesses in legislation in the individual countries, which is largely determined by command-and-control law, are identified and compared. It becomes clear that soil protection in all three countries has not yet been adequately standardised in law and at the same time the efficient use of organic or recycled P fertilizers instead of (finite mineral P fertilizers is inadequately regulated. In particular, frugality, i.e., the strategy of lower (and not only more efficient consumption of P fertilizers, has so far played no regulatory role in land-use governance.

  17. Grazing management effects on sediment, phosphorus, and pathogen loading of streams in cool-season grass pastures.

    Science.gov (United States)

    Schwarte, Kirk A; Russell, James R; Kovar, John L; Morrical, Daniel G; Ensley, Steven M; Yoon, Kyoung-Jin; Cornick, Nancy A; Cho, Yong Il

    2011-01-01

    Erosion and runoff from pastures may lead to degradation of surface water. A 2-yr grazing study was conducted to quantify the effects of grazing management on sediment, phosphorus (P), and pathogen loading of streams in cool-season grass pastures. Six adjoining 12.1-ha pastures bisected by a stream in central Iowa were divided into three treatments: continuous stocking with unrestricted stream access (CSU), continuous stocking with restricted stream access (CSR), and rotational stocking (RS). Rainfall simulations on stream banks resulted in greater ( CSR pastures. Bovine enterovirus was shed by an average of 24.3% of cows during the study period and was collected in the runoff of 8.3 and 16.7% of runoff simulations on bare sites in CSU pastures in June and October of 2008, respectively, and from 8.3% of runoff simulations on vegetated sites in CSU pastures in April 2009. Fecal pathogens (bovine coronavirus [BCV], bovine rotavirus group A, and O157:H7) shed or detected in runoff were almost nonexistent; only BCV was detected in feces of one cow in August of 2008. Erosion of cut-banks was the greatest contributor of sediment and P loading to the stream; contributions from surface runoff and grazing animals were considerably less and were minimized by grazing management practices that reduced congregation of cattle by pasture streams. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  18. Design method of a power management strategy for variable battery capacities range-extended electric vehicles to improve energy efficiency and cost-effectiveness

    International Nuclear Information System (INIS)

    Du, Jiuyu; Chen, Jingfu; Song, Ziyou; Gao, Mingming; Ouyang, Minggao

    2017-01-01

    Energy management strategy and battery capacity are the primary factors for the energy efficiency of range-extended electric buses (REEBs). To improve the energy efficiency of REEBs developed by Tsinghua University, an optimal design method of global optimization-based strategy is investigated. It is real-time and adaptive to variable traction battery capacities of series REEBs. For simulation, the physical model of REEB and key components are established. The optimal strategy is first extracted by the power split ratio (PSR) from REEB simulation result with dynamic program (DP) algorithm. The power distribution map is obtained by series simulations for variable battery capacity options. The control law for developing optimal strategy are achieved by cluster regression for power distribution data. To verify the effect of the proposed energy management strategy, characteristics of powertrain, energy efficiency, operating cost, and computing time are ultimately analyzed. Simulation results show that the energy efficiency of the global optimization-based strategy presented in this paper is similar to that of the DP strategy. Therefore, the overall energy efficiency can be significantly improved compared with that of the CDCS strategy, and operating costs can be substantially reduced. The feasibility of candidate control strategies is thereby assessed via the employment of variable parameters. - Highlights: • Analysis method of powertrain energy efficiency and power distribution is proposed. • The power distribution rules of strategy with variable battery capacities are achieved. • The parametric method of proposed PSR-RB strategy is presented. • The energy efficiency of powertrain is analysis by flow analysis method. • The energy management strategy is global optimization-based and real-time.

  19. Managing urban runoff in residential neighborhoods: Nitrogen and phosphorus in lawn irrigation driven runoff

    Science.gov (United States)

    Occhipinti, Marti L.; Yang, Yun-Ya; Majcherek, Tammy; Haver, Darren; Oki, Lorence

    2017-01-01

    Sources and mechanisms of nutrient transport in lawn irrigation driven surface runoff are largely unknown. We investigated the transport of nitrogen (N) and phosphorus (P) in lawn irrigation driven surface runoff from a residential neighborhood (28 ha) of 56% impervious and 44% pervious areas. Pervious areas encompassing turfgrass (lawns) in the neighborhood were irrigated with the reclaimed water in common areas during the evening to late night and with the municipal water in homeowner’s lawns during the morning. The stormwater outlet pipe draining the residential neighborhood was instrumented with a flow meter and Hach autosampler. Water samples were collected every 1-h and triple composite samples were obtained at 3-h intervals during an intensive sampling period of 1-week. Mean concentrations, over 56 sampling events, of total N (TN) and total P (TP) in surface runoff at the outlet pipe were 10.9±6.34 and 1.3±1.03 mg L–1, respectively. Of TN, the proportion of nitrate–N was 58% and other–N was 42%, whereas of TP, orthophosphate–P was 75% and other–P was 25%. Flow and nutrient (N and P) concentrations were lowest from 6:00 a.m. to noon, which corresponded with the use of municipal water and highest from 6:00 p.m. to midnight, which corresponded with the use of reclaimed water. This data suggests that N and P originating in lawn irrigation driven surface runoff from residential catchments is an important contributor of nutrients in surface waters. PMID:28604811

  20. Duty health physicist program at Byron Nuclear Power Station - a cost-effective way to manage routine plant health physics activities

    International Nuclear Information System (INIS)

    Goldsmith, D.G.; Carey, T.R.

    1987-01-01

    The Duty Health Physicist Program at Byron Station was established to deal with routine health physics tasks and provide an interface between frontline and upper radiation-chemistry management. The program consists of a weekly rotation of selected members of the health physics staff into the duty health physicist position to handle the assigned duty tasks. The tasks include, but are not limited to, daily isotopic and air sample review, effluent release package review, maximum permissible concentration calculations, dose approvals, as-low-as-reasonably-achievable action review of pending jobs, and general availability to answer questions and address problems in health-physics-related areas of plant operation. The daily attendance of the duty health physicist at the radiation-chemistry and station plan-of-the-day meetings has increased the overall presence and visibility of the health physics program to upper station management and other station departments. Since its inception in July of 1985, the Duty Health Physics Program has been a major contributor to the observed 50% reduction in reportable personnel errors in the radiation-chemistry department

  1. Effectiveness, cost effectiveness, acceptability and implementation barriers/enablers of chronic kidney disease management programs for Indigenous people in Australia, New Zealand and Canada: a systematic review of mixed evidence.

    Science.gov (United States)

    Reilly, Rachel; Evans, Katharine; Gomersall, Judith; Gorham, Gillian; Peters, Micah D J; Warren, Steven; O'Shea, Rebekah; Cass, Alan; Brown, Alex

    2016-04-06

    Indigenous peoples in Australia, New Zealand and Canada carry a greater burden of chronic kidney disease (CKD) than the general populations in each country, and this burden is predicted to increase. Given the human and economic cost of dialysis, understanding how to better manage CKD at earlier stages of disease progression is an important priority for practitioners and policy-makers. A systematic review of mixed evidence was undertaken to examine the evidence relating to the effectivness, cost-effectiveness and acceptability of chronic kidney disease management programs designed for Indigenous people, as well as barriers and enablers of implementation of such programs. Published and unpublished studies reporting quantitative and qualitative data on health sector-led management programs and models of care explicitly designed to manage, slow progression or otherwise improve the lives of Indigenous people with CKD published between 2000 and 2014 were considered for inclusion. Data on clinical effectiveness, ability to self-manage, quality of life, acceptability, cost and cost-benefit, barriers and enablers of implementation were of interest. Quantitative data was summarized in narrative and tabular form and qualitative data was synthesized using the Joanna Briggs Institute meta-aggregation approach. Ten studies were included. Six studies provided evidence of clinical effectiveness of CKD programs designed for Indigenous people, two provided evidence of cost and cost-effectiveness of a CKD program, and two provided qualitative evidence of barriers and enablers of implementation of effective and/or acceptable CKD management programs. Common features of effective and acceptable programs were integration within existing services, nurse-led care, intensive follow-up, provision of culturally-appropriate education, governance structures supporting community ownership, robust clinical systems supporting communication and a central role for Indigenous Health Workers. Given

  2. Life-cycle phosphorus management of the crop production-consumption system in China, 1980-2012.

    Science.gov (United States)

    Wu, Huijun; Yuan, Zengwei; Gao, Liangmin; Zhang, Ling; Zhang, Yongliang

    2015-01-01

    Phosphorus (P) is an essential resource for agriculture and also a pollutant capable of causing eutrophication. The possibility of a future P scarcity and the requirement to improve the environment quality necessitate P management to increase the efficiency of P use. This study applied a substance flow analysis (SFA) to implement a P management procedure in a crop production-consumption (PMCPC) system model. This model determined the life-cycle P use efficiency (PUE) of the crop production-consumption system in China during 1980-2012. The system includes six subsystems: fertilizer manufacturing, crop cultivation, crop processing, livestock breeding, rural consumption, and urban consumption. Based on this model, the P flows and PUEs of the subsystems were identified and quantified using data from official statistical databases, published literature, questionnaires, and interviews. The results showed that the total PUE of the crop production-consumption system in China was low, notably from 1980 to 2005, and increased from 7.23% in 1980 to 20.13% in 2012. Except for fertilizer manufacturing, the PUEs of the six subsystems were also low. The PUEs in the urban consumption subsystem and the crop cultivation subsystem were less than 40%. The PUEs of other subsystems, such as the rural consumption subsystem and the livestock breeding subsystem, were also low and even decreased during these years. Measures aimed to improve P management practices in China have been proposed such as balancing fertilization, disposing livestock excrement, adjusting livestock feed, changing the diet of residents, and raising the waste disposal level, etc. This study also discussed several limitations related with the model and data. Conducting additional related studies on other regions and combining the analysis of risks with opportunities may be necessary to develop effective management strategies. Copyright © 2014 Elsevier B.V. All rights reserved.

  3. The second Symptom Management Research Trial in Oncology (SMaRT Oncology-2): a randomised trial to determine the effectiveness and cost-effectiveness of adding a complex intervention for major depressive disorder to usual care for cancer patients.

    Science.gov (United States)

    Walker, Jane; Cassidy, Jim; Sharpe, Michael

    2009-03-30

    Depression Care for People with Cancer is a complex intervention delivered by specially trained cancer nurses, under the supervision of a psychiatrist. It is given as a supplement to the usual care for depression, which patients receive from their general practitioner and cancer service. In a 'proof of concept' trial (Symptom Management Research Trials in Oncology-1) Depression Care for People with Cancer improved depression more than usual care alone. The second Symptom Management Research Trial in Oncology (SMaRT Oncology-2 Trial) will test its effectiveness and cost-effectiveness in a 'real world' setting. A two arm parallel group multi-centre randomised controlled trial. TRIAL PROCEDURES: 500 patients will be recruited through established systematic Symptom Monitoring Services, which screen patients for depression. Patients will have: a diagnosis of cancer (of various types); an estimated life expectancy of twelve months or more and a diagnosis of Major Depressive Disorder. Patients will be randomised to usual care or usual care plus Depression Care for People with Cancer. Randomisation will be carried out by telephoning a secure computerised central randomisation system or by using a secure web interface. The primary outcome measure is 'treatment response' measured at 24 week outcome data collection. 'Treatment response' will be defined as a reduction of 50% or more in the patient's baseline depression score, measured using the 20-item Symptom Checklist (SCL-20D). Secondary outcomes include remission of major depressive disorder, depression severity and patients' self-rated improvement of depression. Current controlled trials ISRCTN40568538 TRIAL HYPOTHESES: (1) Depression Care for People with Cancer as a supplement to usual care will be more effective than usual care alone in achieving a 50% reduction in baseline SCL-20D score at 24 weeks. (2) Depression Care for People with Cancer as a supplement to usual care will cost more than usual care alone but will be

  4. Chemical phosphorus removal: A clean strategy for piggery wastewater management in Brazil

    Science.gov (United States)

    The intensive production of animal protein is known to be an environmental polluting activity, especially if the wastewater produced is not managed properly. Swine production in Brazil is growing and technologies to manage all pollutants present in the wastewater effluent are needed. This work prese...

  5. Protocolised Management In Sepsis (ProMISe): a multicentre randomised controlled trial of the clinical effectiveness and cost-effectiveness of early, goal-directed, protocolised resuscitation for emerging septic shock.

    Science.gov (United States)

    Mouncey, Paul R; Osborn, Tiffany M; Power, G Sarah; Harrison, David A; Sadique, M Zia; Grieve, Richard D; Jahan, Rahi; Tan, Jermaine C K; Harvey, Sheila E; Bell, Derek; Bion, Julian F; Coats, Timothy J; Singer, Mervyn; Young, J Duncan; Rowan, Kathryn M

    2015-11-01

    cardiovascular support days in critical care for the EGDT group. At 1 year, the incremental net benefit for EGDT versus usual resuscitation was negative at -£725 (95% CI -£3000 to £1550). The probability that EGDT was more cost-effective than usual resuscitation was below 30%. There were no significant differences in any other secondary outcomes, including health-related quality of life, or adverse events. Recruitment was lower at weekends and out of hours. The intervention could not be blinded. There was no significant difference in all-cause mortality at 90 days for EGDT compared with usual resuscitation among adults identified with early septic shock presenting to EDs in England. On average, costs were higher in the EGDT group than in the usual-resuscitation group while quality-adjusted life-years were similar in both groups; the probability that it is cost-effective is Management In Sepsis) trial completes the planned trio of evaluations of EGDT across the USA, Australasia and England; all have indicated that EGDT is not superior to usual resuscitation. Recognising that each of the three individual, large trials has limited power for evaluating potentially important subgroups, the harmonised approach adopted provides the opportunity to conduct an individual patient data meta-analysis, enhancing both knowledge and generalisability. Current Controlled Trials ISRCTN36307479. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 97. See the NIHR Journals Library website for further project information.

  6. Which interventions are cost-effective for the management of whiplash-associated and neck pain-associated disorders? A systematic review of the health economic literature by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

    Science.gov (United States)

    van der Velde, Gabrielle; Yu, Hainan; Paulden, Mike; Côté, Pierre; Varatharajan, Sharanya; Shearer, Heather M; Wong, Jessica J; Randhawa, Kristi; Southerst, Danielle; Mior, Silvano; Sutton, Deborah; Jacobs, Craig; Taylor-Vaisey, Anne

    2016-12-01

    Whiplash-associated disorders (WAD) and neck pain and associated disorders (NAD) are prevalent conditions that impact society and impose a significant economic burden on health-care systems. Health economic evidence on WAD and NAD interventions has been sparse: only three economic evaluations of interventions for NAD were identified by the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (NPTF). An updated overview is needed to inform health-care policy and guidelines. This study aimed to determine the cost-effectiveness of interventions for grades I-III WAD and NAD in children and adults. Systematic review of health economic literature, best-evidence synthesis. We systematically searched CINAHL, the Cochrane economic databases (Health Technology Assessment, NHS Economic Evaluation Database), EconLit, EMBASE, MEDLINE, PsycINFO, and Tufts CEA Registry from 2000 to 2015 for economic evaluations of WAD and NAD interventions. We appraised relevant evaluations using the Scottish Intercollegiate Guidelines Network Methodology Criteria for Economic Evaluations. We extracted data, including mean costs (standardized to 2013 Canadian dollars [CAD]) and quality-adjusted life years (QALYs), from studies with adequate methodological quality. We recalculated cost-effectiveness statistics based on the standardized currency using a willingness-to-pay of CAD $50,000 per additional QALY. Funding was provided by the Ministry of Finance. Our search identified 1,616 citations. Six studies fulfilled our selection criteria, including three studies previously reviewed by the NPTF. Structured education appears cost-effective for adults with WAD. For adults with NAD, acupuncture added to routine medical care; manual therapy; multimodal care that includes manual therapy; advice and exercise; and psychological care using cognitive-behavioral therapy appear cost-effective. In contrast, adding manual therapy or diathermy to advice and exercise; multimodal

  7. Study Protocol--Alcohol Management Plans (AMPs) in remote indigenous communities in Queensland: their impacts on injury, violence, health and social indicators and their cost-effectiveness.

    Science.gov (United States)

    Clough, Alan R; Fitts, Michelle S; Robertson, Jan A; Shakeshaft, Anthony; Miller, Adrian; Doran, Christopher M; Muller, Reinhold; Ypinazar, Valmae; Martin, David; McDermott, Robyn; Sanson-Fisher, Rob; Towle, Simon; Margolis, Stephen A; West, Caryn

    2014-01-09

    In 2002/03 the Queensland Government responded to high rates of alcohol-related harm in discrete Indigenous communities by implementing alcohol management plans (AMPs), designed to include supply and harm reduction and treatment measures. Tighter alcohol supply and carriage restrictions followed in 2008 following indications of reductions in violence and injury. Despite the plans being in place for over a decade, no comprehensive independent review has assessed to what level the designed aims were achieved and what effect the plans have had on Indigenous community residents and service providers. This study will describe the long-term impacts on important health, economic and social outcomes of Queensland's AMPs. The project has two main studies, 1) outcome evaluation using de-identified epidemiological data on injury, violence and other health and social indicators for across Queensland, including de-identified databases compiled from relevant routinely-available administrative data sets, and 2) a process evaluation to map the nature, timing and content of intervention components targeting alcohol. Process evaluation will also be used to assess the fidelity with which the designed intervention components have been implemented, their uptake and community responses to them and their perceived impacts on alcohol supply and consumption, injury, violence and community health. Interviews and focus groups with Indigenous residents and service providers will be used. The study will be conducted in all 24 of Queensland's Indigenous communities affected by alcohol management plans. This evaluation will report on the impacts of the original aims for AMPs, what impact they have had on Indigenous residents and service providers. A central outcome will be the establishment of relevant databases describing the parameters of the changes seen. This will permit comprehensive and rigorous surveillance systems to be put in place and provided to communities empowering them with the

  8. Impacts of soil conditioners and water table management on phosphorus loss in tile drainage from a clay loam soil.

    Science.gov (United States)

    Zhang, T Q; Tan, C S; Zheng, Z M; Welacky, T W; Reynolds, W D

    2015-03-01

    Adoption of waste-derived soil conditioners and refined water management can improve soil physical quality and crop productivity of fine-textured soils. However, the impacts of these practices on water quality must be assessed to ensure environmental sustainability. We conducted a study to determine phosphorus (P) loss in tile drainage as affected by two types of soil conditioners (yard waste compost and swine manure compost) and water table management (free drainage and controlled drainage with subirrigation) in a clay loam soil under corn-soybean rotation in a 4-yr period from 1999 to 2003. Tile drainage flows were monitored and sampled on a year-round continuous basis using on-site auto-sampling systems. Water samples were analyzed for dissolved reactive P (DRP), particulate P (PP), and total P (TP). Substantially greater concentrations and losses of DRP, PP, and TP occurred with swine manure compost than with control and yard waste compost regardless of water table management. Compared with free drainage, controlled drainage with subirrigation was an effective way to reduce annual and cumulative losses of DRP, PP, and TP in tile drainage through reductions in flow volume and P concentration with control and yard waste compost but not with swine manure compost. Both DRP and TP concentrations in tile drainage were well above the water quality guideline for P, affirming that subsurface loss of P from fine-textured soils can be one critical source for freshwater eutrophication. Swine manure compost applied as a soil conditioner must be optimized by taking water quality impacts into consideration. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  9. 77 FR 1743 - Discount Rates for Cost-Effectiveness Analysis of Federal Programs

    Science.gov (United States)

    2012-01-11

    ... OFFICE OF MANAGEMENT AND BUDGET Discount Rates for Cost-Effectiveness Analysis of Federal Programs... Appendix C are to be used for cost-effectiveness analysis, including lease-purchase analysis, as specified... (Revised December 2011) Discount Rates for Cost-Effectiveness, Lease Purchase, and Related Analyses...

  10. 76 FR 7881 - Discount Rates for Cost-Effectiveness Analysis of Federal Programs

    Science.gov (United States)

    2011-02-11

    ... OFFICE OF MANAGEMENT AND BUDGET Discount Rates for Cost-Effectiveness Analysis of Federal Programs... Appendix C are to be used for cost-effectiveness analysis, including lease-purchase analysis, as specified... (Revised December 2010) DISCOUNT RATES FOR COST-EFFECTIVENESS, LEASE PURCHASE, AND RELATED ANALYSES...

  11. 78 FR 6140 - Discount Rates for Cost-Effectiveness Analysis of Federal Programs

    Science.gov (United States)

    2013-01-29

    ... OFFICE OF MANAGEMENT AND BUDGET Discount Rates for Cost-Effectiveness Analysis of Federal Programs... in Appendix C are to be used for cost-effectiveness analysis, including lease-purchase analysis, as...) Discount Rates for Cost-Effectiveness, Lease Purchase, and Related Analyses Effective Dates. This appendix...

  12. A long-term experimental case study of the ecological effectiveness and cost effectiveness of invasive plant management in achieving conservation goals: bitou bush control in booderee national park in eastern australia.

    Directory of Open Access Journals (Sweden)

    David B Lindenmayer

    Full Text Available Invasive plant management is often justified in terms of conservation goals, yet progress is rarely assessed against these broader goals, instead focussing on short-term reductions of the invader as a measure of success. Key questions commonly remain unanswered including whether invader removal reverses invader impacts and whether management itself has negative ecosystem impacts. We addressed these knowledge gaps using a seven year experimental investigation of Bitou Bush, Chrysanthemoides monilifera subsp. rotundata. Our case study took advantage of the realities of applied management interventions for Bitou Bush to assess whether it is a driver or passenger of environmental change, and quantified conservation benefits relative to management costs of different treatment regimes. Among treatments examined, spraying with herbicide followed by burning and subsequent re-spraying (spray-fire-spray proved the most effective for reducing the number of individuals and cover of Bitou Bush. Other treatment regimes (e.g. fire followed by spraying, or two fires in succession were less effective or even exacerbated Bitou Bush invasion. The spray-fire-spray regime did not increase susceptibility of treated areas to re-invasion by Bitou Bush or other exotic species. This regime significantly reduced plant species richness and cover, but these effects were short-lived. The spray-fire-spray regime was the most cost-effective approach to controlling a highly invasive species and facilitating restoration of native plant species richness to levels characteristic of uninvaded sites. We provide a decision tree to guide management, where recommended actions depend on the outcome of post-treatment monitoring and performance against objectives. Critical to success is avoiding partial treatments and treatment sequences that may exacerbate invasive species impacts. We also show the value of taking advantage of unplanned events, such as wildfires, to achieve management

  13. A long-term experimental case study of the ecological effectiveness and cost effectiveness of invasive plant management in achieving conservation goals: bitou bush control in booderee national park in eastern australia.

    Science.gov (United States)

    Lindenmayer, David B; Wood, Jeff; MacGregor, Christopher; Buckley, Yvonne M; Dexter, Nicholas; Fortescue, Martin; Hobbs, Richard J; Catford, Jane A

    2015-01-01

    Invasive plant management is often justified in terms of conservation goals, yet progress is rarely assessed against these broader goals, instead focussing on short-term reductions of the invader as a measure of success. Key questions commonly remain unanswered including whether invader removal reverses invader impacts and whether management itself has negative ecosystem impacts. We addressed these knowledge gaps using a seven year experimental investigation of Bitou Bush, Chrysanthemoides monilifera subsp. rotundata. Our case study took advantage of the realities of applied management interventions for Bitou Bush to assess whether it is a driver or passenger of environmental change, and quantified conservation benefits relative to management costs of different treatment regimes. Among treatments examined, spraying with herbicide followed by burning and subsequent re-spraying (spray-fire-spray) proved the most effective for reducing the number of individuals and cover of Bitou Bush. Other treatment regimes (e.g. fire followed by spraying, or two fires in succession) were less effective or even exacerbated Bitou Bush invasion. The spray-fire-spray regime did not increase susceptibility of treated areas to re-invasion by Bitou Bush or other exotic species. This regime significantly reduced plant species richness and cover, but these effects were short-lived. The spray-fire-spray regime was the most cost-effective approach to controlling a highly invasive species and facilitating restoration of native plant species richness to levels characteristic of uninvaded sites. We provide a decision tree to guide management, where recommended actions depend on the outcome of post-treatment monitoring and performance against objectives. Critical to success is avoiding partial treatments and treatment sequences that may exacerbate invasive species impacts. We also show the value of taking advantage of unplanned events, such as wildfires, to achieve management objectives at

  14. Cost-effectiveness of FDG-PET for the management of potentially operable non-small cell lung cancer: priority for a PET-based strategy after nodal-negative CT results

    International Nuclear Information System (INIS)

    Dietlein, M.; Weber, K.; Moka, D.; Theissen, P.; Schicha, H.

    2000-01-01

    Decision analysis is used here to establish the most cost-effective strategy for management of potentially operable non-small cell lung cancers (NSCLCs). The strategies compared were conventional staging (strategy A), dedicated systems of positron emission tomography (PET) using fluorine-18 fluorodeoxyglucose (FDG) in patients with normal-sized (strategy B) or in patients with enlarged mediastinal lymph nodes (part of strategy C), and FDG-PET followed by exclusion from surgical procedures when both computed tomography (CT) and PET were positive for mediastinal lymph nodes (strategy D) or when PET alone was positive (strategy E). Based on published data, the sensitivity and specificity of FDG-PET were estimated at 0.74 and 0.96 for detecting metastasis in normal-sized mediastinal lymph nodes, and at 0.95 and 0.76 when these lymph nodes were enlarged. The calculated probability of up-staging to M1 by using PET was 0.05. The costs quoted correspond to the cost reimbursed in 1999 by the public health provider in Germany. The incremental cost-effectiveness ratio (ICER) of strategy B was much more favourable (143 EUR/LYS; LYS = life year saved) than the ICER of strategy C (36,667 EUR/LYS). In strategy B, the use of PET did not raise the overall costs because the costs of PET were almost balanced by a better selection of patients for beneficial cancer resection. The exclusion from biopsy confirmation in strategies D and E led to cost savings that did not justify the expected reduction in life expectancy. In sensitivity analyses, the ICERs of strategy B were robust to the pretest likelihood of N2/N3, to penalized test parameters of PET and to reimbursement of PET. However, the ICER of strategy B would be raised to 28,000 EUR/LYS through use of thoracic PET without whole-body scanning. To conclude, the implementation of whole-body PET with a full ring of detectors in the preoperative staging of patients with NSCLC and normal-sized lymph nodes is clearly cost-effective

  15. Life-cycle phosphorus management of the crop production–consumption system in China, 1980–2012

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Huijun [School of Earth Environment, Anhui University of Science and Technology, Huainan 232001 (China); Yuan, Zengwei, E-mail: yuanzw@nju.edu.cn [State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023 (China); Gao, Liangmin [School of Earth Environment, Anhui University of Science and Technology, Huainan 232001 (China); Zhang, Ling [College of Economics and Management, Nanjing Forestry University, Nanjing 210037 (China); Zhang, Yongliang [Policy Research Center for Environment and Economy, Ministry of Environmental Protection, Beijing 100029 (China)

    2015-01-01

    Phosphorus (P) is an essential resource for agriculture and also a pollutant capable of causing eutrophication. The possibility of a future P scarcity and the requirement to improve the environment quality necessitate P management to increase the efficiency of P use. This study applied a substance flow analysis (SFA) to implement a P management procedure in a crop production–consumption (PMCPC) system model. This model determined the life-cycle P use efficiency (PUE) of the crop production–consumption system in China during 1980–2012. The system includes six subsystems: fertilizer manufacturing, crop cultivation, crop processing, livestock breeding, rural consumption, and urban consumption. Based on this model, the P flows and PUEs of the subsystems were identified and quantified using data from official statistical databases, published literature, questionnaires, and interviews. The results showed that the total PUE of the crop production–consumption system in China was low, notably from 1980 to 2005, and increased from 7.23% in 1980 to 20.13% in 2012. Except for fertilizer manufacturing, the PUEs of the six subsystems were also low. The PUEs in the urban consumption subsystem and the crop cultivation subsystem were less than 40%. The PUEs of other subsystems, such as the rural consumption subsystem and the livestock breeding subsystem, were also low and even decreased during these years. Measures aimed to improve P management practices in China have been proposed such as balancing fertilization, disposing livestock excrement, adjusting livestock feed, changing the diet of residents, and raising the waste disposal level, etc. This study also discussed several limitations related with the model and data. Conducting additional related studies on other regions and combining the analysis of risks with opportunities may be necessary to develop effective management strategies. - Highlights: • A model of P management of the crop production–consumption system

  16. Life-cycle phosphorus management of the crop production–consumption system in China, 1980–2012

    International Nuclear Information System (INIS)

    Wu, Huijun; Yuan, Zengwei; Gao, Liangmin; Zhang, Ling; Zhang, Yongliang

    2015-01-01

    Phosphorus (P) is an essential resource for agriculture and also a pollutant capable of causing eutrophication. The possibility of a future P scarcity and the requirement to improve the environment quality necessitate P management to increase the efficiency of P use. This study applied a substance flow analysis (SFA) to implement a P management procedure in a crop production–consumption (PMCPC) system model. This model determined the life-cycle P use efficiency (PUE) of the crop production–consumption system in China during 1980–2012. The system includes six subsystems: fertilizer manufacturing, crop cultivation, crop processing, livestock breeding, rural consumption, and urban consumption. Based on this model, the P flows and PUEs of the subsystems were identified and quantified using data from official statistical databases, published literature, questionnaires, and interviews. The results showed that the total PUE of the crop production–consumption system in China was low, notably from 1980 to 2005, and increased from 7.23% in 1980 to 20.13% in 2012. Except for fertilizer manufacturing, the PUEs of the six subsystems were also low. The PUEs in the urban consumption subsystem and the crop cultivation subsystem were less than 40%. The PUEs of other subsystems, such as the rural consumption subsystem and the livestock breeding subsystem, were also low and even decreased during these years. Measures aimed to improve P management practices in China have been proposed such as balancing fertilization, disposing livestock excrement, adjusting livestock feed, changing the diet of residents, and raising the waste disposal level, etc. This study also discussed several limitations related with the model and data. Conducting additional related studies on other regions and combining the analysis of risks with opportunities may be necessary to develop effective management strategies. - Highlights: • A model of P management of the crop production–consumption system

  17. Raising, Sustaining Productivity and Quality in Mixtures Imperata Cylindrica-Stylosanthes Guyanensis Pastures with Phosphorus Fertilization and Defoliation Management

    OpenAIRE

    Nohong, Budiman

    2016-01-01

    Phosphorus fertilization on crop mixtures Cogongrass-Stylo's very important for the development of root nodules, nitrogen fixation and improve the botanical composition Stylo to confront an aggressive Cogon grass. This study aims to improve the productivity and quality of crops mixtures Cogon grass-Stylo through fertilization and defoliation frequency. The study consisted of two factors . The first factor is the phosphorus fertilizer with a dose of 0 (P0 ) and 100 kg P2O/ha (P1 ). The second ...

  18. 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

  19. Soil Phosphorus Storage Capacity for Environmental Risk Assessment

    Directory of Open Access Journals (Sweden)

    Vimala D. Nair

    2014-01-01

    Full Text Available Reliable techniques must be developed to predict phosphorus (P storage and release from soils of uplands, ditches, streams, and wetlands in order to better understand the natural, anthropogenic, and legacy sources of P and their impact on water quality at a field/plot as well as larger scales. A concept called the “safe” soil phosphorus storage capacity (SPSC that is based on a threshold phosphorus saturation ratio (PSR has been developed; the PSR is the molar ratio of P to Fe and Al, and SPSC is a PSR-based calculation of the remaining soil P storage capacity that captures risks arising from previous loading as well as inherently low P sorption capacity of a soil. Zero SPSC amounts to a threshold value below which P runoff or leaching risk increases precipitously. In addition to the use of the PSR/SPSC concept for P risk assessment and management, and its ability to predict isotherm parameters such as the Langmuir strength of bonding, KL, and the equilibrium P concentration, EPC0, this simple, cost-effective, and quantitative approach has the potential to be used as an agronomic tool for more precise application of P for plant uptake.

  20. phosphorus retention data and metadata

    Science.gov (United States)

    phosphorus retention in wetlands data and metadataThis dataset is associated with the following publication:Lane , C., and B. Autrey. Phosphorus retention of forested and emergent marsh depressional wetlands in differing land uses in Florida, USA. Wetlands Ecology and Management. Springer Science and Business Media B.V;Formerly Kluwer Academic Publishers B.V., GERMANY, 24(1): 45-60, (2016).

  1. Effects of Water Management, Arsenic and Phosphorus Levels on Rice Yield in High-Arsenic Soil-Water System

    Institute of Scientific and Technical Information of China (English)

    A. S. M. H. M. TALUKDER; C. A. MEISNER; M. A. R. SARKAR; M. S. ISLAM; K. D. SAYRE

    2014-01-01

    Aerobic rice (Oryza sativa L.) cultivation is considered an alternative production system to combat increased water scarcity and arsenic (As) contamination in the food chain. Pot experiments were conducted at the Wheat Research Centre, Dinajpur, Bangladesh to examine the role of water management (WM), As and phosphorus (P) on yield and yield attributes of boro (variety BRRI dhan 29) and aman (variety BRRI dhan 32) rice. A total of 18 treatment combinations of the three levels of As (0, 20 and 40 mg/kg) and P (0, 12.5 and 25.0 mg/kg) and two WM strategies (aerobic and anaerobic) were investigated. Yield attributes were significantly affected by increasing As levels. Grain yields of BRRI dhan 29 and BRRI dhan 32 were reduced from 63.0 to 7.7 and 35.0 to 16.5 g/pot with increasing As application, respectively, indicating a greater sensitivity of BRRI dhan 29 than BRRI dhan 32. Moreover, As toxicity was reduced with aerobic compared to anaerobic WM for all P levels. During early growth stages, phytotoxic symptoms appeared on BRRI dhan 29 and BRRI dhan 32 rice stems with increasing As levels without applying P under anaerobic WM. Under anaerobic and As-contaminated conditions, BRRI dhan 29 was highly susceptible to straighthead, which dramatically reduced grain yields. There were significant relationships between the number of effective tillers per pot and root dry weight, grain yield, and number of fertile and unfertile grains per pot for both BRRI dhan 29 and BRRI dhan 32 (P<0.001). Our findings indicate that rice could be grown aerobically in As-contaminated areas with a reduced risk of As toxicity and yield loss.

  2. Sodium- and phosphorus-based food additives: persistent but surmountable hurdles in the management of nutrition in chronic kidney disease.

    Science.gov (United States)

    Gutiérrez, Orlando M

    2013-03-01

    Sodium- and phosphorus-based food additives are among the most commonly consumed nutrients in the world. This is because both have diverse applications in processed food manufacturing, leading to their widespread use by the food industry. Since most foods are naturally low in salt, sodium additives almost completely account for the excessive consumption of sodium throughout the world. Similarly, phosphorus additives represent a major and "hidden" phosphorus load in modern diets. These factors pose a major barrier to successfully lowering sodium or phosphorus intake in patients with CKD. As such, any serious effort to reduce sodium or phosphorus consumption will require reductions in the use of these additives by the food industry. The current regulatory environment governing the use of food additives does not favor this goal, however, in large part because these additives have historically been classified as generally safe for public consumption. To overcome these barriers, coordinated efforts will be needed to demonstrate that high intake of these additives is not safe for public consumption and as such should be subject to greater regulatory scrutiny. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  3. Sodium and phosphorus-based food additives: persistent but surmountable hurdles in the management of nutrition in chronic kidney disease

    Science.gov (United States)

    Gutiérrez, Orlando M.

    2012-01-01

    Sodium and phosphorus-based food additives are among the most commonly consumed nutrients in the world. This is because both have diverse applications in processed food manufacturing, leading to their widespread utilization by the food industry. Since most foods are naturally low in salt, sodium additives almost completely account for the excessive consumption of sodium throughout the world. Similarly, phosphorus additives represent a major and “hidden” phosphorus load in modern diets. These factors pose a major barrier to successfully lowering sodium or phosphorus intake in patients with chronic kidney disease. As such, any serious effort to reduce sodium or phosphorus consumption will require reductions in the use of these additives by the food industry. The current regulatory environment governing the use of food additives does not favor this goal, however, in large part because these additives have historically been classified as generally safe for public consumption. To overcome these barriers, coordinated efforts will be needed to demonstrate that high intakes of these additives are not safe for public consumption and as such, should be subject to greater regulatory scrutiny. PMID:23439374

  4. Nitrogen and the Baltic Sea: Managing Nitrogen in Relation to Phosphorus

    Directory of Open Access Journals (Sweden)

    R. Elmgren

    2001-01-01

    Full Text Available The Baltic is a large, brackish sea (4 x 105 km2 extending from 54ÅN to ~66ÅN, with a fourfold larger drainage area (population 8 x 107. Surface salinity (2 to 8 PSU and hence biodiversity is low. In the last century, annual nutrient loads increased to 106 metric tons N and 5 x104 ton P. Eutrophication is evident in the N-limited south, where cyanobacteria fix 2 to 4 x 105 ton N each summer, Secchi depths have been halved, and O2-deficient bottom areas have spread. Production remains low in the P-limited north. In nutrient-enriched coastal areas, phytoplankton blooms, toxic at times, and filamentous macroalgae reduce amenity values. Loads need to be reduced of both N, to reduce production, and P, to limit N-fixing cyanobacterial blooms. When large N-load reductions have been achieved locally, algal biomass has declined. So far, P loads have been reduced more than N loads. If this continues, a P-limited Baltic proper may result, very different from previous N-limited conditions. Reaching the management goal of halved anthropogenic N and P loads at minimum cost will require better understanding of biogeochemical nutrient cycles, economic evaluation of proposed measures, and improved stakeholder participation.

  5. Randomised controlled trial of the clinical and cost-effectiveness of a peer-delivered self-management intervention to prevent relapse in crisis resolution team users: study protocol.

    Science.gov (United States)

    Johnson, Sonia; Mason, Oliver; Osborn, David; Milton, Alyssa; Henderson, Claire; Marston, Louise; Ambler, Gareth; Hunter, Rachael; Pilling, Stephen; Morant, Nicola; Gray, Richard; Weaver, Tim; Nolan, Fiona; Lloyd-Evans, Brynmor

    2017-10-27

    Crisis resolution teams (CRTs) provide assessment and intensive home treatment in a crisis, aiming to offer an alternative for people who would otherwise require a psychiatric inpatient admission. They are available in most areas in England. Despite some evidence for their clinical and cost-effectiveness, recurrent concerns are expressed regarding discontinuity with other services and lack of focus on preventing future relapse and readmission to acute care. Currently evidence on how to prevent readmissions to acute care is limited. Self-management interventions, involving supporting service users in recognising and managing signs of their own illness and in actively planning their recovery, have some supporting evidence, but have not been tested as a means of preventing readmission to acute care in people leaving community crisis care. We thus proposed the current study to test the effectiveness of such an intervention. We selected peer support workers as the preferred staff to deliver such an intervention, as they are well-placed to model and encourage active and autonomous recovery from mental health problems. The CORE (CRT Optimisation and Relapse Prevention) self-management trial compares the effectiveness of a peer-provided self-management intervention for people leaving CRT care, with treatment as usual supplemented by a booklet on self-management. The planned sample is 440 participants, including 40 participants in an internal pilot. The primary outcome measure is whether participants are readmitted to acute care over 1 year of follow-up following entry to the trial. Secondary outcomes include self-rated recovery at 4 and at 18 months following trial entry, measured using the Questionnaire on the Process of Recovery. Analysis will follow an intention to treatment principle. Random effects logistic regression modelling with adjustment for clustering by peer support worker will be used to test the primary hypothesis. The CORE self-management trial was approved

  6. Protocol for an online randomised controlled trial to evaluate the clinical and cost-effectiveness of a peer-supported self-management intervention for relatives of people with psychosis or bipolar disorder: Relatives Education And Coping Toolkit (REACT).

    Science.gov (United States)

    Lobban, Fiona; Robinson, Heather; Appelbe, Duncan; Barraclough, Johanna; Bedson, Emma; Collinge, Lizzi; Dodd, Susanna; Flowers, Sue; Honary, Mahsa; Johnson, Sonia; Mateus, Ceu; Mezes, Barbara; Minns, Valerie; Murray, Elizabeth; Walker, Andrew; Williamson, Paula; Wintermeyer, Catherine; Jones, Steven

    2017-07-18

    Despite clinical guidelines recommendations, many relatives of people with psychosis or bipolar disorder do not currently receive the support they need. Online information and support may offer a solution. This single-blind, parallel, online randomised controlled trial will determine clinical and cost-effectiveness of the Relatives Education And Coping Toolkit (REACT) (including an online resource directory (RD)), compared with RD only, for relatives of people with psychosis or bipolar disorder. Both groups continue to receive treatment as usual. Independent, web-based variable, block, individual randomisation will be used across 666 relatives. Primary outcome is distress at 24 weeks (measured by General Health Questionnaire; GHQ-28) compared between groups using analysis of covariance, adjusting for baseline score. Secondary clinical outcomes are carer well-being and support. Cost-effectiveness analysis will determine cost of a significant unit change (three-point reduction) in the GHQ-28. Costs include offering and supporting the intervention in the REACT arm, relevant healthcare care costs including health professional contacts, medications prescribed and time off (or ability to) work for the relative. Cost utility analysis will be calculated as the marginal cost of changes in quality-adjusted life years, based on EuroQol. We will explore relatives' beliefs, perceived coping and amount of REACT toolkit use as possible outcome mediators. We have embedded two methodological substudies in the protocol to determine the relative effectiveness of a low-value (£10) versus higher value (£20) incentive, and an unconditional versus conditional incentive, on improving follow-up rates. The trial has ethical approval from Lancaster National Research Ethics Service (NRES)Committee (15/NW/0732) and is overseen by an independent Data Monitoring and Ethics Committee and Trial Steering Committee. Protocol version 1.5 was approved on 9 January 2017. All updates to protocols are

  7. Combination Use of Water Quality Modelling and Cost-Effective Analysis to Assess Environmental Benefit of a Watershed - A Case Study of Various Engineering and Management Strategy Arrangements in Taiwan

    Science.gov (United States)

    Fan, C.; Wu, C. Y.

    2017-12-01

    This study aimed to evaluate the potential environmental benefits using the water quality modelling integrated with cost-effective analysis to assess several proposed scenarios of engineering and management arrangements based on regional development planning and pollution mitigation strategy. The QUAL2Kw models of Erhjen river and its major tributary, Sanye creek, were established to simulate the river pollution indices of dissolved oxygen (DO), biochemical oxygen demand (BOD), suspended solids (SS) and ammonia nitrogen (NH3-N). The HEC-RAS was employed to calculate the hydraulic parameters and dilution impact of tidal effect in the downstream section. The verified integrated model was applied to estimating the water quality variations for several given scenarios considering the possible re-arrangement of projected pollution mitigation implementations, such as sewage system construction facilitation, additional on-site treatment facilities establishment and pig-manure anaerobic fermentation for biogas power generation in the Erhjen river watershed. As a result, the water quality of the Sanye creek was apparently improved after the completion of sewage system construction. The ammonia nitrogen concentration reduced from the level 6 to 10 times above severely-polluted standard to the merely-above level. By ignoring the impact of ammonia nitrogen on river pollution index calculation, the water quality of the lower section of the Sanye creek was improved to slightly-polluted or non-polluted level. In the scenario of anaerobic fermentation promotion, if manure anaerobic fermentation facilities were installed in all the pig farms with livestock number more than 2000, water quality was estimated to be improved slightly only. Furthermore, if all the manure waste from pig-farms is collected for subsequent electricity generation in the investigated watershed, the river pollution index is estimated to improve to moderately-polluted category for all the length of Erhjen river

  8. An Application of the Phosphorus Consistent Rule for Environmentally Acceptable Cost-Efficient Management of Broiler Litter in Crop Production

    Science.gov (United States)

    Paudel, Krishna P.; Limaye, Ashutosh; Adhikari, Murali; Martin, Neil R., Jr.

    2004-01-01

    We calculated the profitability of using broiler litter as a source of plant nutrients using the phosphorus consistent litter application rule. The cost saving by using litter is 37% over the use of chemical fertilizer-only option to meet the nutrient needs of major crops grown in Alabama. In the optimal solution, only a few routes of all the possible routes developed were used for inter- and intra- county litter hauling. If litter is not adopted as the sole source of crop nutrients, the best environmental policy may be to pair the phosphorus consistent rule with taxes, marketable permits, and subsidies.flaws

  9. Supporting teachers and children in schools: the effectiveness and cost-effectiveness of the incredible years teacher classroom management programme in primary school children: a cluster randomised controlled trial, with parallel economic and process evaluations

    Directory of Open Access Journals (Sweden)

    Ford Tamsin

    2012-08-01

    Full Text Available Abstract Background Childhood antisocial behaviour has high immediate and long-term costs for society and the individual, particularly in relation to mental health and behaviours that jeopardise health. Managing challenging behaviour is a commonly reported source of stress and burn out among teachers, ultimately resulting in a substantial number leaving the profession. Interventions to improve parenting do not transfer easily to classroom-based problems and the most vulnerable parents may not be easily able to access them. Honing teachers’ skills in proactive behaviour management and the promotion of socio-emotional regulation, therefore, has the potential to improve both child and teacher mental health and well-being and the advantage that it might potentially benefit all the children subsequently taught by any teacher that accesses the training. Methods/Design Cluster randomised controlled trial (RCT of the Incredible Years teacher classroom management (TCM course with combined economic and process evaluations. One teacher of children aged 4–9 years, from 80 schools in the South West Peninsula will be randomised to attend the TCM (intervention arm or to “teach as normal” (control arm. The primary outcome measure will be the total difficulties score from the Strengths and Difficulties Questionnaire (SDQ completed by the current class teachers prior to randomisation, and at 9, 18 and 30 months follow-up, supplemented by parent SDQs. Secondary measures include academic attainment (teacher report supplemented by direct measurement in a sub-sample, children’s enjoyment of school, and teacher reports of their professional self-efficacy, and levels of burn out and stress, supplemented by structured observations of teachers classroom management skills in a subsample. Cost data for the economic evaluation will be based on parental reports of services accessed. Cost-effectiveness, using the SDQ as the measure of effect, will be examined

  10. Supporting teachers and children in schools: the effectiveness and cost-effectiveness of the Incredible Years teacher classroom management programme in primary school children: a cluster randomised controlled trial, with parallel economic and process evaluations.

    Science.gov (United States)

    Ford, Tamsin; Edwards, Vanessa; Sharkey, Siobhan; Ukoumunne, Obioha C; Byford, Sarah; Norwich, Brahm; Logan, Stuart

    2012-08-30

    Childhood antisocial behaviour has high immediate and long-term costs for society and the individual, particularly in relation to mental health and behaviours that jeopardise health. Managing challenging behaviour is a commonly reported source of stress and burn out among teachers, ultimately resulting in a substantial number leaving the profession. Interventions to improve parenting do not transfer easily to classroom-based problems and the most vulnerable parents may not be easily able to access them. Honing teachers' skills in proactive behaviour management and the promotion of socio-emotional regulation, therefore, has the potential to improve both child and teacher mental health and well-being and the advantage that it might potentially benefit all the children subsequently taught by any teacher that accesses the training. Cluster randomised controlled trial (RCT) of the Incredible Years teacher classroom management (TCM) course with combined economic and process evaluations.One teacher of children aged 4-9 years, from 80 schools in the South West Peninsula will be randomised to attend the TCM (intervention arm) or to "teach as normal" (control arm). The primary outcome measure will be the total difficulties score from the Strengths and Difficulties Questionnaire (SDQ) completed by the current class teachers prior to randomisation, and at 9, 18 and 30 months follow-up, supplemented by parent SDQs. Secondary measures include academic attainment (teacher report supplemented by direct measurement in a sub-sample), children's enjoyment of school, and teacher reports of their professional self-efficacy, and levels of burn out and stress, supplemented by structured observations of teachers classroom management skills in a subsample. Cost data for the economic evaluation will be based on parental reports of services accessed. Cost-effectiveness, using the SDQ as the measure of effect, will be examined over the period of the RCT and over the longer term using decision

  11. Critical phosphorus loading of different types of shallow lakes and the consequences for management estimated with the ecosystem model PCLake

    NARCIS (Netherlands)

    Janse, J.H.; De Senerpont Domis, L.N.; Scheffer, M.; Lijklema, L.; Klinge, M.; Mooij, W.M.; Van Liere, L.

    2008-01-01

    Shallow lakes typically can be in one of two contrasting states: a clear state with submerged macrophytes or a turbid state dominated by phytoplankton. Eutrophication may cause a switch from the clear to the turbid state, if the phosphorus loading exceeds a critical value. Recovery of the clear

  12. X-ray fluorescence spectrometry-based approach to precision management of bioavailable phosphorus in soil environments

    Science.gov (United States)

    Declining nutrient use efficiency in crop production has been a global priority to preserve high agricultural productivity with finite non-renewable nutrient resources, in particular phosphorus (P). Rapid spectroscopic methods increase measurement density of soil nutrients, and the availability of ...

  13. A multi-level analysis of China's phosphorus flows to identify options for improved management in agriculture

    NARCIS (Netherlands)

    Li, Guohua; Ittersum, van Martin K.; Leffelaar, Peter A.; Sattari, Sheida Z.; Li, Haigang; Huang, Gaoqiang; Zhang, Fusuo

    2016-01-01

    Phosphorus (P) is a finite natural resource and is essential for food production. The amount of P involved in food production in China relative to the increase of food production has increased dramatically over the past decades, which has led to serious environmental pollution. Because of China's

  14. Cost-effectiveness in Clostridium difficile treatment decision-making

    NARCIS (Netherlands)

    Nuijten, Mark J. C.; Keller, Josbert J.; Visser, Caroline E.; Redekop, Ken; Claassen, Eric; Speelman, Peter; Pronk, Marja H.

    2015-01-01

    To develop a framework for the clinical and health economic assessment for management of Clostridium difficile infection (CDI). CDI has vast economic consequences emphasizing the need for innovative and cost effective solutions, which were aim of this study. A guidance model was developed for

  15. 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.

  16. Cost effectiveness of recycling: A systems model

    Energy Technology Data Exchange (ETDEWEB)

    Tonjes, David J., E-mail: david.tonjes@stonybrook.edu [Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY 11794-3560 (United States); Waste Reduction and Management Institute, School of Marine and Atmospheric Sciences, Stony Brook University, Stony Brook, NY 11794-5000 (United States); Center for Bioenergy Research and Development, Advanced Energy Research and Technology Center, Stony Brook University, 1000 Innovation Rd., Stony Brook, NY 11794-6044 (United States); Mallikarjun, Sreekanth, E-mail: sreekanth.mallikarjun@stonybrook.edu [Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY 11794-3560 (United States)

    2013-11-15

    Highlights: • Curbside collection of recyclables reduces overall system costs over a range of conditions. • When avoided costs for recyclables are large, even high collection costs are supported. • When avoided costs for recyclables are not great, there are reduced opportunities for savings. • For common waste compositions, maximizing curbside recyclables collection always saves money. - Abstract: Financial analytical models of waste management systems have often found that recycling costs exceed direct benefits, and in order to economically justify recycling activities, externalities such as household expenses or environmental impacts must be invoked. Certain more empirically based studies have also found that recycling is more expensive than disposal. Other work, both through models and surveys, have found differently. Here we present an empirical systems model, largely drawn from a suburban Long Island municipality. The model accounts for changes in distribution of effort as recycling tonnages displace disposal tonnages, and the seven different cases examined all show that curbside collection programs that manage up to between 31% and 37% of the waste stream should result in overall system savings. These savings accrue partially because of assumed cost differences in tip fees for recyclables and disposed wastes, and also because recycling can result in a more efficient, cost-effective collection program. These results imply that increases in recycling are justifiable due to cost-savings alone, not on more difficult to measure factors that may not impact program budgets.

  17. A mixed methods study to evaluate the clinical and cost-effectiveness of a self-managed exercise programme versus usual physiotherapy for chronic rotator cuff disorders: protocol for the SELF study.

    Science.gov (United States)

    Littlewood, Chris; Ashton, Jon; Mawson, Sue; May, Stephen; Walters, Stephen

    2012-04-30

    cost-effectiveness and a qualitative investigation will be undertaken to develop greater understanding of the experience of undertaking or prescribing exercise as a self-managed therapy. ISRCTN84709751.

  18. A mixed methods study to evaluate the clinical and cost-effectiveness of a self-managed exercise programme versus usual physiotherapy for chronic rotator cuff disorders: protocol for the SELF study

    Directory of Open Access Journals (Sweden)

    Littlewood Chris

    2012-04-01

    NHS and Personal Social Services perspective to evaluate cost-effectiveness and a qualitative investigation will be undertaken to develop greater understanding of the experience of undertaking or prescribing exercise as a self-managed therapy. Trial registration number ISRCTN84709751

  19. A mixed methods protocol to evaluate the effect and cost-effectiveness of an Integrated electronic Diagnosis Approach (IeDA) for the management of childhood illnesses at primary health facilities in Burkina Faso.

    Science.gov (United States)

    Blanchet, Karl; Lewis, James J; Pozo-Martin, Francisco; Satouro, Arsene; Somda, Serge; Ilboudo, Patrick; Sarrassat, Sophie; Cousens, Simon

    2016-08-04

    Burkina Faso introduced the Integrated Management of Childhood Illnesses (IMCI) strategy in 2003. However, an evaluation conducted in 2013 found that only 28 % of children were assessed for three danger signs as recommended by IMCI, and only 15 % of children were correctly classified. About 30 % of children were correctly prescribed with an antibiotic for suspected pneumonia or oral rehydration salts (ORS) for diarrhoea, and 40 % were correctly referred. Recent advances in information and communication technologies (ICT) and use of electronic clinical protocols hold the potential to transform healthcare delivery in low-income countries. However, no evidence is available on the effect of ICT on adherence to IMCI. This paper describes the research protocol of a mixed methods study that aims to measure the effect of the Integrated electronic Diagnosis Approach innovation (an electronic IMCI protocol provided to nurses) in two regions of Burkina Faso. The study combines a stepped-wedge trial, a realistic evaluation and an economic study in order to capture the effect of the innovation after its introduction on the level of adherence, cost and acceptability. The main challenge is to interconnect the three substudies. In integrating outcome, process and cost data, we focus on three key questions: (i) How does the effectiveness and the cost of the intervention vary by type of health worker and type of health centre? (ii) What is the impact of changes in the content, coverage and quality of the IeDA intervention on adherence and cost-effectiveness? (iii) What mechanisms of change (including costs) might explain the relationship between the IeDA intervention and adherence? Clinicaltrials.gov, NCT02341469 .

  20. Tuition fees and sunk-cost effects

    NARCIS (Netherlands)

    Ketel, N.; Linde, J.; Oosterbeek, H.; van der Klaauw, B.

    2016-01-01

    This article reports on a field experiment testing for sunk-cost effects in an education setting. Students signing up for extra-curricular tutorial sessions randomly received a discount on the tuition fee. The sunk-cost effect predicts that students who pay more will attend more tutorial sessions,

  1. 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.

  2. 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…

  3. Tackling obesity in areas of high social deprivation: clinical effectiveness and cost-effectiveness of a task-based weight management group programme - a randomised controlled trial and economic evaluation.

    Science.gov (United States)

    McRobbie, Hayden; Hajek, Peter; Peerbux, Sarrah; Kahan, Brennan C; Eldridge, Sandra; Trépel, Dominic; Parrott, Steve; Griffiths, Chris; Snuggs, Sarah; Myers Smith, Katie

    2016-10-01

    An increasing number of people require help to manage their weight. The NHS recommends weight loss advice by general practitioners and/or a referral to a practice nurse. Although this is helpful for some, more effective approaches that can be disseminated economically on a large scale are needed. To assess whether or not a task-based weight management programme [Weight Action Programme (WAP)] has better long-term effects than a 'best practice' intervention provided in primary care by practice nurses. Randomised controlled trial with cost-effectiveness analysis. General practices in east London, UK. Three hundred and thirty adults with a body mass index (BMI) of ≥ 30 kg/m 2 or a BMI of ≥ 28 kg/m 2 plus comorbidities were recruited from local general practices and via media publicity. Those who had a BMI of > 45 kg/m 2 , had lost > 5% of their body weight in the previous 6 months, were currently pregnant or taking psychiatric medications were excluded. Participants were randomised (2 : 1) to the WAP or nurse arms. The WAP intervention was delivered in eight weekly group sessions that combined dietary and physical activity, advice and self-monitoring in a group-oriented intervention. The initial course was followed by 10 monthly group maintenance sessions open to all participants in this study arm. The practice nurse intervention (best usual care) consisted of four one-to-one sessions delivered over 8 weeks, and included standard advice on diet and physical activity based on NHS 'Change4Life' materials and motivational support. The primary outcome measure was weight change at 12 months. Secondary outcome measures included change in BMI, waist circumference and blood pressure, and proportion of participants losing at least 5% and 10% of baseline body weight. Staff collecting measurements at the 6- and 12-month follow-ups were blinded to treatment allocation. The primary outcome measure was analysed according to the intention-to-treat principle

  4. Cost-effectiveness analysis of the national implementation of integrated community case management and community-based health planning and services in Ghana for the treatment of malaria, diarrhoea and pneumonia

    DEFF Research Database (Denmark)

    Escribano Ferrer, Blanca; Hansen, Kristian Schultz; Gyapong, Margaret

    2017-01-01

    was to assess the cost-effectiveness of these strategies under programme conditions. Methods: A cost-effectiveness analysis was conducted. Appropriate diagnosis and treatment given was the effectiveness measure used. Appropriate diagnosis and treatment data was obtained from a household survey conducted 2 and 8...... years after implementation of iCCM in the Volta and Northern Regions of Ghana, respectively. The study population was carers of children under-5 years who had fever, diarrhoea and/or cough in the last 2 weeks prior to the interview. Costs data was obtained mainly from the National Malaria Control...... Programme (NMCP), the Ministry of Health, CHPS compounds and from a household survey. Results: Appropriate diagnosis and treatment of malaria, diarrhoea and suspected pneumonia was more cost-effective under the iCCM than under CHPS in the Volta Region, even after adjusting for different discount rates...

  5. How does cognitive dissonance influence the sunk cost effect?

    Directory of Open Access Journals (Sweden)

    Chung SH

    2018-03-01

    Full Text Available Shao-Hsi Chung,1 Kuo-Chih Cheng2 1Department of Business Administration, Meiho University, Pingtung, Taiwan; 2Department of Accounting, National Changhua University of Education, Changhua City, Taiwan Background: The sunk cost effect is the scenario when individuals are willing to continue to invest capital in a failing project. The purpose of this study was to explain such irrational behavior by exploring how sunk costs affect individuals’ willingness to continue investing in an unfavorable project and to understand the role of cognitive dissonance on the sunk cost effect. Methods: This study used an experimental questionnaire survey on managers of firms listed on the Taiwan Stock Exchange and Over-The-Counter. Results: The empirical results show that cognitive dissonance does not mediate the relationship between sunk costs and willingness to continue an unfavorable investment project. However, cognitive dissonance has a moderating effect, and only when the level of cognitive dissonance is high does the sunk cost have significantly positive impacts on willingness to continue on with an unfavorable investment. Conclusion: This study offers psychological mechanisms to explain the sunk cost effect based on the theory of cognitive dissonance, and it also provides some recommendations for corporate management. Keywords: sunk costs, sunk cost effect, cognitive dissonance, behavior, unfavorable investment

  6. Filling two needs with one deed: Potentials to simultaneously improve phosphorus and nitrogen management in Austria as an example for coupled resource management systems.

    Science.gov (United States)

    Tanzer, Julia; Zoboli, Ottavia; Zessner, Matthias; Rechberger, Helmut

    2018-06-04

    The tremendous increase in resource consumption over the past century and the environmental challenges it entails has spurred discussions for a shift from a linear to a circular resource use. However, to date most resource studies are restricted to one material or a single sector or process. In this work, a coupled material flow analysis taking the national phosphorus (P) and nitrogen (N) system of Austria as an example for two closely connected resource systems is conducted. Effects of different measures aimed at reducing P and/or N-demand, increasing recycling or reducing emissions to air and water are compared to a reference state (representing the actual situation in 2015). Changes in the mineral fertilizer demand of the system, P and N losses in the waste sector, water emissions of P and N, P soil accumulation and atmospheric N emissions are analyzed. Overall positive feedbacks between measures and between different goals of one measure always outweigh negative ones, which is why the highest efficiency gains (57±4%) can be achieved by a combination of all the 16 measures studied. Potentials for the reduction of mineral fertilizer demand are larger than for emission reduction though, confirming the past priority of environmental protection over resource protection. Although coupling significantly raises model complexity it can be shown that material flows of more than one substance can be simultaneously analyzed in a rather complex system. This may reveal interrelations, co-benefits and trade-offs between different resources that might have been omitted in a mono-substance analysis and thus improve judgment of sustainability and viability of different management strategies. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

  7. 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.)

  8. CT colonography and cost-effectiveness

    International Nuclear Information System (INIS)

    Mavranezouli, Ifigeneia; East, James E.; Taylor, Stuart A.

    2008-01-01

    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.)

  9. 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.

  10. Sustainable use of phosphorus: a finite resource.

    Science.gov (United States)

    Scholz, Roland W; Ulrich, Andrea E; Eilittä, Marjatta; Roy, Amit

    2013-09-01

    Phosphorus is an essential element of life and of the modern agricultural system. Today, science, policy, agro-industry and other stakeholder groups are increasingly concerned about the sustainable use of this resource, given the dissipative nature of phosphorus and difficulties in assessing, evaluating, and coping with phosphorus pollution in aquatic and terrestrial systems. We argue that predictions about a forthcoming peak, followed by a quick reduction (i.e., physical phosphate rock scarcity) are unreasoned and stress that access to phosphorus (economic scarcity) is already, and may increasingly become critical, in particular for smallholders farmers in different parts of the world. The paper elaborates on the design, development, goals and cutting-edge contributions of a global transdisciplinary process (i.e. mutual learning between science and society including multiple stakeholders) on the understanding of potential contributions and risks related to the current mode of using phosphorus on multiple scales (Global TraPs). While taking a global and comprehensive view on the whole phosphorus-supply chain, Global TraPs organizes and integrates multiple transdisciplinary case studies to better answer questions which inform sustainable future phosphorus use. Its major goals are to contribute to four issues central to sustainable resource management: i) long-term management of biogeochemical cycles, in particular the challenge of closing the phosphorus cycle, ii) achieving food security, iii) avoiding environmental pollution and iv) sustainability learning on a global level by transdisciplinary processes. Copyright © 2013 Elsevier B.V. All rights reserved.

  11. The Cost-Effectiveness of Spinal Cord Stimulation for Complex Regional Pain Syndrome

    NARCIS (Netherlands)

    Kemler, Marius A.; Raphael, Jon H.; Bentley, Anthony; Taylor, Rod S.

    2010-01-01

    Objectives: Health-care policymakers and payers require cost-effectiveness evidence to inform their treatment funding decisions. The aims of this study were to assess the cost-effectiveness of the addition of spinal cord stimulation (SCS) compared with conventional management alone (CMM) in patients

  12. Cost-Effectiveness Analysis of Regorafenib for Metastatic Colorectal Cancer.

    Science.gov (United States)

    Goldstein, Daniel A; Ahmad, Bilal B; Chen, Qiushi; Ayer, Turgay; Howard, David H; Lipscomb, Joseph; El-Rayes, Bassel F; Flowers, Christopher R

    2015-11-10

    Regorafenib is a standard-care option for treatment-refractory metastatic colorectal cancer that increases median overall survival by 6 weeks compared with placebo. Given this small incremental clinical benefit, we evaluated the cost-effectiveness of regorafenib in the third-line setting for patients with metastatic colorectal cancer from the US payer perspective. We developed a Markov model to compare the cost and effectiveness of regorafenib with those of placebo in the third-line treatment of metastatic colorectal cancer. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Drug costs were based on Medicare reimbursement rates in 2014. Model robustness was addressed in univariable and probabilistic sensitivity analyses. Regorafenib provided an additional 0.04 QALYs (0.13 life-years) at a cost of $40,000, resulting in an incremental cost-effectiveness ratio of $900,000 per QALY. The incremental cost-effectiveness ratio for regorafenib was > $550,000 per QALY in all of our univariable and probabilistic sensitivity analyses. Regorafenib provides minimal incremental benefit at high incremental cost per QALY in the third-line management of metastatic colorectal cancer. The cost-effectiveness of regorafenib could be improved by the use of value-based pricing. © 2015 by American Society of Clinical Oncology.

  13. Substoichiometric extraction of phosphorus

    International Nuclear Information System (INIS)

    Shigematsu, T.; Kudo, K.

    1981-01-01

    A study of the substoichiometric extraction of phosphorus is described. Phosphorus was extracted in the form of ternary compounds such as ammonium phosphomolybdate, 8-hydroxyquinolinium phosphomolybdate, tetraphenylarsonium phosphomolybdate and tri-n-octylamine phosphomolybdate. Consequently, phosphorus was extracted substoichiometrically by the addition of a substoichiometric amount of molybdenum for the four phosphomolybdate compounds. On the other hand, phosphorus could be separated substoichiometrically with a substoichiometric amount of tetraphenylarsonium chloride or tri-n-octylamine. Stoichiometric ratios of these ternary compounds obtained substoichiometrically were 1:12:3 for phosphorus, molybdenum and organic reagent. The applicability of these compounds to phosphorus determination is also discussed. (author)

  14. 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

  15. Can Economic Model Transparency Improve Provider Interpretation of Cost-effectiveness Analysis? Evaluating Tradeoffs Presented by the Second Panel on Cost-effectiveness in Health and Medicine.

    Science.gov (United States)

    Padula, William V; McQueen, Robert Brett; Pronovost, Peter J

    2017-11-01

    The Second Panel on Cost-Effectiveness in Health and Medicine convened on December 7, 2016 at the National Academy of Medicine to disseminate their recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses (CEAs). Following its summary, panel proceedings included lengthy discussions including the field's struggle to disseminate findings efficiently through peer-reviewed literature to target audiences. With editors of several medical and outcomes research journals in attendance, there was consensus that findings of cost-effectiveness analyses do not effectively reach other researchers or health care providers. The audience members suggested several solutions including providing additional training to clinicians in cost-effectiveness research and requiring that cost-effectiveness models are made publicly available. However, there remains the questions of whether making economic modelers' work open-access through journals is fair under the defense that these models remain one's own intellectual property, or whether journals can properly manage the peer-review process specifically for cost-effectiveness analyses. In this article, we elaborate on these issues and provide some suggested solutions that may increase the dissemination and application of cost-effectiveness literature to reach its intended audiences and ultimately benefit the patient. Ultimately, it is our combined view as economic modelers and clinicians that cost-effectiveness results need to reach the clinician to improve the efficiency of medical practice, but that open-access models do not improve clinician access or interpretation of the economics of medicine.

  16. Cost-effectiveness analysis of insulin degludec compared with insulin glargine u100 for the management of type 1 and type 2 diabetes mellitus - from the Spanish National Health System perspective.

    Science.gov (United States)

    Mezquita-Raya, Pedro; Darbà, Josep; Ascanio, Meritxell; Ramírez de Arellano, Antonio

    2017-12-01

    The objective of this study was to assess the cost-effectiveness of insulin degludec versus insulin glargine, from the Spanish NHS in three groups of patients. A short-term cost utility model was developed to estimate effectiveness results in terms of the total number of hypoglycaemic events and their disutility impact throughout the year on the initial level of quality of life for patients in each treatment. Degludec was the dominant strategy for T2DM BOT and exhibited an incremental cost-effectiveness ratio of 52.70€/QALY and 11,240.88€/QALY for T1DM B/B and T2DM B/B, respectively. Lower costs are primarily driven by lower nocturnal and severe hypoglycaemic events, which were reduced versus IGlar. Improvements in clinical outcomes in all three patient groups are result of the reduced number of hypoglycaemic events showing 0.0211, 0.0328 and 0.0248 QALYs gained when compared to IGlar for T1DM B/B, T2DM BOT and T2DM B/B, respectively. Different scenario analyses showed that the ICERS were stable to plausible variations in the analysed parameters, except when the same number of SMBG for both treatments is used, with T2DM B/B showing an ICER over the accepted threshold. This analysis demonstrates that degludec is a cost-effective option in the Spanish NHS, when used in patients currently treated with long-acting insulin.

  17. Phosphorus blood test

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/003478.htm Phosphorus blood test To use the sharing features on this page, please enable JavaScript. The phosphorus blood test measures the amount of phosphate in the blood. ...

  18. Investigating the effectiveness and cost-effectiveness of FITNET-NHS (Fatigue In Teenagers on the interNET in the NHS) compared to Activity Management to treat paediatric chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME): protocol for a randomised controlled trial.

    Science.gov (United States)

    Baos, Sarah; Brigden, Amberly; Anderson, Emma; Hollingworth, William; Price, Simon; Mills, Nicola; Beasant, Lucy; Gaunt, Daisy; Garfield, Kirsty; Metcalfe, Chris; Parslow, Roxanne; Downing, Harriet; Kessler, David; Macleod, John; Stallard, Paul; Knoop, Hans; Van de Putte, Elise; Nijhof, Sanne; Bleijenberg, Gijs; Crawley, Esther

    2018-02-22

    Paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and disabling condition. The National Institute for Health and Clinical Excellence (NICE) recommends Cognitive Behavioural Therapy (CBT) as a treatment option for paediatric CFS/ME because there is good evidence that it is effective. Despite this, most young people in the UK are unable to access local specialist CBT for CFS/ME. A randomised controlled trial (RCT) showed FITNET was effective in the Netherlands but we do not know if it is effective in the National Health Service (NHS) or if it is cost-effective. This trial will investigate whether FITNET-NHS is clinically effective and cost-effective in the NHS. Seven hundred and thirty-four paediatric patients (aged 11-17 years) with CFS/ ME will be randomised (1:1) to receive either FITNET-NHS (online CBT) or Activity Management (delivered via video call). The internal pilot study will use integrated qualitative methods to examine the feasibility of recruitment and the acceptability of treatment. The full trial will assess whether FITNET-NHS is clinically effective and cost-effective. The primary outcome is disability at 6 months, measured using the SF-36-PFS (Physical Function Scale) questionnaire. Cost-effectiveness is measured via cost-utility analysis from an NHS perspective. Secondary subgroup analysis will investigate the effectiveness of FITNET-NHS in those with co-morbid mood disorders. If FITNET-NHS is found to be feasible and acceptable (internal pilot) and effective and cost-effective (full trial), its provision by the NHS has the potential to deliver substantial health gains for the large number of young people suffering from CFS/ME but unable to access treatment because there is no local specialist service. This trial will provide further evidence evaluating the delivery of online CBT to young people with chronic conditions. ISRCTN registry, registration number: ISRCTN18020851 . Registered on 4 August 2016.

  19. Cost-effectiveness analysis of treatments for vertebral compression fractures.

    Science.gov (United States)

    Edidin, Avram A; Ong, Kevin L; Lau, Edmund; Schmier, Jordana K; Kemner, Jason E; Kurtz, Steven M

    2012-07-01

    Vertebral compression fractures (VCFs) can be treated by nonsurgical management or by minimally invasive surgical treatment including vertebroplasty and balloon kyphoplasty. The purpose of the present study was to characterize the cost to Medicare for treating VCF-diagnosed patients by nonsurgical management, vertebroplasty, or kyphoplasty. We hypothesized that surgical treatments for VCFs using vertebroplasty or kyphoplasty would be a cost-effective alternative to nonsurgical management for the Medicare patient population. Cost per life-year gained for VCF patients in the US Medicare population was compared between operated (kyphoplasty and vertebroplasty) and non-operated patients and between kyphoplasty and vertebroplasty patients, all as a function of patient age and gender. Life expectancy was estimated using a parametric Weibull survival model (adjusted for comorbidities) for 858 978 VCF patients in the 100% Medicare dataset (2005-2008). Median payer costs were identified for each treatment group for up to 3 years following VCF diagnosis, based on 67 018 VCF patients in the 5% Medicare dataset (2005-2008). A discount rate of 3% was used for the base case in the cost-effectiveness analysis, with 0% and 5% discount rates used in sensitivity analyses. After accounting for the differences in median costs and using a discount rate of 3%, the cost per life-year gained for kyphoplasty and vertebroplasty patients ranged from $US1863 to $US6687 and from $US2452 to $US13 543, respectively, compared with non-operated patients. The cost per life-year gained for kyphoplasty compared with vertebroplasty ranged from -$US4878 (cost saving) to $US2763. Among patients for whom surgical treatment was indicated, kyphoplasty was found to be cost effective, and perhaps even cost saving, compared with vertebroplasty. Even for the oldest patients (85 years of age and older), both interventions would be considered cost effective in terms of cost per life-year gained.

  20. Diversity and Gene Expression of Phosphatase Genes Provide Insight into Soil Phosphorus Dynamics in a New Zealand Managed Grassland

    Science.gov (United States)

    Dunfield, K. E.; Gaiero, J. R.; Condron, L.

    2017-12-01

    Healthy and diverse communities of soil organisms influence key soil ecosystem services such as carbon sequestration, water quality protection, climate regulation and nutrient cycling. Microbially driven mineralization of organic phosphorus is an important contributor to plant available inorganic orthophosphates. In acidic soils, microbes produce non-specific acid phosphatases (NSAPs) which act on common forms of organic phosphorus (P). Our current understanding of P turnover in soils has been limited by lack of research tools capable of targeting these genes. Thus, we developed a set of oligonucleotide PCR primers that targeted bacteria with the genetic potential for acid phosphatase production. A long term randomized-block pasture trial was sampled following 22 years of continued aerial biomass removal and retention. Primers were used to target genes encoding alkaline phosphatase (phoD) and the three classes (CAAP, CBAP, CCAP) of non-specific acid phosphatases. PCR amplicons targeting total genes and gene transcripts were sequenced using Illumina MiSeq to understand the diversity of the bacterial phosphatase producing communities. In general, the majority of operational taxonomic units (OTUs) were shared across both treatments and across metagenomes and transcriptomes. However, analysis of DNA OTUs revealed significantly different communities driven by treatment differences (P reduced Olsen P levels (15 vs. 36 mg kg-1 in retained treatment). Acid phosphatase activity was measured in all samples, and found to be highest in the biomass retained treatment (16.8 vs. 11.4 µmol g-1 dry soil h-1), likely elevated due to plant-derived enzymes; however, was still correlated to bacterial gene abundances. Overall, the phosphatase producing microbial communities responded to the effect of consistent P limitation as expected, through alteration in the composition of the community structure and through increased levels of gene expression of the phosphatase genes.

  1. How does cognitive dissonance influence the sunk cost effect?

    Science.gov (United States)

    Chung, Shao-Hsi; Cheng, Kuo-Chih

    2018-01-01

    The sunk cost effect is the scenario when individuals are willing to continue to invest capital in a failing project. The purpose of this study was to explain such irrational behavior by exploring how sunk costs affect individuals' willingness to continue investing in an unfavorable project and to understand the role of cognitive dissonance on the sunk cost effect. This study used an experimental questionnaire survey on managers of firms listed on the Taiwan Stock Exchange and Over-The-Counter. The empirical results show that cognitive dissonance does not mediate the relationship between sunk costs and willingness to continue an unfavorable investment project. However, cognitive dissonance has a moderating effect, and only when the level of cognitive dissonance is high does the sunk cost have significantly positive impacts on willingness to continue on with an unfavorable investment. This study offers psychological mechanisms to explain the sunk cost effect based on the theory of cognitive dissonance, and it also provides some recommendations for corporate management.

  2. Cost-effectiveness of a quality improvement collaborative focusing on patients with diabetes.

    NARCIS (Netherlands)

    Schouten, L.M.T.; Niessen, L.W.; Pas, J.W. van der; Grol, R.P.T.M.; Hulscher, M.E.J.L.

    2010-01-01

    OBJECTIVE: To investigate the lifelong health effects, costs, and cost-effectiveness of a quality improvement collaborative focusing on improving diabetes management in an integrated care setting. STUDY DESIGN AND METHODS: Economic evaluation from a healthcare perspective with lifetime horizon

  3. 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.

  4. Cost-effectiveness of colorectal cancer screening

    NARCIS (Netherlands)

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

    2011-01-01

    textabstractColorectal cancer is an important public health problem. Several screening methods have been shown to be effective in reducing colorectal cancer mortality. The objective of this review was to assess the cost-effectiveness of the different colorectal cancer screening methods and to

  5. The Interpersonal Sunk-Cost Effect.

    Science.gov (United States)

    Olivola, Christopher Y

    2018-05-01

    The sunk-cost fallacy-pursuing an inferior alternative merely because we have previously invested significant, but nonrecoverable, resources in it-represents a striking violation of rational decision making. Whereas theoretical accounts and empirical examinations of the sunk-cost effect have generally been based on the assumption that it is a purely intrapersonal phenomenon (i.e., solely driven by one's own past investments), the present research demonstrates that it is also an interpersonal effect (i.e., people will alter their choices in response to other people's past investments). Across eight experiments ( N = 6,076) covering diverse scenarios, I documented sunk-cost effects when the costs are borne by someone other than the decision maker. Moreover, the interpersonal sunk-cost effect is not moderated by social closeness or whether other people observe their sunk costs being "honored." These findings uncover a previously undocumented bias, reveal that the sunk-cost effect is a much broader phenomenon than previously thought, and pose interesting challenges for existing accounts of this fascinating human tendency.

  6. [Cost-effectiveness of addiction care].

    Science.gov (United States)

    Suijkerbuijk, A W M; van Gils, P F; Greeven, P G J; de Wit, G A

    2015-01-01

    A large number of interventions are available for the treatment of addiction. Professionals need to know about the effectiveness and cost-effectiveness of interventions so they can prioritise appropriate interventions for the treatment of addiction. To provide an overview of the scientific literature on the cost-effectiveness of addiction treatment for alcohol- and drug-abusers. We searched the databases Medline and Centre for Reviews and Dissemination. To be relevant for our study, articles had to focus on interventions in the health-care setting, have a Western context and have a health-related outcome measure such as quality adjusted life years (QALY). Twenty-nine studies met our inclusion criteria: 15 for alcohol and 14 for drugs. The studies on alcohol addiction related mainly to brief interventions. They proved to be cost-saving or had a favourable incremental cost-effectiveness ratio (ICER), remaining below the threshold of € 20,000 per QALY. The studies on drug addiction all involved pharmacotherapeutic interventions. In the case of 10 out of 14 interventions, the ICER was less than € 20,000 per QALY. Almost all of the interventions studied were cost-saving or cost-effective. Many studies consider only health-care costs. Additional research, for instance using a social cost-benefit analysis, could provide more details about the costs of addiction and about the impact that an intervention could have in these/the costs.

  7. 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...

  8. Screening crops for efficient phosphorus acquisition in a low phosphorus soil using radiotracer technique

    International Nuclear Information System (INIS)

    Meena, S.; Malarvizhi, P.; Rajeswari, R.

    2017-01-01

    Deficiency of phosphorus (P) is the major limitation to agricultural production. Identification of cultivars with greater capacity to grow in soils having low P availability (phosphorus efficiency) will help in P management in a sustainable way. Green house experiment with maize (CO 6) and cotton (MCU 13) as test crops with four levels of phosphorus (0, 3.75, 7.50 and 15 mg P kg -1 soil) was conducted in a P deficient soil (7.2 kg ha -1 ) to study the phosphorus acquisition characteristics and to select efficient crop using 32 P radiotracer technique. Carrier free 32 P obtained as orthophosphoric acid in dilute hydrochloric acid medium from the Board of Radiation and Isotope Technology, Mumbai was used for labeling the soil @ 3200 kBq pot -1 . After 60 days the crops were harvested and the radioactivity was measured in the plant samples using Liquid scintillation counter (PerkinElmer - Tricarb 2810 TR). Different values of specific radioactivity and Isotopically Exchangeable Phosphorus for maize and cotton indicated that chemically different pools of soil P were utilized and maize accessing a larger pool than cotton. Maize having recorded high Phosphorus Use Efficiency, Phosphorus Efficiency and low Phosphorus Stress Factor values, it is a better choice for P deficient soils. Higher Phosphorus Acquisition Efficiency of maize (59 %) than cotton (48%) can be related to the ability of maize to take up P from insoluble inorganic P forms. (author)

  9. Phosphorus and Compost Management Influence Maize (Zea mays) Productivity Under Semiarid Condition with and without Phosphate Solubilizing Bacteria

    Science.gov (United States)

    Amanullah

    2015-01-01

    Phosphorus (P) unavailability and lack of organic matter in the soils under semiarid climates are the two major constraints for low crop productivity. Field trial was conducted to study the effects of P levels, compost application times and seed inoculation with phosphate solubilizing bacteria (PSB) on the yield and yield components of maize (Zea mays L., cv. Azam). The experiment was conducted at the Agronomy Research Farm of The University of Agriculture Peshawar-Pakistan during summer 2014. The experiment was laid out in randomized complete block design with split plot arrangement using three replications. The two PSB levels [(1) inoculated seed with PSB (+) and (2) seed not inoculated with PSB (- or control)] and three compost application times (30, 15, and 0 days before sowing) combination (six treatments) were used as main plot factor, while four P levels (25, 50, 75, and 100 kg P ha-1) used as subplot factor. The results confirmed that compost applied at sowing time and P applied at the two higher rates (75 and 100 kg P ha-1) had significantly increased yield and yield components of maize under semiarid condition. Maize seed inoculated with PSB (+) had tremendously increased yield and yield components of maize over PSB-control plots (-) under semiarid condition. PMID:26697038

  10. Phosphorus and compost management influence maize (Zea mays productivity under semiarid condition with and without phosphate solubilizing bacteria

    Directory of Open Access Journals (Sweden)

    Amanullah eAmanullah

    2015-12-01

    Full Text Available Phosphorus (P unavailability and lack of organic matter in the soils under semiarid climates are the two major constraints for low crop productivity. Field trial was conducted to study the effects of P levels, compost application times and seed inoculation with phosphate solubilizing bacteria (PSB on the yield and yield components of maize (Zea mays L., cv. Azam. The experiment was conducted at the Agronomy Research Farm of The University of Agriculture Peshawar-Pakistan during summer 2014. The experiment was laid out in randomized complete block design with split plot arrangement using three replications. The two PSB levels [(1 inoculated seed with PSB (+ and (2 seed not inoculated with PSB (- or control] and three compost application times [(30, 15 and 0 days before sowing (DBS] combination (six treatments were used as main plot factor, while four P levels (25, 50, 75 and 100 kg P ha-1 used as subplot factor. The results confirmed that compost applied at sowing time and P applied at the two higher rates (75 and 100 kg P ha-1 had significantly increased yield and yield components of maize under semiarid condition. Maize seed inoculated with PSB (+ had tremendously increased yield and yield components of maize over PSB-control plots (- under semiarid condition.

  11. Processes Affecting Phosphorus and Copper Concentrations and Their Relation to Algal Growth in Two Supply Reservoirs in the Lower Coastal Plain of Virginia, 2002-2003, and Implications for Alternative Management Strategies

    Science.gov (United States)

    Speiran, Gary K.; Simon, Nancy S.; Mood-Brown, Maria L.

    2007-01-01

    Elevated phosphorus concentrations commonly promote excessive growth of algae in waters nationwide. When such waters are used for public supply, the algae can plug filters during treatment and impart tastes and odors to the finished water. This increases treatment costs and results in finished water that may not be of the quality desired for public supply. Consequently, copper sulfate is routinely applied to many reservoirs to control algal growth but only is a 'temporary fix' and must be reapplied at intervals that can range from more than 30 days in the winter to less than 7 days in the summer. Because copper has a maximum allowable concentration in public drinking water and can be toxic to aquatic life, water suppliers commonly seek to develop alternative, long-term strategies for managing reservoirs. Because these are nationwide issues and part of the mission of the U.S. Geological Survey (USGS) is to define and protect the quality of the Nation's water resources and better understand the physical, chemical, and biological processes in wetlands, lakes, reservoirs, and estuaries, investigations into these issues are important to the fulfillment of the mission of the USGS. The City of Newport News, Virginia, provides 50 million gallons per day of treated water for public supply from Lee Hall and Harwoods Mill Reservoirs (terminal reservoirs) to communities on the lower York-James Peninsula. About 3,500 pounds of copper sulfate are applied to each reservoir at 3- to 99-day intervals to control algal growth. Consequently, the USGS, in cooperation with the City of Newport News, investigated the effects of management practices and natural processes on phosphorus (the apparent growth-limiting nutrient), copper, and algal concentrations in the terminal reservoirs to provide information that can be used to develop alternative management strategies for the terminal reservoirs. Initial parts of the research evaluated circulation and stratification in the reservoirs

  12. 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.

  13. Issues in assessing the cost-effectiveness of coordinated DSM programs

    International Nuclear Information System (INIS)

    Hill, L.J.; Brown, M.A.

    1995-01-01

    Coordinated demand-side management (DSM) programs, co-administered by government agencies and electric and gas utilities, are likely to grow in importance in the coming years. Because of the unique features of these types of DSM programs, special care must be taken in assessing their cost-effectiveness. In this paper, we discuss these features, suggest how standard cost-effectiveness measures must be adapted to accommodate them, and show how important these adaptations are in assessing the cost-effectiveness of coordinated programs. At first, we use a least-cost, financial approach. The discussion indicates that failure to account properly for the special features of coordinated programs materially affects estimates of cost-effectiveness and, in extreme cases, may lead to rejection of otherwise cost-effective programs. Then extending the analysis to include economic factors, we speculate that most types of coordinated programs are more attractive than when evaluated on a financial basis. (author)

  14. Cost-effectiveness of tubal patency tests.

    Science.gov (United States)

    Verhoeve, H R; Moolenaar, L M; Hompes, P; van der Veen, F; Mol, B W J

    2013-04-01

    Guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing; therefore, we evaluated the cost-effectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment. Cost-effectiveness analysis. Decision analytic framework. Computer-simulated cohort of subfertile women. We evaluated six scenarios: (1) no tests and no treatment; (2) immediate treatment without tubal testing; (3) delayed treatment without tubal testing; (4) hysterosalpingogram (HSG), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); (5) HSG and a diagnostic laparoscopy (DL) in case HSG does not prove tubal patency, followed by tailored treatment; and (6) DL followed by tailored treatment. Expected cumulative live births after 3 years. Secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. For a 30-year-old woman with otherwise unexplained subfertility for 12 months, 3-year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4%, and costs per couple were €0, €6968, €5063, €5410, €5405 and €6163 for scenarios 1, 2, 3, 4, 5 and 6, respectively. The incremental cost-effectiveness ratios compared with scenario 1 (reference strategy), were €26,541, €19,046, €20,372, €20,150 and €23,184 for scenarios 2, 3, 4, 5 and 6, respectively. Sensitivity analysis showed the model to be robust over a wide range of values for the variables. The most cost-effective scenario is to perform no diagnostic tubal tests and to delay in vitro fertilisation (IVF) treatment for at least 12 months for women younger than 38 years old, and to perform no tubal tests and start immediate IVF treatment from the age of 39 years. If an invasive diagnostic test is planned, HSG followed by tailored treatment, or a DL if HSG shows no tubal patency, is more cost-effective than DL. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013

  15. Cost-effectiveness in Clostridium difficile treatment decision-making.

    Science.gov (United States)

    Nuijten, Mark Jc; Keller, Josbert J; Visser, Caroline E; Redekop, Ken; Claassen, Eric; Speelman, Peter; Pronk, Marja H

    2015-11-16

    To develop a framework for the clinical and health economic assessment for management of Clostridium difficile infection (CDI). CDI has vast economic consequences emphasizing the need for innovative and cost effective solutions, which were aim of this study. A guidance model was developed for coverage decisions and guideline development in CDI. The model included pharmacotherapy with oral metronidazole or oral vancomycin, which is the mainstay for pharmacological treatment of CDI and is recommended by most treatment guidelines. A design for a patient-based cost-effectiveness model was developed, which can be used to estimate the cost-effectiveness of current and future treatment strategies in CDI. Patient-based outcomes were extrapolated to the population by including factors like, e.g., person-to-person transmission, isolation precautions and closing and cleaning wards of hospitals. The proposed framework for a population-based CDI model may be used for clinical and health economic assessments of CDI guidelines and coverage decisions for emerging treatments for CDI.

  16.  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.......   Results The incremental cost effectiveness (CE) ratio for one day free of dyspeptic symptoms using the endoscopy strategy was €/day 300 compared with the PPI strategy. The incremental CE ratio for one patient free of dyspeptic symptoms after one year using the endoscopy strategy was € 13,600 based....... The empirical PPI strategy was hence the more cost-effective strategy for managing patients with dyspepsia in general practice especially if reflux was the predominant symptom.  ...

  17. 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.

  18. Cost-effectiveness of root caries preventive treatments.

    Science.gov (United States)

    Schwendicke, Falk; Göstemeyer, Gerd

    2017-01-01

    With a growing number of individuals retaining their teeth lifelong, often with periodontitis-induced root surface exposure, there is the need for cost-effective management strategies for root caries lesions. The present study aimed to assess the cost-effectiveness of root caries preventive treatments. Patients were simulated over 10 years using a Markov model. Four treatments were compared: No treatment, daily 225-800ppm fluoride rinses, chlorhexidine (CHX) varnish (2×/year), silver diamine fluoride (SDF) varnish (2×/year). Data from a systematic review were submitted to network meta-analysis for inferring relative efficacies of treatments. The health outcome was years of teeth being free of root caries. A mixed public-private payer perspective within 2016 German healthcare was taken, with costs being estimated from fee item catalogues or based on market prices. Populations with different numbers of teeth and tooth-level risks were modelled. Monte-Carlo microsimulations, univariate- and probabilistic sensitivity analyses were performed. In populations with 16 teeth at risk and low tooth-level risk for root caries, providing no preventive treatment was least costly, but also least effective (130 Euro, 144 years). SDF ranked next, being more costly (180 Euro), but also more effective (151 years). Payers willing to invest 8.30 Euro per root caries-free tooth-year found SDF most cost-effective. CHX varnish and fluoride rinse were not cost-effective. In populations with more teeth and high tooth-level risk, SDF was the most effective and least costly option. Root caries preventive treatments (like SDF) are effective and might even be cost-saving in high risk populations. Application of SDF can be recommended as a cost-saving treatment for prevention of root caries in patients with high risk of root caries. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Clinical effectiveness, cost-effectiveness and acceptability of low-intensity interventions in the management of obsessive-compulsive disorder: the Obsessive-Compulsive Treatment Efficacy randomised controlled Trial (OCTET).

    Science.gov (United States)

    Lovell, Karina; Bower, Peter; Gellatly, Judith; Byford, Sarah; Bee, Penny; McMillan, Dean; Arundel, Catherine; Gilbody, Simon; Gega, Lina; Hardy, Gillian; Reynolds, Shirley; Barkham, Michael; Mottram, Patricia; Lidbetter, Nicola; Pedley, Rebecca; Molle, Jo; Peckham, Emily; Knopp-Hoffer, Jasmin; Price, Owen; Connell, Janice; Heslin, Margaret; Foley, Christopher; Plummer, Faye; Roberts, Christopher

    2017-01-01

    BACKGROUND The Obsessive-Compulsive Treatment Efficacy randomised controlled Trial emerged from a research recommendation in National Institute for Health and Care Excellence obsessive-compulsive disorder (OCD) guidelines, which specified the need to evaluate cognitive-behavioural therapy (CBT) treatment intensity formats. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of two low-intensity CBT interventions [supported computerised cognitive-behavioural therapy (cCBT) and guided self-help]: (1) compared with waiting list for high-intensity CBT in adults with OCD at 3 months; and (2) plus high-intensity CBT compared with waiting list plus high-intensity CBT in adults with OCD at 12 months. To determine patient and professional acceptability of low-intensity CBT interventions. DESIGN A three-arm, multicentre, randomised controlled trial. SETTING Improving Access to Psychological Therapies services and primary/secondary care mental health services in 15 NHS trusts. PARTICIPANTS Patients aged ≥ 18 years meeting Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for OCD, on a waiting list for high-intensity CBT and scoring ≥ 16 on the Yale-Brown Obsessive Compulsive Scale (indicative of at least moderate severity OCD) and able to read English. INTERVENTIONS Participants were randomised to (1) supported cCBT, (2) guided self-help or (3) a waiting list for high-intensity CBT. MAIN OUTCOME MEASURES The primary outcome was OCD symptoms using the Yale-Brown Obsessive Compulsive Scale - Observer Rated. RESULTS Patients were recruited from 14 NHS trusts between February 2011 and May 2014. Follow-up data collection was complete by May 2015. There were 475 patients randomised: supported cCBT (n = 158); guided self-help (n = 158) and waiting list for high-intensity CBT (n = 159). Two patients were excluded post randomisation (one supported cCBT and one waiting list for high-intensity CBT); therefore, data

  20. Cost-effectiveness of the fenceline cow

    Energy Technology Data Exchange (ETDEWEB)

    Eichholz, G G; Lando, A V [Georgia Inst. of Tech., Atlanta (USA). School of Nuclear Engineering

    1979-07-01

    The grass-cow-milk pathway for /sup 131/I is one of the main contributers to estimated population dose from BWR's and PWR's. Such estimates assume a cow at the fenceline grazing for 12 months of the year. Reductions in the population dose would require a trade-off, based on cost-effectiveness criteria, between additions to the effluent treatment system, expanding the exclusion area, or raising the stack height. It is suggested that a more practical and more cost-effective means may be provided by redistribution of nearby dairy cattle (or goats), and that the plant operator buy these animals and/or contract with the land owner(s) to use the land for alternative crops. Even a subsidy to compensate the farmer for any financial losses entailed in these changes might be less expensive than alternative technical installations to lower iodine effluent levels. Figures are provided to illustrate these points.

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

    National Research Council Canada - National Science Library

    Tan Torres Edejer, Tessa

    2003-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 6. Uncertainty in cost-effectiveness analysis . . . . . . . . . . . . . . . . . . 73 7. 8. Policy uses of Generalized CEA...

  2. Cost-effectiveness Analysis with Influence Diagrams.

    Science.gov (United States)

    Arias, M; Díez, F J

    2015-01-01

    Cost-effectiveness analysis (CEA) is used increasingly in medicine to determine whether the health benefit of an intervention is worth the economic cost. Decision trees, the standard decision modeling technique for non-temporal domains, can only perform CEA for very small problems. To develop a method for CEA in problems involving several dozen variables. We explain how to build influence diagrams (IDs) that explicitly represent cost and effectiveness. We propose an algorithm for evaluating cost-effectiveness IDs directly, i.e., without expanding an equivalent decision tree. The evaluation of an ID returns a set of intervals for the willingness to pay - separated by cost-effectiveness thresholds - and, for each interval, the cost, the effectiveness, and the optimal intervention. The algorithm that evaluates the ID directly is in general much more efficient than the brute-force method, which is in turn more efficient than the expansion of an equivalent decision tree. Using OpenMarkov, an open-source software tool that implements this algorithm, we have been able to perform CEAs on several IDs whose equivalent decision trees contain millions of branches. IDs can perform CEA on large problems that cannot be analyzed with decision trees.

  3. Cost-effectiveness Analysis for Technology Acquisition.

    Science.gov (United States)

    Chakravarty, A; Naware, S S

    2008-01-01

    In a developing country with limited resources, it is important to utilize the total cost visibility approach over the entire life-cycle of the technology and then analyse alternative options for acquiring technology. The present study analysed cost-effectiveness of an "In-house" magnetic resonance imaging (MRI) scan facility of a large service hospital against outsourcing possibilities. Cost per unit scan was calculated by operating costing method and break-even volume was calculated. Then life-cycle cost analysis was performed to enable total cost visibility of the MRI scan in both "In-house" and "outsourcing of facility" configuration. Finally, cost-effectiveness analysis was performed to identify the more acceptable decision option. Total cost for performing unit MRI scan was found to be Rs 3,875 for scans without contrast and Rs 4,129 with contrast. On life-cycle cost analysis, net present value (NPV) of the "In-house" configuration was found to be Rs-(4,09,06,265) while that of "outsourcing of facility" configuration was Rs-(5,70,23,315). Subsequently, cost-effectiveness analysis across eight Figures of Merit showed the "In-house" facility to be the more acceptable option for the system. Every decision for acquiring high-end technology must be subjected to life-cycle cost analysis.

  4. 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.

  5. Is expanding Medicare coverage cost-effective?

    Directory of Open Access Journals (Sweden)

    Muennig Peter

    2005-03-01

    Full Text Available Abstract Background Proposals to expand Medicare coverage tend to be expensive, but the value of services purchased is not known. This study evaluates the efficiency of the average private supplemental insurance plan for Medicare recipients. Methods Data from the National Health Interview Survey, the National Death Index, and the Medical Expenditure Panel Survey were analyzed to estimate the costs, changes in life expectancy, and health-related quality of life gains associated with providing private supplemental insurance coverage for Medicare beneficiaries. Model inputs included socio-demographic, health, and health behavior characteristics. Parameter estimates from regression models were used to predict quality-adjusted life years (QALYs and costs associated with private supplemental insurance relative to Medicare only. Markov decision analysis modeling was then employed to calculate incremental cost-effectiveness ratios. Results Medicare supplemental insurance is associated with increased health care utilization, but the additional costs associated with this utilization are offset by gains in quality-adjusted life expectancy. The incremental cost-effectiveness of private supplemental insurance is approximately $24,000 per QALY gained relative to Medicare alone. Conclusion Supplemental insurance for Medicare beneficiaries is a good value, with an incremental cost-effectiveness ratio comparable to medical interventions commonly deemed worthwhile.

  6. Training effectiveness vs. cost effectiveness: The next millennium challenge

    International Nuclear Information System (INIS)

    Coe, Richard P.

    2003-01-01

    With the advent of the new millennium and energy deregulation, organizations will be challenged to be cost competitive and profitable. Deregulation in the US energy industry will force utilities and, more specifically, commercial nuclear power production to unprecedented cost control measures. It will also renew the fires of debate about costs vs. safety. With personnel costs being the single largest expenditure for most organizations management will be faced with constant dilemmas of competition for scarce resources. Salaries, benefits and training costs will be under greater scrutiny. Training resources and programs will face increased pressure to be job related, based on conservative requirements and more cost effective than in the past. For nearly two decades the US National Academy for Nuclear Training (NANT) has developed and used industry-wide accreditation and evaluation standards based on the Systematic Approach to Training (SAT). This process assures that existing and emerging technical training is constantly reviewed and evaluated against standardized criteria to assure job relatedness and enhanced job performance. The process also requires management to approve, actively participate in and support the training of NPP personnel. Instructors must be highly skilled and well trained in the SAT process and various instructional strategies. The SAT process is grounded in five interlocking keystone steps; Analysis - Design - Development - Implementation - Evaluation (ADDIE). Evaluation of training is often said to be the most crucial and most difficult step. Here is where an organization determines if the training is effective and meeting the legitimate needs of all of the stakeholders. This QA/QC aspect of training must be an ongoing process involving management, instructors and the students. It is only through the discipline of an SAT based evaluation process that an organization can truly determine if the training is efficient, effective, cost effective and

  7. Phosphorus poisoning in waterfowl

    Science.gov (United States)

    Coburn, D.R.; DeWitt, J.B.; Derby, J.V.; Ediger, E.

    1950-01-01

    Black ducks and mallards were found to be highly susceptible to phosphorus poisoning. 3 mg. of white phosphorus per kg. of body weight given in a single dose resulted in death of a black duck in 6 hours. Pathologic changes in both acute and chronic poisoning were studied. Data are presented showing that diagnosis can be made accurately by chemical analysis of stored tissues in cases of phosphorus poisoning.

  8. [Incremental cost effectiveness of multifocal cataract surgery].

    Science.gov (United States)

    Pagel, N; Dick, H B; Krummenauer, F

    2007-02-01

    Supplementation of cataract patients with multifocal intraocular lenses involves an additional financial investment when compared to the corresponding monofocal supplementation, which usually is not funded by German health care insurers. In the context of recent resource allocation discussions, however, the cost effectiveness of multifocal cataract surgery could become an important rationale. Therefore an evidence-based estimation of its cost effectiveness was carried out. Three independent meta-analyses were implemented to estimate the gain in uncorrected near visual acuity and best corrected visual acuity (vision lines) as well as the predictability (fraction of patients without need for reading aids) of multifocal supplementation. Study reports published between 1995 and 2004 (English or German language) were screened for appropriate key words. Meta effects in visual gain and predictability were estimated by means and standard deviations of the reported effect measures. Cost data were estimated by German DRG rates and individual lens costs; the cost effectiveness of multifocal cataract surgery was then computed in terms of its marginal cost effectiveness ratio (MCER) for each clinical benefit endpoint; the incremental costs of multifocal versus monofocal cataract surgery were further estimated by means of their respective incremental cost effectiveness ratio (ICER). An independent meta-analysis estimated the complication profiles to be expected after monofocal and multifocal cataract surgery in order to evaluate expectable complication-associated additional costs of both procedures; the marginal and incremental cost effectiveness estimates were adjusted accordingly. A sensitivity analysis comprised cost variations of +/- 10 % and utility variations alongside the meta effect estimate's 95 % confidence intervals. Total direct costs from the health care insurer's perspective were estimated 3363 euro, associated with a visual meta benefit in best corrected visual

  9. [Research progress on phosphorus budgets and regulations in reservoirs].

    Science.gov (United States)

    Shen, Xiao; Li, Xu; Zhang, Wang-shou

    2014-12-01

    Phosphorus is an important limiting factor of water eutrophication. A clear understanding of its budget and regulated method is fundamental for reservoir ecological health. In order to pro- mote systematic research further and improve phosphorus regulation system, the budget balance of reservoir phosphorus and its influencing factors were concluded, as well as conventional regulation and control measures. In general, the main phosphorus sources of reservoirs include upstream input, overland runoff, industrial and domestic wastewater, aquaculture, atmospheric deposition and sediment release. Upstream input is the largest phosphorus source among them. The principal output path of phosphorus is the flood discharge, the emission load of which is mainly influenced by drainage patterns. In addition, biological harvest also can export a fraction of phosphorus. There are some factors affecting the reservoir phosphorus balance, including reservoirs' function, hydrological conditions, physical and chemical properties of water, etc. Therefore, the phosphorus budgets of different reservoirs vary greatly, according to different seasons and regions. In order to reduce the phosphorus loading in reservoirs, some methods are carried out, including constructed wetlands, prefix reservoir, sediment dredging, biomanipulation, etc. Different methods need to be chosen and combined according to different reservoirs' characteristics and water quality management goals. Thus, in the future research, it is reasonable to highlight reservoir ecological characteristics and proceed to a complete and systematic analysis of the inherent complexity of phosphorus budget and its impact factors for the reservoirs' management. Besides, the interaction between phosphorus budget and other nutrients in reservoirs also needs to be conducted. It is fundamental to reduce the reservoirs' phosphorus loading to establish a scientific and improved management system based on those researches.

  10. Isotopic techniques to study phosphorus cycling in soils

    International Nuclear Information System (INIS)

    Manjaiah, K.M.; Sreenivasa Chari, M.; Sachdev, P.; Sachdev, M.S.

    2008-01-01

    A sound understanding of phosphorus cycling in soil system is essential in order to manage this system in a sustainable manner. Phosphorus transformations are characterized by physico-chemical (sorption-desorption) and biological processes . The transformation rates need to be taken into account while developing nutrient management strategies for economical and sustainable production. One of the important tools and the method gaining popularity for determining the gross transformation rates of nutrients in the soil is the isotopic dilution technique. The major processes in the soil-plant system which determine the distribution and bioavailability of phosphorus in various inorganic and organic soil components consist of: (1) the dissolution of soil mineral phosphates, (2) retention of phosphorus by inorganic soil constituents, (3) decomposition of organic phosphorus contained in plant, animal and microbial detritus and (4) Immobilization of phosphorus via the soil microbial biomass and plan uptake

  11. The business value and cost-effectiveness of genomic medicine.

    Science.gov (United States)

    Crawford, James M; Aspinall, Mara G

    2012-05-01

    Genomic medicine offers the promise of more effective diagnosis and treatment of human diseases. Genome sequencing early in the course of disease may enable more timely and informed intervention, with reduced healthcare costs and improved long-term outcomes. However, genomic medicine strains current models for demonstrating value, challenging efforts to achieve fair payment for services delivered, both for laboratory diagnostics and for use of molecular information in clinical management. Current models of healthcare reform stipulate that care must be delivered at equal or lower cost, with better patient and population outcomes. To achieve demonstrated value, genomic medicine must overcome many uncertainties: the clinical relevance of genomic variation; potential variation in technical performance and/or computational analysis; management of massive information sets; and must have available clinical interventions that can be informed by genomic analysis, so as to attain more favorable cost management of healthcare delivery and demonstrate improvements in cost-effectiveness.

  12. Clinical effectiveness and cost-effectiveness of surgical options for the management of anterior and/or posterior vaginal wall prolapse: two randomised controlled trials within a comprehensive cohort study - results from the PROSPECT Study.

    Science.gov (United States)

    Glazener, Cathryn; Breeman, Suzanne; Elders, Andrew; Hemming, Christine; Cooper, Kevin; Freeman, Robert; Smith, Anthony; Hagen, Suzanne; Montgomery, Isobel; Kilonzo, Mary; Boyers, Dwayne; McDonald, Alison; McPherson, Gladys; MacLennan, Graeme; Norrie, John

    2016-12-01

    The use of mesh in prolapse surgery is controversial, leading to a number of enquiries into its safety and efficacy. To compare synthetic non-absorbable mesh inlay, biological graft and mesh kit with a standard repair in terms of clinical effectiveness, adverse effects, quality of life (QoL), costs and cost-effectiveness. Two randomised controlled trials within a comprehensive cohort (CC) study. Allocation was by a remote web-based randomisation system in a 1 :1 : 1 ratio (Primary trial) or 1 : 1 : 2 ratio (Secondary trial), and was minimised on age, type of prolapse repair planned, need for a concomitant continence procedure, need for a concomitant upper vaginal prolapse procedure and surgeon. Participants and outcome assessors were blinded to randomisation; participants were unblinded if they requested the information. Surgeons were not blinded to allocated procedure. Thirty-five UK hospitals. Primary study : 2474 women in the analysis (including 1348 randomised) having primary anterior or posterior prolapse surgery. Secondary study : 398 in the analysis (including 154 randomised) having repeat anterior or posterior prolapse surgery. CC3 : 215 women having either uterine or vault prolapse repair. Anterior or posterior repair alone, or with mesh inlay, biological graft or mesh kit. Prolapse symptoms [Pelvic Organ Prolapse Symptom Score (POP-SS)]; prolapse-specific QoL; cost-effectiveness [incremental cost per quality-adjusted life-year (QALY)]. Primary trials : adjusting for baseline and minimisation covariates, mean POP-SS was similar for each comparison {standard 5.4 [standard deviation (SD) 5.5] vs. mesh 5.5 (SD 5.1), mean difference (MD) 0.00, 95% confidence interval (CI) -0.70 to 0.71; standard 5.5 (SD 5.6) vs. graft 5.6 (SD 5.6), MD -0.15, 95% CI -0.93 to 0.63}. Serious non-mesh adverse effects rates were similar between the groups in year 1 [standard 7.2% vs. mesh 7.8%, risk ratio (RR) 1.08, 95% CI 0.68 to 1.72; standard 6.3% vs. graft 9.8%, RR 1

  13. Point of care testing for urinary tract infection in primary care (POETIC): protocol for a randomised controlled trial of the clinical and cost effectiveness of FLEXICULT™ informed management of uncomplicated UTI in primary care.

    Science.gov (United States)

    Bates, Janine; Thomas-Jones, Emma; Pickles, Timothy; Kirby, Nigel; Gal, Micaela; Bongard, Emily; Hood, Kerenza; Francis, Nicolas; Little, Paul; Moore, Michael; Rumsby, Kate; Llor, Carlos; Burgman, Curt; Verheij, Theo; Cohen, David; Wootton, Mandy; Howe, Robin; Butler, Christopher C

    2014-11-25

    Urinary tract infections (UTI) are the most frequent bacterial infection affecting women and account for about 15% of antibiotics prescribed in primary care. However, some women with a UTI are not prescribed antibiotics or are prescribed the wrong antibiotics, while many women who do not have a microbiologically confirmed UTI are prescribed antibiotics. Inappropriate antibiotic prescribing unnecessarily increases the risk of side effects and the development of antibiotic resistance, and wastes resources. 614 adult female patients will be recruited from four primary care research networks (Wales, England, Spain, the Netherlands) and individually randomised to either POCT guided care or the guideline-informed 'standard care' arm. Urine and stool samples (where possible) will be obtained at presentation (day 1) and two weeks later for microbiological analysis. All participants will be followed up on the course of their illness and their quality of life, using a 2 week self-completed symptom diary. At 3 months, a primary care notes review will be conducted for evidence of further evidence of treatment failures, recurrence, complications, hospitalisations and health service costs. Although the Flexicult™ POCT is used in some countries in routine primary care, it's clinical and cost effectiveness has never been evaluated in a randomised clinical trial. If shown to be effective, the use of this POCT could benefit individual sufferers and provide evidence for health care authorities to develop evidence based policies to combat the spread and impact of the unprecedented rise of infections caused by antibiotic resistant bacteria in Europe. ISRCTN65200697 (Registered 10 September 2013).

  14. A Methodology to Integrate Security and Cost-effectiveness in ATM

    OpenAIRE

    Matarese, Francesca; Montefusco, Patrizia; Neves, José; Rocha, André

    2014-01-01

    The objective of this paper is the definition of a new methodology for carrying out security risk assessment in the air traffic management (ATM) domain so as to enhance security awareness and integrate secure and cost-effective design objectives. This process is carried out by modelling the system, identifying the assets, threats and vulnerabilities, prioritizing the threats and proposing cost-effective countermeasures for the weaknesses found. ATM security is concerned with securing ATM a...

  15. Cost effective material control and accountability training

    International Nuclear Information System (INIS)

    Robichaux, J.J.; Shull, L.M.; Salizzoni, L.M.

    1995-01-01

    DOE Order 5630.15, ''Safeguards and Security Training Program'' is being implemented at the Savannah River Site within the Westinghouse Savannah River Company's material control and accountability program. This paper reviews the development of a material control and accountability task analysis, the development of specific material control and accountability courses, and the cost effective and innovative strategies employed to implement the training program. The paper also discusses how the site material control and accountability policies and procedures are incorporated into the Westinghouse Savannah River Company training program to ensure that personnel receive the most current information

  16. Cost benefit analysis cost effectiveness analysis

    International Nuclear Information System (INIS)

    Lombard, J.

    1986-09-01

    The comparison of various protection options in order to determine which is the best compromise between cost of protection and residual risk is the purpose of the ALARA procedure. The use of decision-aiding techniques is valuable as an aid to selection procedures. The purpose of this study is to introduce two rather simple and well known decision aiding techniques: the cost-effectiveness analysis and the cost-benefit analysis. These two techniques are relevant for the great part of ALARA decisions which need the use of a quantitative technique. The study is based on an hypothetical case of 10 protection options. Four methods are applied to the data

  17. Pre-school manager training: a cost-effective tool to promote nutrition- and health-related practice improvements in the Irish full-day-care pre-school setting.

    LENUS (Irish Health Repository)

    Johnston Molloy, Charlotte

    2013-10-18

    To evaluate the impact on nutrition- and health-related practice of two methods of delivery of a nutrition and health intervention in Irish full-day-care pre-schools: training of pre-school managers only or training of managers and their staff.

  18. A cost effective CO2 strategy

    DEFF Research Database (Denmark)

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

  19. On cost-effective communication network designing

    Science.gov (United States)

    Zhang, Guo-Qiang

    2010-02-01

    How to efficiently design a communication network is a paramount task for network designing and engineering. It is, however, not a single objective optimization process as perceived by most previous researches, i.e., to maximize its transmission capacity, but a multi-objective optimization process, with lowering its cost to be another important objective. These two objectives are often contradictive in that optimizing one objective may deteriorate the other. After a deep investigation of the impact that network topology, node capability scheme and routing algorithm as well as their interplays have on the two objectives, this letter presents a systematic approach to achieve a cost-effective design by carefully choosing the three designing aspects. Only when routing algorithm and node capability scheme are elegantly chosen can BA-like scale-free networks have the potential of achieving good tradeoff between the two objectives. Random networks, on the other hand, have the built-in character for a cost-effective design, especially when other aspects cannot be determined beforehand.

  20. Clinical evaluation based on cost-effectiveness

    International Nuclear Information System (INIS)

    Inoue, Takehiro; Inoue, Toshihiko

    1998-01-01

    We carried out two Phase III clinical trials using high dose rate (HDR) remote afterloading brachytherapy unit. We evaluated the clinical results based not only on the medical but also the economical standpoint. The first trial is the Phase III trial for cervical cancer treated with HDR or medium dose rate (MDR) intracavitary radiotherapy. The second one is the Phase III trial for tongue cancer treated with HDR or low dose rate (LDR) interstitial radiation. For cervical cancer, the survival rate of patients treated with HDR brachytherapy is the some as for LDR brachytherapy. The average total cost of treatment for the HDR group was 1.47 million yen, while that for the MDR group was 1.58 million yen. The average total admission days was 63. For tongue cancer, the local control rate of the HDR group is almost the same as that of the LDR groups. The average total cost for the HDR group was 780 thousand yen, and that for the LDR group was 830 thousand yen. The average total admission days was 34. According to the cost-effectiveness, HDR brachytherapy for cervical cancer has the same result as MDR, and HDR brachytherapy for tongue cancer has the same result as LDR. However, HDR can be treated without admission for patients who live near the hospital. HDR can be applied for these patients with less expense. We must be aware of not only the medical results but also the cost-effectiveness. (author)

  1. Deregulation and Nuclear Training: Cost Effective Alternatives

    International Nuclear Information System (INIS)

    Richard P. Coe; Patricia A. Lake

    2000-01-01

    Training is crucial to the success of any organization. It is also expensive, with some estimates exceeding $50 billion annually spent on training by U.S. corporations. Nuclear training, like that of many other highly technical organizations, is both crucial and costly. It is unlikely that the amount of training can be significantly reduced. If anything, current trends indicate that training needs will probably increase as the industry and workforce ages and changes. With the advent of energy deregulation in the United States, greater pressures will surface to make the costs of energy more cost-competitive. This in turn will drive businesses to more closely examine existing costs and find ways to do things in a more cost-effective way. The commercial nuclear industry will be no exception, and nuclear training will be equally affected. It is time for nuclear training and indeed the entire nuclear industry to begin using more aggressive techniques to reduce costs. This includes the need for nuclear training to find alternatives to traditional methods for the delivery of cost-effective high-quality training that meets regulatory requirements and produces well-qualified personnel capable of working in an efficient and safe manner. Computer-based and/or Web-based training are leading emerging technologies

  2. Cost effective tools for soil organic carbon monitoring

    Science.gov (United States)

    Shepherd, Keith; Aynekulu, Ermias

    2013-04-01

    There is increasing demand for data on soil properties at fine spatial resolution to support management and planning decisions. Measurement of soil organic carbon has attracted much interest because (i) soil organic carbon is widely cited as a useful indicator of soil condition and (ii) of the importance of soil carbon in the global carbon cycle and climate mitigation strategies. However in considering soil measurement designs there has been insufficient attention given to careful analysis of the specific decisions that the measurements are meant to support and on what measurements have high information value for decision-making. As a result, much measurement effort may be wasted or focused on the wrong variables. A cost-effective measurement is one that reduces risk in decisions and does not cost more than the societal returns to additional evidence. A key uncertainty in measuring soil carbon as a soil condition indicator is what constitutes a good or bad level of carbon on a given soil. A measure of soil organic carbon concentration may have limited value for informing management decisions without the additional information required to interpret it, and so expending further efforts on improving measurements to increase precision may then have no value to improving the decision. Measuring soil carbon stock changes for carbon trading purposes requires high levels of measurement precision but there is still large uncertainty on whether the costs of measurement exceed the benefits. Since the largest cost component in soil monitoring is often travel to the field and physically sampling soils, it is generally cost-effective to meet multiple objectives by analysing a number of properties on a soil sample. Diffuse reflectance infrared spectroscopy is playing a key role in allowing multiple soil properties to be determined rapidly and at low cost. The method provides estimation of multiple soil properties (e.g. soil carbon, texture and mineralogy) in one measurement

  3. 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

  4. Some Observations on Cost-Effectiveness Analysis in Education.

    Science.gov (United States)

    Geske, Terry G.

    1979-01-01

    The general nature of cost-effectiveness analysis is discussed, analytical frameworks for conducting cost-effectiveness studies are described, and some of the problems inherent in measuring educational costs and in assessing program effectiveness are addressed. (Author/IRT)

  5. OPCAB surgery is cost-effective for elderly patients

    DEFF Research Database (Denmark)

    Houlind, Kim Christian; Kjeldsen, Bo Juul; Madsen, Susanne Nørgaard

    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....

  6. Understanding Cost-Effectiveness of Energy Efficiency Programs

    Science.gov (United States)

    Discusses the five standard tests used to assess the cost-effectiveness of energy efficiency, how states are using these tests, and how the tests can be used to determine the cost-effectiveness of energy efficiency measures.

  7. 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.

  8. Design And Implementation Of Cost Effective Inverter

    Directory of Open Access Journals (Sweden)

    Niaz Morshedul Haque

    2017-10-01

    Full Text Available This paper deals with the design and construct of a 100 Watt 220 Volt and 50 Hz Inverter. The system is designed without any microcontroller and it has a cost-effective design architecture. The elementary purpose of this device is to transmute 12 V DC to 220 V AC. Snubber technology is used to diminish the reverse potential transients and excessive heat of transformer winding and transistor switches. Switching pulse generated by NE 555 timer circuit and comparator circuit was used to take signal strength input from its rear as well as from both sides for triggering the MOSFET switches. Another switch is used to invert pulse between two switching circuitries. A 5 volts regulator IC 7805 was used to supply fixed 5V for biasing the switching and amplifying circuitry.

  9. 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.

  10. Cost-effective implementation of intelligent systems

    Science.gov (United States)

    Lum, Henry, Jr.; Heer, Ewald

    1990-01-01

    Significant advances have occurred during the last decade in knowledge-based engineering research and knowledge-based system (KBS) demonstrations and evaluations using integrated intelligent system technologies. Performance and simulation data obtained to date in real-time operational environments suggest that cost-effective utilization of intelligent system technologies can be realized. In this paper the rationale and potential benefits for typical examples of application projects that demonstrate an increase in productivity through the use of intelligent system technologies are discussed. These demonstration projects have provided an insight into additional technology needs and cultural barriers which are currently impeding the transition of the technology into operational environments. Proposed methods which addresses technology evolution and implementation are also discussed.

  11. Cost effectiveness of transportation fuels from biomass

    International Nuclear Information System (INIS)

    De Jager, D.; Faaij, A.P.C.; Troelstra, W.P.

    1998-06-01

    The aim of the study on the title subject was to investigate whether stimulation of the production and use of biofuels for transportation is worthwhile compared to the production of electricity from biomass. Several options are compared to each other and with reference technologies on the basis of the consumption or the avoided input of fossil fuels, emissions of greenhouse gases, specific costs and cost effectiveness. For each phase in the biomass conversion process (cultivation, pretreatment, transportation, conversion, distribution and final consumption) indicators were collected from the literature. Next to costs of the bioconversion routes attention is paid to other relevant aspects that are important for the introduction of the technological options in the Netherlands. 41 refs

  12. Cost-effectiveness analysis of risk reduction at nuclear power plants

    International Nuclear Information System (INIS)

    Lochard, J.; Maccia, C.; Pages, P.

    1985-01-01

    Cost-effectiveness analysis of risk reduction is now widely accepted as a rational analytical framework to consistently address the resource allocation problem underlying any risk management process. This paper presents how this technique can be usefully applied to complex systems such as the management of radioactive releases from nuclear power plants into the environment. (orig.) [de

  13. 10 CFR 455.63 - Cost-effectiveness testing.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Cost-effectiveness testing. 455.63 Section 455.63 Energy..., Hospitals, Units of Local Government, and Public Care Institutions § 455.63 Cost-effectiveness testing. (a... paragraph (a) of this section, if the State plan requires the cost effectiveness of an energy conservation...

  14. 10 CFR 436.18 - Measuring cost-effectiveness.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Measuring cost-effectiveness. 436.18 Section 436.18 Energy... Procedures for Life Cycle Cost Analyses § 436.18 Measuring cost-effectiveness. (a) In accordance with this section, each Federal agency shall measure cost-effectiveness by combining cost data established under...

  15. 42 CFR 457.1015 - Cost-effectiveness.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Cost-effectiveness. 457.1015 Section 457.1015... Waivers: General Provisions § 457.1015 Cost-effectiveness. (a) Definition. For purposes of this subpart... may demonstrate cost-effectiveness by comparing the cost of coverage for the family to the cost of...

  16. 49 CFR 639.21 - Determination of cost-effectiveness.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Determination of cost-effectiveness. 639.21... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CAPITAL LEASES Cost-Effectiveness § 639.21 Determination of cost...-effectiveness comparison as described in this subpart, it may ask FTA to approve an alternate form of cost...

  17. Modelling the cost effectiveness of antidepressant treatment in primary care.

    Science.gov (United States)

    Revicki, D A; Brown, R E; Palmer, W; Bakish, D; Rosser, W W; Anton, S F; Feeny, D

    1995-12-01

    The aim of this study was to estimate the cost effectiveness of nefazodone compared with imipramine or fluoxetine in treating women with major depressive disorder. Clinical decision analysis and a Markov state-transition model were used to estimate the lifetime health outcomes and medical costs of 3 antidepressant treatments. The model, which represents ideal primary care practice, compares treatment with nefazodone to treatment with either imipramine or fluoxetine. The economic analysis was based on the healthcare system of the Canadian province of Ontario, and considered only direct medical costs. Health outcomes were expressed as quality-adjusted life years (QALYs) and costs were in 1993 Canadian dollars ($Can; $Can1 = $US0.75, September 1995). Incremental cost-utility ratios were calculated comparing the relative lifetime discounted medical costs and QALYs associated with nefazodone with those of imipramine or fluoxetine. Data for constructing the model and estimating necessary parameters were derived from the medical literature, clinical trial data, and physician judgement. Data included information on: Ontario primary care physicians' clinical management of major depression; medical resource use and costs; probabilities of recurrence of depression; suicide rates; compliance rates; and health utilities. Estimates of utilities for depression-related hypothetical health states were obtained from patients with major depression (n = 70). Medical costs and QALYs were discounted to present value using a 5% rate. Sensitivity analyses tested the assumptions of the model by varying the discount rate, depression recurrence rates, compliance rates, and the duration of the model. The base case analysis found that nefazodone treatment costs $Can1447 less per patient than imipramine treatment (discounted lifetime medical costs were $Can50,664 vs $Can52,111) and increases the number of QALYs by 0.72 (13.90 vs 13.18). Nefazodone treatment costs $Can14 less than fluoxetine

  18. Phosphorus dendrimers for nanomedicine.

    Science.gov (United States)

    Caminade, Anne-Marie

    2017-08-31

    From biomaterials to imaging, and from drug delivery to drugs by themselves, phosphorus-containing dendrimers offer a large palette of biological properties, depending essentially on their types of terminal functions. The most salient examples of phosphorus dendrimers used for the elaboration of bio-chips and of supports for cell cultures, for imaging biological events, and for carrying and delivering drugs or biomacromolecules are presented in this feature article. Several phosphorus dendrimers can be considered also as drugs per se (by themselves) in particular to fight against cancers, neurodegenerative diseases, and inflammation, both in vitro and in vivo. Toxicity assays are also reported.

  19. Cost-effectiveness assessment in outpatient sinonasal surgery.

    Science.gov (United States)

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

    2018-02-01

    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. Cost-Effectiveness of Surgery, Stereotactic Body Radiation Therapy, and Systemic Therapy for Pulmonary Oligometastases

    Energy Technology Data Exchange (ETDEWEB)

    Lester-Coll, Nataniel H., E-mail: nataniel.lester-coll@yale.edu [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Rutter, Charles E.; Bledsoe, Trevor J. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Goldberg, Sarah B. [Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, Connecticut (United States); Decker, Roy H.; Yu, James B. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States)

    2016-06-01

    Introduction: Pulmonary oligometastases have conventionally been managed with surgery and/or systemic therapy. However, given concerns about the high cost of systemic therapy and improvements in local treatment of metastatic cancer, the optimal cost-effective management of these patients is unclear. Therefore, we sought to assess the cost-effectiveness of initial management strategies for pulmonary oligometastases. Methods and Materials: A cost-effectiveness analysis using a Markov modeling approach was used to compare average cumulative costs, quality adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) among 3 initial disease management strategies: video-assisted thoracic surgery (VATS) wedge resection, stereotactic body radiation therapy (SBRT), and systemic therapy among 5 different cohorts of patient disease: (1) melanoma; (2) non-small cell lung cancer adenocarcinoma without an EGFR mutation (NSCLC AC); (3) NSCLC with an EGFR mutation (NSCLC EGFRm AC); (4) NSCLC squamous cell carcinoma (NSCLC SCC); and (5) colon cancer. One-way sensitivity analyses and probabilistic sensitivity analyses were performed to analyze uncertainty with regard to model parameters. Results: In the base case, SBRT was cost effective for melanoma, with costs/net QALYs of $467,787/0.85. In patients with NSCLC, the most cost-effective strategies were SBRT for AC ($156,725/0.80), paclitaxel/carboplatin for SCC ($123,799/0.48), and erlotinib for EGFRm AC ($147,091/1.90). Stereotactic body radiation therapy was marginally cost-effective for EGFRm AC compared to erlotinib with an incremental cost-effectiveness ratio of $126,303/QALY. For colon cancer, VATS wedge resection ($147,730/2.14) was the most cost-effective strategy. Variables with the greatest influence in the model were erlotinib-associated progression-free survival (EGFRm AC), toxicity (EGFRm AC), cost of SBRT (NSCLC SCC), and patient utilities (all histologies). Conclusions: Video-assisted thoracic

  1. The animal feed mineral phosphorus tax in Denmark

    DEFF Research Database (Denmark)

    Andersen, Mikael Skou

    2017-01-01

    Denmark’s tax on animal feed phosphorus came into effect in 2005 with a tax rate of DKK 4 (EUR 0.53) per kg of phosphorus. It targets commercial animal feed phosphate and aims to reduce the saturation of soils with phosphorus, and leaching to surface waters. Consumption of mineral phosphate...... in animal feeds has been reduced by about 2,000 tonnes (or 15%) since the introduction of the tax, although the tax rate has not been adjusted with inflation. The tax is believed to have improved overall efficiency in the use of animal feed. Farmer organisations did not oppose the tax and accepted...... it as part of a broader package deal on measures to reduce nutrient leaching and pollution of surface waters. Environmental NGOs voiced concerns about impacts on organic farms, and were not strong advocates of the tax. The tax arose from efforts to identify the most cost-effective means for reducing nutrient...

  2. Isotopically exchangeable phosphorus

    International Nuclear Information System (INIS)

    Barbaro, N.O.

    1984-01-01

    A critique revision of isotope dilution is presented. The concepts and use of exchangeable phosphorus, the phosphate adsorption, the kinetics of isotopic exchange and the equilibrium time in soils are discussed. (M.A.C.) [pt

  3. Carbon, nitrogen and phosphorus accumulation and partitioning, and C:N:P stoichiometry in late-season rice under different water and nitrogen managements.

    Directory of Open Access Journals (Sweden)

    Yushi Ye

    Full Text Available Water and nitrogen availability plays an important role in the biogeochemical cycles of essential elements, such as carbon (C, nitrogen (N and phosphorus (P, in agricultural ecosystems. In this study, we investigated the seasonal changes of C, N and P concentrations, accumulation, partitioning, and C:N:P stoichiometric ratios in different plant tissues (root, stem-leaf, and panicle of late-season rice under two irrigation regimes (continuous flooding, CF; alternate wetting and drying, AWD and four N managements (control, N0; conventional urea at 240 kg N ha(-1, UREA; controlled-release bulk blending fertilizer at 240 kg N ha(-1, BBF; polymer-coated urea at 240 kg N ha(-1, PCU. We found that water and N treatments had remarkable effects on the measured parameters in different plant tissues after transplanting, but the water and N interactions had insignificant effects. Tissue C:N, N:P and C:P ratios ranged from 14.6 to 52.1, 3.1 to 7.8, and 76.9 to 254.3 over the rice growing seasons, respectively. The root and stem-leaf C:N:P and panicle C:N ratios showed overall uptrends with a peak at harvest whereas the panicle N:P and C:P ratios decreased from filling to harvest. The AWD treatment did not affect the concentrations and accumulation of tissue C and N, but greatly decreased those of P, resulting in enhanced N:P and C:P ratios. N fertilization significantly increased tissue N concentration, slightly enhanced tissue P concentration, but did not affect tissue C concentration, leading to a significant increase in tissue N:P ratio but a decrease in C:N and C:P ratios. Our results suggested that the growth of rice in the Taihu Lake region was co-limited by N and P. These findings broadened our understanding of the responses of plant C:N:P stoichiometry to simultaneous water and N managements in subtropical high-yielding rice systems.

  4. Carbon, Nitrogen and Phosphorus Accumulation and Partitioning, and C:N:P Stoichiometry in Late-Season Rice under Different Water and Nitrogen Managements

    Science.gov (United States)

    Ye, Yushi; Liang, Xinqiang; Chen, Yingxu; Li, Liang; Ji, Yuanjing; Zhu, Chunyan

    2014-01-01

    Water and nitrogen availability plays an important role in the biogeochemical cycles of essential elements, such as carbon (C), nitrogen (N) and phosphorus (P), in agricultural ecosystems. In this study, we investigated the seasonal changes of C, N and P concentrations, accumulation, partitioning, and C:N:P stoichiometric ratios in different plant tissues (root, stem-leaf, and panicle) of late-season rice under two irrigation regimes (continuous flooding, CF; alternate wetting and drying, AWD) and four N managements (control, N0; conventional urea at 240 kg N ha−1, UREA; controlled-release bulk blending fertilizer at 240 kg N ha−1, BBF; polymer-coated urea at 240 kg N ha−1, PCU). We found that water and N treatments had remarkable effects on the measured parameters in different plant tissues after transplanting, but the water and N interactions had insignificant effects. Tissue C:N, N:P and C:P ratios ranged from 14.6 to 52.1, 3.1 to 7.8, and 76.9 to 254.3 over the rice growing seasons, respectively. The root and stem-leaf C:N:P and panicle C:N ratios showed overall uptrends with a peak at harvest whereas the panicle N:P and C:P ratios decreased from filling to harvest. The AWD treatment did not affect the concentrations and accumulation of tissue C and N, but greatly decreased those of P, resulting in enhanced N:P and C:P ratios. N fertilization significantly increased tissue N concentration, slightly enhanced tissue P concentration, but did not affect tissue C concentration, leading to a significant increase in tissue N:P ratio but a decrease in C:N and C:P ratios. Our results suggested that the growth of rice in the Taihu Lake region was co-limited by N and P. These findings broadened our understanding of the responses of plant C:N:P stoichiometry to simultaneous water and N managements in subtropical high-yielding rice systems. PMID:24992006

  5. Cost-effective treatment of low-risk carcinoma not invading bladder muscle.

    Science.gov (United States)

    Green, David A; Rink, Michael; Cha, Eugene K; Xylinas, Evanguelos; Chughtai, Bilal; Scherr, Douglas S; Shariat, Shahrokh F; Lee, Richard K

    2013-03-01

    Study Type - Therapy (cost effectiveness analysis) Level of Evidence 2a What's known on the subject? and What does the study add? Bladder cancer is one of the costliest malignancies to treat throughout the life of a patient. The most cost-effective management for low-risk non-muscle-invasive bladder cancer is not known. The current study shows that employing cystoscopic office fulguration for low-risk appearing bladder cancer recurrences can materially impact the cost-effectiveness of therapy. In a follow-up protocol where office fulguration is routinely employed for low-risk bladder cancers, peri-operative intravesical chemotherapy may not provide any additional cost-effectiveness benefit. To examine the cost-effectiveness of fulguration vs transurethral resection of bladder tumour (TURBT) with and without perioperative intravesical chemotherapy (PIC) for managing low-risk carcinoma not invading bladder muscle (NMIBC). Low-risk NMIBC carries a low progression rate, lending support to the use of office-based fulguration for small recurrences rather than traditional TURBT. A Markov state transition model was created to simulate treatment of NMIBC with vs without PIC, with recurrence treated by formal TURBT vs treatment with fulguration. Costing data were obtained from the Medicare Resource Based Relative Value Scale. Data regarding the success of PIC were obtained from the peer-reviewed literature, as were corresponding utilities for bladder cancer-related procedures. Sensitivity analyses were performed. At 5-year follow-up, a strategy of fulguration without PIC was the most cost-effective (mean cost-effectiveness = US $654.8/quality-adjusted life year), despite a lower recurrence rate with PIC. Both fulguration strategies dominated each TURBT strategy. Sensitivity analysis showed that fulguration without PIC dominated all other strategies when the recurrence rate after PIC was increased to ≥14.2% per year. Similarly, the cost-effectiveness of TURBT becomes more

  6. A Cost Effective System Design Approach for Critical Space Systems

    Science.gov (United States)

    Abbott, Larry Wayne; Cox, Gary; Nguyen, Hai

    2000-01-01

    NASA-JSC required an avionics platform capable of serving a wide range of applications in a cost-effective manner. In part, making the avionics platform cost effective means adhering to open standards and supporting the integration of COTS products with custom products. Inherently, operation in space requires low power, mass, and volume while retaining high performance, reconfigurability, scalability, and upgradability. The Universal Mini-Controller project is based on a modified PC/104-Plus architecture while maintaining full compatibility with standard COTS PC/104 products. The architecture consists of a library of building block modules, which can be mixed and matched to meet a specific application. A set of NASA developed core building blocks, processor card, analog input/output card, and a Mil-Std-1553 card, have been constructed to meet critical functions and unique interfaces. The design for the processor card is based on the PowerPC architecture. This architecture provides an excellent balance between power consumption and performance, and has an upgrade path to the forthcoming radiation hardened PowerPC processor. The processor card, which makes extensive use of surface mount technology, has a 166 MHz PowerPC 603e processor, 32 Mbytes of error detected and corrected RAM, 8 Mbytes of Flash, and I Mbytes of EPROM, on a single PC/104-Plus card. Similar densities have been achieved with the quad channel Mil-Std-1553 card and the analog input/output cards. The power management built into the processor and its peripheral chip allows the power and performance of the system to be adjusted to meet the requirements of the application, allowing another dimension to the flexibility of the Universal Mini-Controller. Unique mechanical packaging allows the Universal Mini-Controller to accommodate standard COTS and custom oversized PC/104-Plus cards. This mechanical packaging also provides thermal management via conductive cooling of COTS boards, which are typically

  7. Cost-Effectiveness of Competing Treatment Strategies for Clostridium difficile Infection: A Systematic Review.

    Science.gov (United States)

    Le, Phuc; Nghiem, Van T; Mullen, Patricia Dolan; Deshpande, Abhishek

    2018-04-01

    BACKGROUND Clostridium difficile infection (CDI) presents a substantial economic burden and is associated with significant morbidity. While multiple treatment strategies have been evaluated, a cost-effective management strategy remains unclear. OBJECTIVE We conducted a systematic review to assess cost-effectiveness analyses of CDI treatment and to summarize key issues for clinicians and policy makers to consider. METHODS We searched PubMed and 5 other databases from inception to August 2016. These searches were not limited by study design or language of publication. Two reviewers independently screened the literature, abstracted data, and assessed methodological quality using the Drummond and Jefferson checklist. We extracted data on study characteristics, type of CDI, treatment characteristics, and model structure and inputs. RESULTS We included 14 studies, and 13 of these were from high-income countries. More than 90% of these studies were deemed moderate-to-high or high quality. Overall, 6 studies used a decision-tree model and 7 studies used a Markov model. Cost of therapy, time horizon, treatment cure rates, and recurrence rates were common influential factors in the study results. For initial CDI, fidaxomicin was a more cost-effective therapy than metronidazole or vancomycin in 2 of 3 studies. For severe initial CDI, 2 of 3 studies found fidaxomicin to be the most cost-effective therapy. For recurrent CDI, fidaxomicin was cost-effective in 3 of 5 studies, while fecal microbiota transplantation (FMT) by colonoscopy was consistently cost-effective in 4 of 4 studies. CONCLUSIONS The cost-effectiveness of fidaxomicin compared with other pharmacologic therapies was not definitive for either initial or recurrent CDI. Despite its high cost, FMT by colonoscopy may be a cost-effective therapy for recurrent CDI. A consensus on model design and assumptions are necessary for future comparison of CDI treatment. Infect Control Hosp Epidemiol 2018;39:412-424.

  8. Risk assessment methodologies for predicting phosphorus losses

    NARCIS (Netherlands)

    Schoumans, O.F.; Chardon, W.J.

    2003-01-01

    Risk assessment parameters are needed to assess the contribution of phosphorus (P) losses from soil to surface water, and the effectiveness of nutrient and land management strategies for the reduction of P loss. These parameters need to take into account the large temporal and spatial variation in P

  9. Weather, landscape, and management effects on nitrate and soluble phosphorus concentrations in subsurface drainage discharge in the western Lake Erie basin

    Science.gov (United States)

    Subsurface drainage, while an important and necessary agricultural production practice in the Midwest, contributes nitrate (NO3) and soluble phosphorus (P) to surface waters. Eutrophication (i.e., excessive enrichment of waters by NO3 and soluble P) supports harmful algal blooms (HABs) in receiving ...

  10. Can conservation agriculture improve phosphorus (P) availability in weathered soils? Effects of tillage and residue management on soil P status after 9 years in a Kenyan Oxisol

    NARCIS (Netherlands)

    Margenot, Andrew; Paul, B.K.; Pulleman, M.M.; Parikh, Sanjai; Fonte, Steven J.

    2017-01-01

    The widespread promotion of conservation agriculture (CA) in regions with weathered soils prone to phosphorus (P) deficiency merits explicit consideration of its effect on P availability. A long-term CA field trial located on an acid, weathered soil in western Kenya was evaluated for effects of

  11. A cost-effectiveness analysis of water security and water quality: impacts of climate and land-use change on the River Thames system.

    Science.gov (United States)

    Whitehead, P G; Crossman, J; Balana, B B; Futter, M N; Comber, S; Jin, L; Skuras, D; Wade, A J; Bowes, M J; Read, D S

    2013-11-13

    The catchment of the River Thames, the principal river system in southern England, provides the main water supply for London but is highly vulnerable to changes in climate, land use and population. The river is eutrophic with significant algal blooms with phosphorus assumed to be the primary chemical indicator of ecosystem health. In the Thames Basin, phosphorus is available from point sources such as wastewater treatment plants and from diffuse sources such as agriculture. In order to predict vulnerability to future change, the integrated catchments model for phosphorus (INCA-P) has been applied to the river basin and used to assess the cost-effectiveness of a range of mitigation and adaptation strategies. It is shown that scenarios of future climate and land-use change will exacerbate the water quality problems, but a range of mitigation measures can improve the situation. A cost-effectiveness study has been undertaken to compare the economic benefits of each mitigation measure and to assess the phosphorus reductions achieved. The most effective strategy is to reduce fertilizer use by 20% together with the treatment of effluent to a high standard. Such measures will reduce the instream phosphorus concentrations to close to the EU Water Framework Directive target for the Thames.

  12. Organic chemistry of elemental phosphorus

    International Nuclear Information System (INIS)

    Milyukov, V A; Budnikova, Yulia H; Sinyashin, Oleg G

    2005-01-01

    The principal achievements and the modern trends in the development of the chemistry of elemental phosphorus are analysed, described systematically and generalised. The possibilities and advantages of the preparation of organophosphorus compounds directly from white phosphorus are demonstrated. Attention is focused on the activation and transformation of elemental phosphorus in the coordination sphere of transition metal complexes. The mechanisms of the reactions of white phosphorus with nucleophilic and electrophilic reagents are discussed. Electrochemical approaches to the synthesis of organic phosphorus derivatives based on white phosphorus are considered.

  13. Distribution and sources of carbon, nitrogen, phosphorus and ...

    Indian Academy of Sciences (India)

    (TN), total phosphorus (TP) and biogenic silica (BSi) in the sedimentary environments of Asia's largest brackish ... Chilika lagoon on water quality, ecology, metal pollution ...... coast of India; In: Mangrove Management & Conserva- tion (ed.) ...

  14. phosphorus sorption capacity as a guide for phosphorus availability

    African Journals Online (AJOL)

    Prof. Adipala Ekwamu

    drained, light yellowish brown, loamy sand ... Dongola 2 Akked series: Deep, dark grayish brown, clay ... energy. Statistical analysis. Data collected were statistically analysed using ANOVA of MStatc ... phosphorus sorbed versus phosphorus.

  15. Statin cost effectiveness in primary prevention: A systematic review of the recent cost-effectiveness literature in the United States

    Directory of Open Access Journals (Sweden)

    Mitchell Aaron P

    2012-07-01

    Full Text Available Abstract Background The literature on the cost-effectiveness of statin drugs in primary prevention of coronary heart disease is complex. The objective of this study is to compare the disparate results of recent cost-effectiveness analyses of statins. Findings We conducted a systematic review of the literature on statin cost-effectiveness. The four studies that met inclusion criteria reported varying conclusions about the cost-effectiveness of statin treatment, without a clear consensus as to whether statins are cost-effective for primary prevention. However, after accounting for each study’s assumptions about statin costs, we found substantial agreement among the studies. Studies that assumed statins to be more expensive found them to be less cost-effective, and vice-versa. Furthermore, treatment of low-risk groups became cost-effective as statins became less expensive. Conclusions Drug price is the primary determinant of statin cost-effectiveness within a given risk group. As more statin drugs become generic, patients at low risk for coronary disease may be treated cost-effectively. Though many factors must be weighed in any medical decision, from a cost-effectiveness perspective, statins may now be considered an appropriate therapy for many patients at low risk for heart disease.

  16. Preparation of phosphorus targets using the compound phosphorus nitride

    International Nuclear Information System (INIS)

    Maier-Komor, P.

    1987-01-01

    Commercially available phosphorus nitride (P 3 N 5 ) shows a high oxygen content. Nevertheless, this material is attractive for use as phosphorus targets in experiments where red phosphorus would disappear due to its high vapor pressure and where a metal partner in the phosphide must be excluded due to its high atomic number. Methods are described to produce phosphorus nitride targets by vacuum evaporation condensation. (orig.)

  17. Assessing Cognitive behavioural Therapy in Irritable Bowel (ACTIB): protocol for a randomised controlled trial of clinical-effectiveness and cost-effectiveness of therapist delivered cognitive behavioural therapy and web-based self-management in irritable bowel syndrome in adults.

    Science.gov (United States)

    Everitt, Hazel; Landau, Sabine; Little, Paul; Bishop, Felicity L; McCrone, Paul; O'Reilly, Gilly; Coleman, Nicholas; Logan, Robert; Chalder, Trudie; Moss-Morris, Rona

    2015-07-15

    Irritable bowel syndrome (IBS) affects 10-22% of the UK population, with England's annual National Health Service (NHS) costs amounting to more than £200 million. Abdominal pain, bloating and altered bowel habit affect quality of life, social functioning and time off work. Current treatment relies on a positive diagnosis, reassurance, lifestyle advice and drug therapies, but many people suffer ongoing symptoms. Cognitive behaviour therapy (CBT) and self-management can be helpful, but availability is limited. To determine the clinical- and cost-effectiveness of therapist delivered cognitive behavioural therapy (TCBT) and web-based CBT self-management (WBCBT) in IBS, 495 participants with refractory IBS will be randomised to TCBT plus treatment as usual (TAU); WBCBT plus TAU; or TAU alone. The two CBT programmes have similar content. However, TCBT consists of six, 60 min telephone CBT sessions with a therapist over 9 weeks, at home, and two 'booster' 1 hour follow-up phone calls at 4 and 8 months (8 h therapist contact time). WBCBT consists of access to a previously developed and piloted WBCBT management programme (Regul8) and three 30 min therapist telephone sessions over 9 weeks, at home, and two 'booster' 30 min follow-up phone calls at 4 and 8 months (2½ h therapist contact time). Clinical effectiveness will be assessed by examining the difference between arms in the IBS Symptom Severity Score (IBS SSS) and Work and Social Adjustment Scale (WASAS) at 12 months from randomisation. Cost-effectiveness will combine measures of resource use with the IBS SSS at 12 months and quality-adjusted life years. This trial has full ethical approval. It will be disseminated via peer reviewed publications and conference presentations. The results will enable clinicians, patients and health service planners to make informed decisions regarding the management of IBS with CBT. ISRCTN44427879. Published by the BMJ Publishing Group Limited. For permission to

  18. Cost effective water treatment program in Heavy Water Plant (Manuguru)

    International Nuclear Information System (INIS)

    Mohapatra, C.; Prasada Rao, G.

    2002-01-01

    Water treatment technology is in a state of continuous evolution. The increasing urgency to conserve water and reduce pollution has in recent years produced an enormous demand for new chemical treatment programs and technologies. Heavy water plant (Manuguru) uses water as raw material (about 3000 m 3 /hr) and its treatment and management has benefited the plant in a significant way. It is a fact that if the water treatment is not proper, it can result in deposit formation and corrosion of metals, which can finally leads to production losses. Therefore, before selecting treatment program, complying w.r.t. quality requirements, safety and pollution aspects cost effectiveness shall be examined. The areas where significant benefits are derived, are raw water treatment using polyelectrolyte instead of inorganic coagulant (alum), change over of regenerant of cation exchangers from hydrochloric acid to sulfuric acid and in-house development of cooling water treatment formulation. The advantages and cost effectiveness of these treatments are discussed in detail. Further these treatments has helped the plant in achieving zero discharge and indirectly increased cost reduction of final product (heavy water); the dosage of 3 ppm of polyelectrolyte can replace 90 ppm alum at turbidity level of 300 NTU of raw water which has resulted in cost saving of Rs. 15-20 lakhs in a year beside other advantages; the change over of regenerant from HCl to H 2 SO 4 will result in cost saving of at least Rs.1.4 crore a year besides other advantages; the change over to proprietary formulation to in-house formulation in cooling water treatment has resulted in a saving about Rs.11 lakhs a year. To achieve the above objectives in a sustainable way the performance results are being monitored. (author)

  19. III. Quantitative aspects of phosphorus excretionin ruminants

    OpenAIRE

    Bravo , David; Sauvant , Daniel; Bogaert , Catherine; Meschy , François

    2003-01-01

    International audience; Ruminant phosphorus excretion and metabolism were studied through a database. Faecal endogenous phosphorus is the main pathway of phosphorus excretion and averages 0.85 of total faecal phosphorus. The remaining 0.15 is unabsorbed dietary phosphorus. Faecal endogenous phosphorus is mainly unabsorbed phosphorus, with saliva being the major source, and is correlated to factors influencing saliva secretion (DM intake, physical dietary characteristics and dietary phosphorus...

  20. Cost-effectiveness, feed utilization and body composition of african ...

    African Journals Online (AJOL)

    Cost-effectiveness, feed utilization and body composition of african sharptooth catfish ( Clarias gariepinus , Burchell 1822) fingerlings fed locally formulated and commercial pelleted diets in tarpaulin tanks.

  1. Traps for phosphorus adsorption

    International Nuclear Information System (INIS)

    Montoya, Nawer D; Villegas, Wilson E; Rodriguez, Lino M; Taborda, Nelson; Montes de C, Consuelo

    2001-01-01

    Several AL 2 O 3 supported oxides such as: NiO, CuO, Co 2 O 3 BaO, CeO 2 and ZnO were investigated for phosphorus adsorption. Zno/y-Al 2 O 3 exhibited the highest phosphorus adsorption capacity. However, since it diminishes the activity of to the reaction mixture it should be located upstream of the NoX catalyst, i.e. 0,3% Pd-H-MOR, in order to protect it against p poisoning. The treatment procedure with citric acid was effective for the removal of more than 70% phosphorus from the adsorbent, ZnO/y-Al 2 O 3

  2. Cost-effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections of insulin in Type 1 diabetes

    DEFF Research Database (Denmark)

    Roze, S.; Smith-Palmer, J.; Valentine, W.

    2015-01-01

    Aim: Continuous subcutaneous insulin infusion (CSII) is increasingly used in clinical practice for the management of selected patients with Type 1 diabetes. Several cost-effectiveness studies comparing CSII vs. multiple insulin injections (MDI) have been reported. The aim was systematically...... to review these analyses and test the hypothesis that CSII is a cost-effective use of healthcare resources across settings. Methods: A literature review was performed using MEDLINE, Cochrane Library and other databases. No time limit or language restrictions were applied. After two rounds of screening, 11...... cost-effectiveness analyses were included in the final review, of which nine used the CORE Diabetes Model. A narrative synthesis was conducted and mean cost effectiveness calculated. Results: CSII was considered cost-effective vs. MDI in Type 1 diabetes in all 11 studies in 8 countries, with a mean (95...

  3. [Myocardial perfusion scintigraphy. Exact and cost-effective coronary disease imaging - secondary publication

    DEFF Research Database (Denmark)

    Hesse, B.; Petersen, C.L.; Marcassa, C.

    2008-01-01

    Mortality rates due to coronary arterial disease (CAD) have declined as result of improved prevention, diagnosis and management, but CAD remains the leading cause of death. Myocardial perfusion scintigraphy (MPS) provides a cost-effective tool for early detection of CAD in symptomatic individuals...

  4. Preliminary analysis of phosphorus flow in Hue Citadel.

    Science.gov (United States)

    Anh, T N Q; Harada, H; Fujii, S; Anh, P N; Lieu, P K; Tanaka, S

    2016-01-01

    Characteristics of waste and wastewater management can affect material flows. Our research investigates the management of waste and wastewater in urban areas of developing countries and its effects on phosphorus flow based on a case study in Hue Citadel, Hue, Vietnam. One hundred households were interviewed to gain insight into domestic waste and wastewater management together with secondary data collection. Next, a phosphorus flow model was developed to quantify the phosphorus input and output in the area. The results showed that almost all wastewater generated in Hue Citadel was eventually discharged into water bodies and to the ground/groundwater. This led to most of the phosphorus output flowing into water bodies (41.2 kg P/(ha year)) and ground/groundwater (25.3 kg P/(ha year)). Sewage from the sewer system was the largest source of phosphorus loading into water bodies, while effluent from on-site sanitation systems was responsible for a major portion of phosphorus into the ground/groundwater. This elevated phosphorus loading is a serious issue in considering surface water and groundwater protection.

  5. Chromatography of phosphorus oxoacids

    International Nuclear Information System (INIS)

    Ohashi, S.

    1975-01-01

    The present state of studies on the chromatographic separation of phosphorus oxoacids is surveyed. In this paper, chromatographic techniques are divided into four groups, i.e. paper and thin-layer chromatography, paper electrophoresis, ion-exchange chromatography, and gel chromatography. The separation mechanisms and characteristics for these chromatographic methods are discussed and some examples for the separation of phosphorus oxoacids are described. As examples of the application of ion-exchange and gel chromatography, studies on the hot atom chemistry of 32 P in solid inorganic phosphates and those on the substitution reactions between diphosphonate (diphosphite) and polyphosphates are reported. (author)

  6. Sewage-effluent phosphorus: A greater risk to river eutrophication than agricultural phosphorus?

    International Nuclear Information System (INIS)

    Jarvie, Helen P.; Neal, Colin; Withers, Paul J.A.

    2006-01-01

    Phosphorus (P) concentrations from water quality monitoring at 54 UK river sites across seven major lowland catchment systems are examined in relation to eutrophication risk and to the relative importance of point and diffuse sources. The over-riding evidence indicates that point (effluent) rather than diffuse (agricultural) sources of phosphorus provide the most significant risk for river eutrophication, even in rural areas with high agricultural phosphorus losses. Traditionally, the relative importance of point and diffuse sources has been assessed from annual P flux budgets, which are often dominated by diffuse inputs in storm runoff from intensively managed agricultural land. However, the ecological risk associated with nuisance algal growth in rivers is largely linked to soluble reactive phosphorus (SRP) concentrations during times of ecological sensitivity (spring/summer low-flow periods), when biological activity is at its highest. The relationships between SRP and total phosphorus (TP; total dissolved P + suspended particulate P) concentrations within UK rivers are evaluated in relation to flow and boron (B; a tracer of sewage effluent). SRP is the dominant P fraction (average 67% of TP) in all of the rivers monitored, with higher percentages at low flows. In most of the rivers the highest SRP concentrations occur under low-flow conditions and SRP concentrations are diluted as flows increase, which is indicative of point, rather than diffuse, sources. Strong positive correlations between SRP and B (also TP and B) across all the 54 river monitoring sites also confirm the primary importance of point source controls of phosphorus concentrations in these rivers, particularly during spring and summer low flows, which are times of greatest eutrophication risk. Particulate phosphorus (PP) may form a significant proportion of the phosphorus load to rivers, particularly during winter storm events, but this is of questionable relevance for river eutrophication

  7. Cost-effectiveness of diagnostic-therapeutic strategies for paediatric visceral leishmaniasis in Morocco.

    Science.gov (United States)

    Alonso, Sergi; Tachfouti, Nabil; Najdi, Adil; Sicuri, Elisa; Picado, Albert

    2017-01-01

    Visceral leishmaniasis (VL) is a neglected parasitic disease with a high fatality rate if left untreated. Endemic in Morocco, as well as in other countries in the Mediterranean basin, VL mainly affects children living in rural areas. In Morocco, the direct observation of Leishmania parasites in bone marrow (BM) aspirates is used to diagnose VL and meglumine antimoniate (SB) is the first line of treatment. Less invasive, more efficacious and safer alternatives exist. In this study we estimate the cost-effectiveness of alternative diagnostic-therapeutic algorithms for paediatric VL in Morocco. A decision tree was used to estimate the cost-effectiveness of using BM or rapid diagnostic tests (RDTs) as diagnostic tools and/or SB or two liposomal amphotericin B (L-AmB) regimens: 6-day and 2-day courses to treat VL. Incremental cost-effectiveness ratios, expressed as cost per death averted, were estimated by comparing costs and effectiveness of the alternative algorithms. A threshold analysis evaluated at which price L-AmB became cost-effective compared with current practices. Implementing RDT and/or L-AmB treatments would be cost-effective in Morocco according to the WHO thresholds. Introducing the 6-day course L-AmB, current second-line treatment, would be highly cost-effective if L-AmB price was below US$100/phial. The 2-day L-AmB treatment, current standard treatment of paediatric VL in France, is highly cost-effective, with L-AmB at its market price (US$165/phial). The results of this study should encourage the implementation of RDT and/or short-course L-AmB treatments for paediatric VL management in Morocco and other North African countries.

  8. Phosphorus in Agriculture : 100 % Zero

    NARCIS (Netherlands)

    Schnug, Ewald; De Kok, Luit J.

    2016-01-01

    Phosphorus is essential for all living organisms, reserves in geogenic deposits are finite, and phosphorus nutrient mining and oversupply are common phenomenons on agricultural soils. Only if the agricultural phosphorus cycle can be closed and the fertilized nutrient been utilized completely,

  9. Anthropogenic phosphorus flow analysis of Hefei City, China.

    Science.gov (United States)

    Li, Sisi; Yuan, Zengwei; Bi, Jun; Wu, Huijun

    2010-11-01

    The substance flow analysis (SFA) method was employed to examine phosphorus flow and its connection to water pollution in the city of Hefei, China, in 2008. As human activity is the driving force of phosphorus flux from the environment to the economy, the study provides a conceptual framework for analyzing an anthropogenic phosphorus cycle that includes four stages: extraction, fabrication and manufacturing, use, and waste management. Estimates of phosphorus flow were based on existing data as well as field research, expert advice, local accounting systems, and literature. The total phosphorus input into Hefei in 2008 reached 7810 tons, mainly as phosphate ore, chemical fertilizer, pesticides, crops and animal products. Approximately 33% of the total phosphorus input left the area, and nearly 20% of that amount was discharged as waste to surface water. Effluent containing excessive fertilizer from farming operations plays an important role in phosphorus overloads onto surface water; the other major emission source is sewage discharge. We also provide suggestions for reducing phosphorus emissions, for example reducing fertilizer use, recycling farming residues, and changing human consumption patterns. Crown Copyright © 2010. Published by Elsevier B.V. All rights reserved.

  10. Phosphorus run-off assessment in a watershed.

    Science.gov (United States)

    Chebud, Yirgalem; Naja, Ghinwa M; Rivero, Rosanna

    2011-01-01

    The Watershed Assessment Model was used to simulate the runoff volume, peak flows, and non-point source phosphorus loadings from the 5870 km(2) Lake Okeechobee watershed as a case study. The results were compared to on-site monitoring to verify the accuracy of the method and to estimate the observed/simulated error. In 2008, the total simulated phosphorus contribution was 9634, 6524 and 3908 kg (P) y(-1) from sod farms, citrus farms and row crop farmlands, respectively. Although the dairies represent less than 1% of the total area of Kissimmee basin, the simulated P load from the dairies (9283 kg (P) y(-1) in 2008) made up 5.4% of the total P load during 2008. On average, the modeled P yield rates from dairies, sod farms and row crop farmlands are 3.85, 2.01 and 0.86 kg (P) ha(-1) y(-1), respectively. The maximum sediment simulated phosphorus yield rate is about 2 kg (P) ha(-1) and the particulate simulated phosphorus contribution from urban, improved pastures and dairies to the total phosphorus load was estimated at 9%, 3.5%, and 1%, respectively. Land parcels with P oversaturated soil as well as the land parcels with high phosphorus assimilation and high total phosphorus contribution were located. The most critical sub-basin was identified for eventual targeting by enforced agricultural best management practices. Phosphorus load, including stream assimilation, incoming to Lake Okeechobee from two selected dairies was also determined.

  11. Anthropogenic phosphorus flow analysis of Hefei City, China

    International Nuclear Information System (INIS)

    Li Sisi; Yuan Zengwei; Bi Jun; Wu Huijun

    2010-01-01

    The substance flow analysis (SFA) method was employed to examine phosphorus flow and its connection to water pollution in the city of Hefei, China, in 2008. As human activity is the driving force of phosphorus flux from the environment to the economy, the study provides a conceptual framework for analyzing an anthropogenic phosphorus cycle that includes four stages: extraction, fabrication and manufacturing, use, and waste management. Estimates of phosphorus flow were based on existing data as well as field research, expert advice, local accounting systems, and literature. The total phosphorus input into Hefei in 2008 reached 7810 tons, mainly as phosphate ore, chemical fertilizer, pesticides, crops and animal products. Approximately 33% of the total phosphorus input left the area, and nearly 20% of that amount was discharged as waste to surface water. Effluent containing excessive fertilizer from farming operations plays an important role in phosphorus overloads onto surface water; the other major emission source is sewage discharge. We also provide suggestions for reducing phosphorus emissions, for example reducing fertilizer use, recycling farming residues, and changing human consumption patterns.

  12. Scalable and cost-effective NGS genotyping in the cloud.

    Science.gov (United States)

    Souilmi, Yassine; Lancaster, Alex K; Jung, Jae-Yoon; Rizzo, Ettore; Hawkins, Jared B; Powles, Ryan; Amzazi, Saaïd; Ghazal, Hassan; Tonellato, Peter J; Wall, Dennis P

    2015-10-15

    While next-generation sequencing (NGS) costs have plummeted in recent years, cost and complexity of computation remain substantial barriers to the use of NGS in routine clinical care. The clinical potential of NGS will not be realized until robust and routine whole genome sequencing data can be accurately rendered to medically actionable reports within a time window of hours and at scales of economy in the 10's of dollars. We take a step towards addressing this challenge, by using COSMOS, a cloud-enabled workflow management system, to develop GenomeKey, an NGS whole genome analysis workflow. COSMOS implements complex workflows making optimal use of high-performance compute clusters. Here we show that the Amazon Web Service (AWS) implementation of GenomeKey via COSMOS provides a fast, scalable, and cost-effective analysis of both public benchmarking and large-scale heterogeneous clinical NGS datasets. Our systematic benchmarking reveals important new insights and considerations to produce clinical turn-around of whole genome analysis optimization and workflow management including strategic batching of individual genomes and efficient cluster resource configuration.

  13. Cost-effectiveness evaluation of alternatives in environmental impact statements

    International Nuclear Information System (INIS)

    Weiser, A.L.

    1977-01-01

    Although it has been Federal government officials who have been accused in courts of law with mismanagement with regard to the consideration of alternatives in the environmental impact statement, the responsibility for systematically considering all alternatives to a proposed project remains with project decisionmakers in the Federal, state, or local levels of government and in industry. By applying the techniques of system cost-effectiveness analysis to the assessment of alternatives, it is believed that management will be able to clearly demonstrate that the selection of the proposed approach was neither arbitrary nor capricious. A rational approach to the assessment of alternatives should aid in meeting the mandates of environmental legislation and EIS guidelines, and it should eliminate the merit of any plaintiff's charge of mismanagement with regard to management's consideration of alternatives. Even though many interfaces between the proposed system and the environment cannot as yet be objectively quantified, application of CE techniques will demonstrate that a rigorous exploration and objective evaluation has been applied to the consideration of alternatives with respect to project objectives, financial conditions, and adverse environmental impacts

  14. A Delphi study to establish national cost-effectiveness research priorities for positron emission tomography

    International Nuclear Information System (INIS)

    Robert, Glenn; Milne, Ruairidh

    1999-01-01

    Objective: This study aimed to determine the key cost-effectiveness research questions relating to positron emission tomography (PET) in the UK. Methods: A systematic literature review was conducted to establish the existing knowledge base relating to the cost-effectiveness of PET in the various conditions for which it has been proposed. A three-round postal Delphi study of relevant individuals was used to determine the key cost-effectiveness research questions relating to PET in the UK. The content and structure of the Delphi study was informed by the results of the literature review. Results: The most important cost-effectiveness research priorities for the National Health Service (NHS) relating to PET were in the clinical areas of lung cancer, breast cancer and the assessment of myocardial viability. Gamma camera PET using coincidence imaging was highlighted as a modality whose clinical role needed to be determined urgently. Conclusion: Underlying the cost-effectiveness research priorities which were established is the need for evidence that the use of the various PET modalities as a diagnostic technique will alter patient management as compared to existing diagnostic strategies. The findings of the project provide a contemporary overview of the potential role for PET in the NHS and will be relevant to other countries

  15. Cost effectiveness of haemophilia treatment : a cross-national assessment

    NARCIS (Netherlands)

    Lippert, B; Berger, K; Berntorp, E; Giangrande, P; van den Berg, M; Schramm, W; Siebert, U

    2005-01-01

    The aim of this study was to assess the incremental cost effectiveness of on-demand versus prophylactic haemophilia therapy in Germany, Sweden, the United Kingdom and The Netherlands from the third-party payers' perspective. Using a decision tree model, the cost effectiveness of on-demand versus

  16. Cost-effectiveness of antiplatelet drugs after percutaneous coronary intervention.

    Science.gov (United States)

    Wisløff, Torbjørn; Atar, Dan

    2016-01-01

    Clopidogrel has, for long time, been accepted as the standard treatment for patients who have undergone a percutaneous coronary intervention (PCI). The introduction of prasugrel-and more recently, ticagrelor-has introduced a decision-making problem for clinicians and governments worldwide: to use the cheaper clopidogrel or the more effective, and also more expensive prasugrel or ticagrelor. We aim to give helpful contributions to this debate by analysing the cost-effectiveness of clopidogrel, prasugrel, and ticagrelor compared with each other. We modified a previously developed Markov model of cardiac disease progression. In the model, we followed up cohorts of patients who have recently had a PCI until 100 years or death. Possible events are revascularization, bleeding, acute myocardial infarction, and death. Our analysis shows that ticagrelor is cost-effective in 77% of simulations at an incremental cost-effectiveness ratio of €7700 compared with clopidogrel. Ticagrelor was also cost-effective against prasugrel at a cost-effectiveness ratio of €7800. Given a Norwegian cost-effectiveness threshold of €70 000, both comparisons appear to be clearly cost-effective in favour of ticagrelor. Ticagrelor is cost-effective compared with both clopidogrel and prasugrel for patients who have undergone a PCI.

  17. Cost effectiveness of Tuberculosis Treatment from the Patients ...

    African Journals Online (AJOL)

    ... Directly Observed Treatment Short course is more cost effective from the patients' point of view. DOTS needs to be re-focused out of the hospitals and clinics and made community based in view of the increasing TB caseload occasioned by HI V/AIDS. Key Words: Cost effectiveness, Tuberculosis treatment, personal cost, ...

  18. Index method for analyzing cost effectiveness of drilling rigs

    Energy Technology Data Exchange (ETDEWEB)

    Batura, N P; Bocharov, V V

    1978-01-01

    The method for a complete analysis of the factors determining cost effectiveness of a drilling rig fleet is examined. The system of calculating production indexes from statistical reports is relatively simple and is not difficult to use for production organizations. The analytical results may be used to develop actual measures used to increase cost effectiveness of drilling operations.

  19. Cost-effectiveness of trachoma control in seven world regions.

    NARCIS (Netherlands)

    Baltussen, R.M.P.M.; Sylla, M.; Frick, K.D.; Mariotti, S.P.

    2005-01-01

    BACKGROUND/AIMS: The fight against blinding trachoma is being addressed with an integrated strategy of surgery, antibiotics, hygiene promotion, and environmental improvement-the SAFE strategy, but its cost-effectiveness is largely unknown. This paper estimates the cost effectiveness of surgery and

  20. 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…

  1. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Presuming cost-effectiveness results. 436.13 Section 436... Methodology and Procedures for Life Cycle Cost Analyses § 436.13 Presuming cost-effectiveness results. (a) If the investment and other costs for an energy or water conservation measure considered for retrofit to...

  2. Costs and cost-effectiveness of periviable care.

    Science.gov (United States)

    Caughey, Aaron B; Burchfield, David J

    2014-02-01

    With increasing concerns regarding rapidly expanding healthcare costs, cost-effectiveness analysis allows assessment of whether marginal gains from new technology are worth the increased costs. Particular methodologic issues related to cost and cost-effectiveness analysis in the area of neonatal and periviable care include how costs are estimated, such as the use of charges and whether long-term costs are included; the challenges of measuring utilities; and whether to use a maternal, neonatal, or dual perspective in such analyses. A number of studies over the past three decades have examined the costs and the cost-effectiveness of neonatal and periviable care. Broadly, while neonatal care is costly, it is also cost effective as it produces both life-years and quality-adjusted life-years (QALYs). However, as the gestational age of the neonate decreases, the costs increase and the cost-effectiveness threshold is harder to achieve. In the periviable range of gestational age (22-24 weeks of gestation), whether the care is cost effective is questionable and is dependent on the perspective. Understanding the methodology and salient issues of cost-effectiveness analysis is critical for researchers, editors, and clinicians to accurately interpret results of the growing body of cost-effectiveness studies related to the care of periviable pregnancies and neonates. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. ORIGINAL ARTICLES Cost-effectiveness analysis for priority-setting ...

    African Journals Online (AJOL)

    health outcomes and wasted resources.4-5 It was found that the cost- effectiveness of South ... Priorities for Developing Countries Project was that emergency (and even some elective) ... to control air pollutants found that in South Africa the most cost- effective ..... outdoor air pollution in South Africa in 2000. S Afr Med J ...

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

    African Journals Online (AJOL)

    ACSS

    and Investment Plan 2011-2015 (DSIP,. 2010), whose increase in .... 11.9b. 169.6a. 16.1b. 18.4a. 4.9a. 2.7b. Pre-Atz+1hh. 253 ab. 13.3ab. 175.3a. 17.0ab. 18.2a. 0.6c ... *ROI (%) costs (U.shs ha-1) from maize sales (U.shs ha-1). (U.shs ha-1).

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

    African Journals Online (AJOL)

    stressed the importance of the rational and appropriate use of resources. ... changes in blood pressure (BP) control following a change from nifedipine to other ..... information on prescribing behaviour than has previously been reported in ...

  6. Phosphorus in agricultural soils:

    NARCIS (Netherlands)

    Ringeval, Bruno; Augusto, Laurent; Monod, Hervé; Apeldoorn, van D.F.; Bouwman, A.F.; Yang, X.; Achat, D.L.; Chini, L.P.; Oost, van K.; Guenet, Bertrand; Wang, R.; Decharme, B.; Nesme, T.; Pellerin, S.

    2017-01-01

    Phosphorus (P) availability in soils limits crop yields in many regions of the World, while excess of soil P triggers aquatic eutrophication in other regions. Numerous processes drive the global spatial distribution of P in agricultural soils, but their relative roles remain unclear. Here, we

  7. Cost Effective RADIUS Authentication for Wireless Clients

    Directory of Open Access Journals (Sweden)

    Alexandru ENACEANU

    2010-12-01

    Full Text Available Network administrators need to keep administrative user information for each network device, but network devices usually support only limited functions for user management. WLAN security is a modern problem that needs to be solved and it requires a lot of overhead especially when applied to corporate wireless networks. Administrators can set up a RADIUS server that uses an external database server to handle authentication, authorization, and accounting for network security issues.

  8. Identifying potentially cost effective chronic care programs for people with COPD

    Directory of Open Access Journals (Sweden)

    L M G Steuten

    2008-12-01

    Full Text Available L M G Steuten1, K M M Lemmens2, A P Nieboer2, H JM Vrijhoef31Maastricht University Medical Centre, School for Care and Public Health Research, Department of Health, Organisation, Policy and Economics, Maastricht, The Netherlands; 2Erasmus University Medical Centre, Institute of Health Policy and Management, Rotterdam, The Netherlands; 3Maastricht University Medical Centre, School for Care and Public Health Research, Department of Integrated Care, Maastricht, The NetherlandsObjective: To review published evidence regarding the cost effectiveness of multi-component COPD programs and to illustrate how potentially cost effective programs can be identified.Methods: Systematic search of Medline and Cochrane databases for evaluations of multi-component disease management or chronic care programs for adults with COPD, describing process, intermediate, and end results of care. Data were independently extracted by two reviewers and descriptively summarized.Results: Twenty articles describing 17 unique COPD programs were included. There is little evidence for significant improvements in process and intermediate outcomes, except for increased provision of patient self-management education and improved disease-specific knowledge. Overall, the COPD programs generate end results equivalent to usual care, but programs containing ≥3 components show lower relative risks for hospitalization. There is limited scope for programs to break-even or save money.Conclusion: Identifying cost effective multi-component COPD programs remains a challenge due to scarce methodologically sound studies that demonstrate significant improvements on process, intermediate and end results of care. Estimations of potential cost effectiveness of specific programs illustrated in this paper can, in the absence of ‘perfect data’, support timely decision-making regarding these programs. Nevertheless, well-designed health economic studies are needed to decrease the current decision

  9. Using a phosphorus loss model to evaluate the Kentucky phosphorus index

    Science.gov (United States)

    U.S. Department of Agriculture’s Natural Resource Conservation Service (USDA-NRCS) has recently revised its 590 Nutrient Management Conservation Standard. As part of this revision, USDA-NRCS is requiring states to test the accuracy of their phosphorus (P) index using either measured P loss data or s...

  10. Urban phosphorus sustainability: Systemically incorporating social, ecological, and technological factors into phosphorus flow analysis

    Science.gov (United States)

    Genevieve S. Metson; David M. Iwaniec; Lawrence A. Baker; Elena M. Bennett; Daniel L. Childers; Dana Cordell; Nancy B. Grimm; J. Morgan Grove; Daniel A. Nidzgorski; Stuart. White

    2015-01-01

    Phosphorus (P) is an essential fertilizer for agricultural production but is also a potent aquatic pollutant. Current P management fails to adequately address both the issue of food security due to P scarcity and P pollution threats to water bodies. As centers of food consumption and waste production, cities transport and store much P and thus provide important...

  11. Effect of phosphorus stress on Microcystis aeruginosa growth and phosphorus uptake.

    Directory of Open Access Journals (Sweden)

    Sajeela Ghaffar

    Full Text Available This study was designed to advance understanding of phosphorus regulation of Microcystis aeruginosa growth, phosphorus uptake and storage in changing phosphorus (P conditions as would occur in lakes. We hypothesized that Microcystis growth and nutrient uptake would fit classic models by Monod, Droop, and Michaelis-Menten in these changing conditions. Microcystis grown in luxury nutrient concentrations was transferred to treatments with phosphorus concentrations ranging from 0-256 μg P∙L-1 and luxury nitrogen. Dissolved phosphorus concentration, cell phosphorus quota, P uptake rate and cell densities were measured at day 3 and 6. Results showed little relationship to predicted models. Microcystis growth was asymptotically related to P treatment from day 0-3, fitting Monod model well, but negatively related to P treatment and cell quota from day 3-6. From day 0-3, cell quota was negatively related to P treatments at <2 μg∙L-1, but increased slightly at higher P. Cell quota decreased greatly in low P treatments from day 3-6, which may have enabled high growths in low P treatments. P uptake was positively and linearly related to P treatment during both periods. Negative uptake rates and increases in measured culture phosphorus concentrations to 5 μg∙L-1 in the lowest P treatments indicated P leaked from cells into culture medium. This leakage during early stages of the experiment may have been sufficient to stimulate metabolism and use of intracellular P stores in low P treatments for rapid growth. Our study shows P regulation of Microcystis growth can be complex as a result of changing P concentrations, and this complexity may be important for modeling Microcystis for nutrient and ecosystem management.

  12. The challenge of controlling phosphorus in chronic kidney disease.

    Science.gov (United States)

    Cannata-Andía, Jorge B; Martin, Kevin J

    2016-04-01

    The pathogenesis and management of chronic kidney disease-mineral bone disorders (CKD-MBD) has experienced major changes, but the control of serum phosphorus at all stages of CKD still seems to be a key factor to improve clinical outcomes. High serum phosphorus is the most important uremia-related, non-traditional risk factor associated with vascular calcification in CKD patients and in the general population. Phosphorus may also be one of the key elements linking vascular calcification with low bone turnover. The main hormones and factors that contribute to the kidney regulation of phosphorus and calcium include parathyroid hormone, FGF-23, klotho and 1,25-dihydroxyvitamin D (1,25(OH)2D). Serum phosphorus did not start rising until CKD 3b in contrast with the earlier changes observed with fibroblast growth factor-23 (FGF-23), Klotho, calcitriol and parathyroid hormone (PTH). Despite FGF-23 and PTH having synergic effects regarding phosphorus removal, they have opposite effects on 1,25(OH)2D3. At the same stages of CKD in which phosphorus retention appears to occur, calcium retention also occurs. As phosphorus accumulation is associated with poor outcomes, an important question without a clear answer is at which level-range should serum phosphorus be maintained at different stages of CKD to improve clinical outcomes. There are four main strategies to manage phosphate homeostasis; phosphorus dietary intake, administration of phosphate binder agents, effective control of hyperparathyroidism and to ensure in the CKD 5D setting, an adequate scheme of dialysis. Despite all the available strategies, and the introduction of new phosphate binder agents in the market, controlling serum phosphorus remains challenging, and hyperphosphatemia continues to be extremely common in CKD 5 patients. Furthermore, despite phosphate binding agents having proved to be effective in reducing serum phosphorus, their ultimate effects on clinical outcomes remain controversial. Thus, we still

  13. Can a Costly Intervention Be Cost-effective?

    Science.gov (United States)

    Foster, E. Michael; Jones, Damon

    2009-01-01

    Objectives To examine the cost-effectiveness of the Fast Track intervention, a multi-year, multi-component intervention designed to reduce violence among at-risk children. A previous report documented the favorable effect of intervention on the highest-risk group of ninth-graders diagnosed with conduct disorder, as well as self-reported delinquency. The current report addressed the cost-effectiveness of the intervention for these measures of program impact. Design Costs of the intervention were estimated using program budgets. Incremental cost-effectiveness ratios were computed to determine the cost per unit of improvement in the 3 outcomes measured in the 10th year of the study. Results Examination of the total sample showed that the intervention was not cost-effective at likely levels of policymakers' willingness to pay for the key outcomes. Subsequent analysis of those most at risk, however, showed that the intervention likely was cost-effective given specified willingness-to-pay criteria. Conclusions Results indicate that the intervention is cost-effective for the children at highest risk. From a policy standpoint, this finding is encouraging because such children are likely to generate higher costs for society over their lifetimes. However, substantial barriers to cost-effectiveness remain, such as the ability to effectively identify and recruit such higher-risk children in future implementations. PMID:17088509

  14. Cost-effectiveness of Chlamydia antibody tests in subfertile women.

    Science.gov (United States)

    Fiddelers, A A A; Land, J A; Voss, G; Kessels, A G H; Severens, J L

    2005-02-01

    For the evaluation of tubal function, Chlamydia antibody testing (CAT) has been introduced as a screening test. We compared six CAT screening strategies (five CAT tests and one combination of tests), with respect to their cost-effectiveness, by using IVF pregnancy rate as outcome measure. A decision analytic model was developed based on a source population of 1715 subfertile women. The model incorporates hysterosalpingography (HSG), laparoscopy and IVF. To calculate IVF pregnancy rates, costs, effects, cost-effectiveness and incremental costs per effect of the six different CAT screening strategies were determined. pELISA Medac turned out to be the most cost-effective CAT screening strategy (15 075 per IVF pregnancy), followed by MIF Anilabsystems (15 108). A combination of tests (pELISA Medac and MIF Anilabsystems; 15 127) did not improve the cost-effectiveness of the single strategies. Sensitivity analyses showed that the results are robust for changes in the baseline values of the model parameters. Only small differences were found between the screening strategies regarding the cost-effectiveness, although pELISA Medac was the most cost-effective strategy. Before introducing a particular CAT test into clinical practice, one should consider the effects and consequences of the entire screening strategy, instead of only the diagnostic accuracy of the test used.

  15. Cost-effectiveness and the socialization of health care.

    Science.gov (United States)

    Musgrove, P

    1995-01-01

    The more health care is socialized, the more cost-effectiveness is an appropriate criterion for expenditure. Utility-maximizing individuals, facing divisibility of health care purchases and declining marginal health gains, and complete information about probable health improvements, should buy health care according to its cost-effectiveness. Absent these features, individual health spending will not be cost-effective; and in any case, differences in personal utilities and risk aversion will not lead to the same ranking of health care interventions for everyone. Private insurance frees consumers from concern for cost, which undermines cost-effectiveness, but lets them emphasize effectiveness, which favors value for money. This is most important for costly and cost-effective interventions, especially for poor people. Cost-effectiveness is more appropriate and easier to achieve under second-party insurance. More complete socialization of health care, via public finance, can yield greater efficiency by making insurance compulsory. Cost-effectiveness is also more attractive when taxpayers subsidize others' care: needs (effectiveness) take precedence over wants (utility). The gain in effectiveness may be greater, and the welfare loss from Pareto non-optimality smaller, in poor countries than in rich ones.

  16. Structuring a cost-effective site characterization

    International Nuclear Information System (INIS)

    Berven, B.A.; Little, C.A.; Swaja, R.E.

    1990-01-01

    Successful chemical and radiological site characterizations are complex activities which require meticulously detailed planning. Each layer of investigation is based upon previously generated information about the site. Baseline historical, physical, geological, and regulatory information is prerequisite for preliminary studies at a site. Preliminary studies then provide samples and measurements which define the identity of potential contaminants and define boundaries around the area to be investigated. The goal of a full site characterization is to accurately determine the extent and magnitude of contaminants and carefully define the site conditions such that the future movements of site contaminants can be assessed for potential exposure to human occupants and/or environmental impacts. Critical to this process is the selection of appropriate measurement and sampling methodology, selection and use of appropriate instrumentation and management/interpretation of site information. Site investigations require optimization between the need of information to maximize the understanding of site conditions and the cost of acquiring that information. 5 refs., 1 tab

  17. The Potential Cost-Effectiveness of Amblyopia Screening Programs

    Science.gov (United States)

    Rein, David B.; Wittenborn, John S.; Zhang, Xinzhi; Song, Michael; Saaddine, Jinan B.

    2013-01-01

    Background To estimate the incremental cost-effectiveness of amblyopia screening at preschool and kindergarten, we compared the costs and benefits of 3 amblyopia screening scenarios to no screening and to each other: (1) acuity/stereopsis (A/S) screening at kindergarten, (2) A/S screening at preschool and kindergarten, and (3) photoscreening at preschool and A/S screening at kindergarten. Methods We programmed a probabilistic microsimulation model of amblyopia natural history and response to treatment with screening costs and outcomes estimated from 2 state programs. We calculated the probability that no screening and each of the 3 interventions were most cost-effective per incremental quality-adjusted life year (QALY) gained and case avoided. Results Assuming a minimal 0.01 utility loss from monocular vision loss, no screening was most cost-effective with a willingness to pay (WTP) of less than $16,000 per QALY gained. A/S screening at kindergarten alone was most cost-effective between a WTP of $17,000 and $21,000. A/S screening at preschool and kindergarten was most cost-effective between a WTP of $22,000 and $75,000, and photoscreening at preschool and A/S screening at kindergarten was most cost-effective at a WTP greater than $75,000. Cost-effectiveness substantially improved when assuming a greater utility loss. All scenarios were cost-effective when assuming a WTP of $10,500 per case of amblyopia cured. Conclusions All 3 screening interventions evaluated are likely to be considered cost-effective relative to many other potential public health programs. The choice of screening option depends on budgetary resources and the value placed on monocular vision loss prevention by funding agencies. PMID:21877675

  18. Cost-effective practices in the blood service sector.

    Science.gov (United States)

    Katsaliaki, Korina

    2008-05-01

    The objective of this study is to recommend alternative policies, which are tested on a computer simulation model, towards a more cost-effective management of the blood supply chain in the UK. With the use of primary and secondary data from the National Blood Service (NBS) and the supplied hospitals, statistical analysis is conducted and a detailed discrete event simulation model of a vertical part of the UK supply chain of blood products is developed to test and identify good ordering, inventory and distribution practices. Fewer outdates, group substitutions, shortages and deliveries could be achieved by blood banks: holding stock of rare blood groups of red blood cells (RBC), having a second routine delivery per weekday, exercising a more insensitive ordering point for RBC, reducing the total crossmatch release period to less than 1.5 days, increasing the transfusion-to-crossmatch ratio to 70%, adhering to an age-based issuing of orders, holding RBC stock of a weighted average of approximately 4 days. The blood supply simulation model can offer useful pieces of advice to the stakeholders of the examined system which leads to cost reductions and increased safety. Moreover, it provides a great range of experimental capabilities in a risk-free environment.

  19. A cost-effective simulation curriculum for preclinical endodontics.

    Science.gov (United States)

    Pileggi, Roberta; Glickman, Gerald N

    2004-02-01

    A challenge in contemporary dental education is to achieve a smooth transition from preclinical teaching environments to patient-care clinics in a cost-effective manner. The preclinical endodontic courses at The University of Texas, Dental Branch at Houston provide a unique learning environment that enables the student to perform endodontic treatment on extracted teeth in a typodont, and be involved in diagnosis and treatment-planning discussions. The specially designed stone typodont used has built-in radiographic capability, and is mounted at each chair in the clinic. During each preclinical session, students are assigned clinical cubicles and proper aseptic protocol is followed. Students are required to wear gloves, masks and eyewear, and place a rubber dam during treatment. Written self-assessment evaluations based upon prescribed criteria are utilised; feedback is given by faculty composed of both full-time endodontists and graduate students who periodically rotate and are calibrated on a regular basis. In the lecture phase, clinical case scenarios are presented to reinforce concepts of diagnosis and emergency care and to help integrate endodontics with other disciplines; a Socratic-like teaching style is established by the faculty facilitator to create an environment for developing critical-thinking and problem-solving skills. The overall feedback from graduating students has been very positive. Advantages of this format are an easier transition to patient management, a more keen interest in specialsation and a perceived increase in levels of confidence.

  20. Systematic review of the cost-effectiveness of transcatheter interventions for valvular heart disease.

    Science.gov (United States)

    Gialama, Fotini; Prezerakos, Panagiotis; Apostolopoulos, Vasilis; Maniadakis, Nikolaos

    2018-04-01

    Transcatheter aortic valve implantation (TAVI) and transcatheter mitral valve repair (TMVR) are increasingly used for managing patients with valvular heart disease to whom surgery presents a high-risk. As these are costly procedures, a systematic review of studies concerned with their economic assessment was undertaken. The search was performed in PubMed and the Cochrane Library and followed recommended methodological steps. Studies were screened and their data were retrieved and were synthesized using a narrative approach. Twenty-four, good to high quality, evaluations were identified, representing different viewpoints, modelling techniques and willingness-to-pay thresholds. Studies show that in high-risk patients with symptomatic aortic stenosis, TAVI may be cost-effective compared with medical management (MM) across many health care settings. In contrast, studies of TAVI compared with surgical aortic valve replacement (SAVR) yield conflicting and inconclusive results. The limited data available show that TMVR may also be cost-effective relative to MM in mitral valve disease. Existing evidence indicates that transcatheter techniques may be cost-effective options, relative to MM, in high-risk patients with valvular disease. Nonetheless, more research is needed to establish their economic value further, to investigate the drives of cost-effectiveness, and to evaluate surgical with transcatheter techniques in aortic valvular disease.

  1. Cost effectiveness analysis of indoor radon control measures

    International Nuclear Information System (INIS)

    Fujimoto, Kenzo

    1989-01-01

    The problem of radon 222 in buildings as a contributor to radiation exposure is described. Five different control methods and the dose reductions that would result from each are analysed. The annualized cost for each control measure was evaluated and the cost effectiveness of each control measure was calculated on the basis of dollars per person-sievert dose reduction. The use of unipolar ion generators for particle removal appears to be the most cost effective and the use of ceiling fans to increase air circulation the least cost effective. 3 figs., 1 tab

  2. Cost effective decommissioning and dismantling of nuclear power plants

    International Nuclear Information System (INIS)

    Wasinger, Karl

    2012-01-01

    As for any large and complex project, the basis for cost effective decommissioning and dismantling of nuclear power plants is established with the development of the project. Just as its construction, dismantling of a nuclear power plant is similarly demanding. Daily changing situations due to the progress of construction - in the present case progress of dismantling - result in significant logistical challenges for project managers and site supervisors. This will be aggravated by the fact that a considerable amount of the removed parts are contaminated or even activated. Hence, not only occupational health, safety and environmental protection is to be assured, employees, public and environment are to be adequately protected against the adverse effect of radioactive radiation as well. Work progress and not least expenses involved with the undertaking depend on adherence to the planned course of actions. Probably the most frequent cause of deviation from originally planned durations and costs of a project are disruptions in the flow of work. For being enabled to counteract in a timely and efficient manner, all required activities are to be comprehensively captured with the initial planning. The effect initial activities may have on subsequent works until completion must particularly be investigated. This is the more important the larger and more complex the project actually are. Comprehensive knowledge of all the matters which may affect the progress of the works is required in order to set up a suitable work break-down structure; such work break-down structure being indispensable for successful control and monitoring of the project. In building the related organizational structure of the project, all such stakeholders not being direct part of the project team but which may potentially affect the progress of the project are to be considered as well. Cost effective and lost time injury free dismantling of decommissioned nuclear power plants is based on implementing

  3. Substoichiometric determination of phosphorus

    International Nuclear Information System (INIS)

    Shigematsu, T.; Kudo, K.

    1981-01-01

    Phosphorus in orchard leaves (NBS SRM-1571) and spinach (SRM-1570) was determined by various substoichiometric analytical methods such as the direct method, Gravshchenko's method and the method of carrier amount variation. All samples were labelled with 32 P radioisotope. The data obtained by the method of carrier amount variation were also treated by the method of least squares instead of De Voe's method. Phosphorus concentration in orchard leaves was 0.206+-0.011% by the direct method, 0.219+-0.011% by Gravshchenko's method, 0.211+-0.011% by the method of carrier amount variation and 0.207+-0.007% by the method of least squares, respectively. These values agree with the value reported by NBS (0.21+-0.01%). Furthermore, these concentrations obtained by various substoichiometric methods were compared with those by radioactivation reported in a previous paper. (author)

  4. Phosphorus Transport in Rivers.

    Science.gov (United States)

    1978-11-01

    be attributed to excessive nutrient inputs to the lake. These nutrients sti- mulate the phytoplankton (algae) growth which yields excess growth. The...phosphorus in relation to the restoration of Lake Erie. The various computational techniques presented herein aid in the understanding of total...as caused by the absorption on clay materials and by assimilation by periphyton . Other investigators have found correlations between flow and other

  5. Cost effectiveness of facility and home based HIV voluntary ...

    African Journals Online (AJOL)

    Cost effectiveness of facility and home based HIV voluntary counseling and ... Background: In Uganda, the main stay for provision of human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) ... AJOL African Journals Online.

  6. Cost-effectiveness and radiation risk of breast cancer screening

    International Nuclear Information System (INIS)

    Rombach, J.J.

    1987-01-01

    Base cost effectiveness risk associated with radiological screening for tuberculosis and lung tumor the Government of Netherlands advised against mass screening. However, mass screening remains an important method in the case of breast cancer

  7. Bioinformatics tools for development of fast and cost effective simple ...

    African Journals Online (AJOL)

    Bioinformatics tools for development of fast and cost effective simple sequence repeat ... comparative mapping and exploration of functional genetic diversity in the ... Already, a number of computer programs have been implemented that aim at ...

  8. Costs and Cost-Effectiveness of Plasmodium vivax Control.

    Science.gov (United States)

    White, Michael T; Yeung, Shunmay; Patouillard, Edith; Cibulskis, Richard

    2016-12-28

    The continued success of efforts to reduce the global malaria burden will require sustained funding for interventions specifically targeting Plasmodium vivax The optimal use of limited financial resources necessitates cost and cost-effectiveness analyses of strategies for diagnosing and treating P. vivax and vector control tools. Herein, we review the existing published evidence on the costs and cost-effectiveness of interventions for controlling P. vivax, identifying nine studies focused on diagnosis and treatment and seven studies focused on vector control. Although many of the results from the much more extensive P. falciparum literature can be applied to P. vivax, it is not always possible to extrapolate results from P. falciparum-specific cost-effectiveness analyses. Notably, there is a need for additional studies to evaluate the potential cost-effectiveness of radical cure with primaquine for the prevention of P. vivax relapses with glucose-6-phosphate dehydrogenase testing. © The American Society of Tropical Medicine and Hygiene.

  9. A cost-effectiveness analysis of self-debriefing versus instructor debriefing for simulated crises in perioperative medicine in Canada.

    Science.gov (United States)

    Isaranuwatchai, Wanrudee; Alam, Fahad; Hoch, Jeffrey; Boet, Sylvain

    2017-01-01

    High-fidelity simulation training is effective for learning crisis resource management (CRM) skills, but cost is a major barrier to implementing high-fidelity simulation training into the curriculum. The aim of this study was to examine the cost-effectiveness of self-debriefing and traditional instructor debriefing in CRM training programs and to calculate the minimum willingness-to-pay (WTP) value when one debriefing type becomes more cost-effective than the other. This study used previous data from a randomized controlled trial involving 50 anesthesiology residents in Canada. Each participant managed a pretest crisis scenario. Participants who were randomized to self-debrief used the video of their pretest scenario with no instructor present during their debriefing. Participants from the control group were debriefed by a trained instructor using the video of their pretest scenario. Participants individually managed a post-test simulated crisis scenario. We compared the cost and effectiveness of self-debriefing versus instructor debriefing using net benefit regression. The cost-effectiveness estimate was reported as the incremental net benefit and the uncertainty was presented using a cost-effectiveness acceptability curve. Self-debriefing costs less than instructor debriefing. As the WTP increased, the probability that self-debriefing would be cost-effective decreased. With a WTP ≤Can$200, the self-debriefing program was cost-effective. However, when effectiveness was priced higher than cost-savings and with a WTP >Can$300, instructor debriefing was the preferred alternative. With a lower WTP (≤Can$200), self-debriefing was cost-effective in CRM simulation training when compared to instructor debriefing. This study provides evidence regarding cost-effectiveness that will inform decision-makers and clinical educators in their decision-making process, and may help to optimize resource allocation in education.

  10. A cost-effectiveness analysis of self-debriefing versus instructor debriefing for simulated crises in perioperative medicine in Canada

    Directory of Open Access Journals (Sweden)

    Wanrudee Isaranuwatchai

    2016-12-01

    Full Text Available Purpose High-fidelity simulation training is effective for learning crisis resource management (CRM skills, but cost is a major barrier to implementing high-fidelity simulation training into the curriculum. The aim of this study was to examine the cost-effectiveness of self-debriefing and traditional instructor debriefing in CRM training programs and to calculate the minimum willingness-to-pay (WTP value when one debriefing type becomes more cost-effective than the other. Methods This study used previous data from a randomized controlled trial involving 50 anesthesiology residents in Canada. Each participant managed a pretest crisis scenario. Participants who were randomized to self-debrief used the video of their pretest scenario with no instructor present during their debriefing. Participants from the control group were debriefed by a trained instructor using the video of their pretest scenario. Participants individually managed a post-test simulated crisis scenario. We compared the cost and effectiveness of self-debriefing versus instructor debriefing using net benefit regression. The cost-effectiveness estimate was reported as the incremental net benefit and the uncertainty was presented using a cost-effectiveness acceptability curve. Results Self-debriefing costs less than instructor debriefing. As the WTP increased, the probability that self-debriefing would be cost-effective decreased. With a WTP ≤Can$200, the self-debriefing program was cost-effective. However, when effectiveness was priced higher than cost-savings and with a WTP >Can$300, instructor debriefing was the preferred alternative. Conclusion With a lower WTP (≤Can$200, self-debriefing was cost-effective in CRM simulation training when compared to instructor debriefing. This study provides evidence regarding cost-effectiveness that will inform decision-makers and clinical educators in their decision-making process, and may help to optimize resource allocation in education.

  11. Cost-effective treatment for the couple with infertility.

    Science.gov (United States)

    Van Voorhis, B J; Syrop, C H

    2000-12-01

    Although the evaluation of cost-effective approaches to infertility treatment remains in its infancy, several important principles have emerged from the initial studies in this field. Currently, in treating couples with infertility without tubal disease or severe male-factor infertility, the most cost-effective approach is to start with IUI or superovulation-IUI treatments before resorting to IVF procedures. The woman's age and number of sperm present for insemination are significant factors influencing cost-effectiveness. The influence of certain diagnoses on the cost-effectiveness of infertility treatments requires further study. Even when accounting for the costs associated with multiple gestations and premature deliveries, the cost of IVF decreases within the range of other cost-effective medical procedures and decreases to less than the willingness to pay for these procedures. Indeed, for patients with severe tubal disease, IVF has been found to be more cost-effective than surgical repair. The cost-effectiveness of IVF will likely improve as success rates show continued improvements over the course of time. In addition, usefulness of embryo selection and practices to reduce the likelihood of high-order multiple pregnancies, without reductions in pregnancy rates, will significantly impact cost-effectiveness. The exclusion of infertility treatments from insurance plans is unfortunate and accentuates the importance of physicians understanding the economics of infertility treatment with costs that are often passed directly to the patient. The erroneous economic policies and judgments that have led to inequities in access to infertility health care should not be tolerated.

  12. Sustainable Phosphorus Measures: Strategies and Technologies for Achieving Phosphorus Security

    Directory of Open Access Journals (Sweden)

    Stuart White

    2013-01-01

    Full Text Available Phosphorus underpins the world’s food systems by ensuring soil fertility, maximising crop yields, supporting farmer livelihoods and ultimately food security. Yet increasing concerns around long-term availability and accessibility of the world’s main source of phosphorus—phosphate rock, means there is a need to investigate sustainable measures to buffer the world’s food systems against the long and short-term impacts of global phosphorus scarcity. While the timeline of phosphorus scarcity is contested, there is consensus that more efficient use and recycling of phosphorus is required. While the agricultural sector will be crucial in achieving this, sustainable phosphorus measures in sectors upstream and downstream of agriculture from mine to fork will also need to be addressed. This paper presents a comprehensive classification of all potential phosphorus supply- and demand-side measures to meet long-term phosphorus needs for food production. Examples range from increasing efficiency in the agricultural and mining sector, to technologies for recovering phosphorus from urine and food waste. Such measures are often undertaken in isolation from one another rather than linked in an integrated strategy. This integrated approach will enable scientists and policy-makers to take a systematic approach when identifying potential sustainable phosphorus measures. If a systematic approach is not taken, there is a risk of inappropriate investment in research and implementation of technologies and that will not ultimately ensure sufficient access to phosphorus to produce food in the future. The paper concludes by introducing a framework to assess and compare sustainable phosphorus measures and to determine the least cost options in a given context.

  13. Phosphorus containing sintered alloys (review)

    International Nuclear Information System (INIS)

    Muchnik, S.V.

    1984-01-01

    Phosphorus additives are considered for their effect on the properties of sintered alloys of different applications: structural, antifriction, friction, magnetic, hard, superhard, heavy etc. Data are presented on compositions and properties of phosphorus-containing materials produced by the powder metallurgy method. Phosphorus is shown to be an effective activator of sintering in some cases. When its concentration in the material is optimal it imparts the material such properties as strength, viscosity, hardness, wear resistance. Problems concerning powder metallurgy of amorphous phosphorus-containing alloys are reported

  14. Phosphorus and the dairy cow

    OpenAIRE

    Ekelund, Adrienne

    2003-01-01

    The general aim of the present work was to investigate phosphorus balance in the dairy cow, with reference to the amount and source of phosphorus. Furthermore, biochemical bone markers were used to study the bone turnover during the lactation and dry period. Phosphorus is located in every cell of the body and has more known functions than any other mineral element in the animal body. Phosphorus is also an important constituent of milk, and is therefore required in large amounts in a high yiel...

  15. Phosphorus conditions at various depths in some mineral soils

    Directory of Open Access Journals (Sweden)

    Armi Kaila

    1963-05-01

    Full Text Available The fractionation method of CHANG and JACKSON (2 was used for the analysing of the distribution of inorganic phosphorus in the topsoil and subsoil of twelve virgin and twelve cultivated soils from various parts of the country; two virgin soils and twenty cultivated soils were studied down to the depths of 60 cm or 70 cm, one even to 2 m. In the more intensively podsolized virgin soils the surface layers, particularly the A2-horizon, are very poor in all the forms of inorganic phosphorus while the enrichment layer will contain fairly high amounts of iron and aluminium bound phosphorus. The application of fertilizers and the other cultivation managements tend to accumulate aluminium and iron bound phosphorus in the plough layer. In some soils the minimum content of calcium bound phosphorus occurs in the layer below the plough layer, but an increase with the depth seems to be typical to it in all the non-Litorina soils, while the first two fractions usually decrease with the depth. In the Litorina soils the iron bound phosphorus is dominant in all the layers studied, but the content of reductant soluble phosphorus is low in these soils, and their content of calcium bound phosphorus is higher than the content of phosphorus bound by aluminium. The predominance of calcium phosphate in the subsoil and the rather low content of reductant soluble and occluded fractions indicate that the chemical weathering in most of our soils is not yet at an advanced stage. The test values determined were in accordance with the results of the fractionation and the estimation of ammonium oxalate soluble aluminium and iron.

  16. The determinants of cost-effectiveness potential: an historical perspective on lipid-lowering therapies.

    Science.gov (United States)

    Refoios Camejo, Rodrigo; McGrath, Clare; Miraldo, Marisa; Rutten, Frans

    2013-05-01

    The concept of cost effectiveness emerged in an attempt to link the prices of new healthcare technologies to the immediate value they provide, with payers defining the acceptable cost per unit of incremental effect over the alternatives available. It has been suggested that such measures allow developers to assess potential market profitability in an early stage of development, but may result in discouraging investment in efficient research if not used appropriately. The objective of this study is to identify the pattern of the factors determining cost effectiveness and assess the evolution of cost-effectiveness potential for drugs in development using lipid-lowering therapy as a case study. The study is based on observational clinical and market data covering a 20-year period (from 1990 to 2010) in the UK. Real-life clinical data including total cholesterol laboratory test results were extracted from the Clinical Practice Research Datalink (CPRD) and are used to illustrate how the clinical effectiveness of existing standard care changed over time in patients managed in clinical practice. Prescription Cost Analysis (PCA) data were extracted and the average price of the drug mix used was computed throughout the study period. Using this information, the maximum clinical benefit and cost savings to be had were estimated for each year of the analysis using a cost-effectiveness model. Subsequently, the highest price a new technology providing the maximum clinical effectiveness possible (i.e. eliminating cardiovascular risk from high cholesterol levels) could achieve under current cost-effectiveness rules was calculated and used as a measure of the potential cost effectiveness of drugs in development. The results in this study show that the total cholesterol values of patients managed in clinical practice moved steadily towards recommended clinical targets. Overall, the absolute potential for incremental health-related quality of life decreased by approximately 78

  17. 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.

  18. A single phosphorus treatment doubles growth of cyanobacterial lichen transplants.

    Science.gov (United States)

    McCune, Bruce; Caldwell, Bruce A

    2009-02-01

    Lichens are reputedly slow growing and become unhealthy or die in response to supplements of the usual limiting resources, such as water and nitrogen. We found, however, that the tripartite cyanobacterial lichen Lobaria pulmonaria doubled in annual biomass growth after a single 20-minute immersion in a phosphorus solution (K2HPO4), as compared to controls receiving no supplemental phosphorus. This stimulation of cyanolichens by phosphorus has direct relevance to community and population ecology of lichens, including improving models of lichen performance in relation to air quality, improving forest management practices affecting old-growth associated cyanolichens, and understanding the distribution and abundance of cyanolichens on the landscape. Phosphorus may be as important a stimulant to cyanobacterial-rich lichen communities as it is to cyanobacteria in aquatic ecosystems.

  19. Cost-effectiveness of measures to improve biodiversity in Swedish forests

    OpenAIRE

    Ekvall, Hans

    2014-01-01

    The main objective of this thesis is to analyse the cost-effectiveness of measures, which improve biodiversity among life forms dependent on coarse woody debris (CWD). The amount of CWD in forest land has decreased due to modern forest management. The wood of the trees is an important source of income for the forest owner and there is an undeniable conflict between increasing the amount of CWD and the economics of silviculture. To gain acceptance among forest owners of an increased re...

  20. Cost-effectiveness analysis of treatments for premenstrual dysphoric disorder.

    Science.gov (United States)

    Rendas-Baum, Regina; Yang, Min; Gricar, Joseph; Wallenstein, Gene V

    2010-01-01

    Premenstrual syndrome (PMS) is reported to affect between 13% and 31% of women. Between 3% and 8% of women are reported to meet criteria for the more severe form of PMS, premenstrual dysphoric disorder (PMDD). Although PMDD has received increased attention in recent years, the cost effectiveness of treatments for PMDD remains unknown. To evaluate the cost effectiveness of the four medications with a US FDA-approved indication for PMDD: fluoxetine, sertraline, paroxetine and drospirenone plus ethinyl estradiol (DRSP/EE). A decision-analytic model was used to evaluate both direct costs (medication and physician visits) and clinical outcomes (treatment success, failure and discontinuation). Medication costs were based on average wholesale prices of branded products; physician visit costs were obtained from a claims database study of PMDD patients and the Agency for Healthcare Research and Quality. Clinical outcome probabilities were derived from published clinical trials in PMDD. The incremental cost-effectiveness ratio (ICER) was calculated using the difference in costs and percentage of successfully treated patients at 6 months. Deterministic and probabilistic sensitivity analyses were used to assess the impact of uncertainty in parameter estimates. Threshold values where a change in the cost-effective strategy occurred were identified using a net benefit framework. Starting therapy with DRSP/EE dominated both sertraline and paroxetine, but not fluoxetine. The estimated ICER of initiating treatment with fluoxetine relative to DRSP/EE was $US4385 per treatment success (year 2007 values). Cost-effectiveness acceptability curves revealed that for ceiling ratios>or=$US3450 per treatment success, fluoxetine had the highest probability (>or=0.37) of being the most cost-effective treatment, relative to the other options. The cost-effectiveness acceptability frontier further indicated that DRSP/EE remained the option with the highest expected net monetary benefit for

  1. 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

  2. Reducing surface water pollution through the assessment of the cost-effectiveness of BMPs at different spatial scales.

    Science.gov (United States)

    Panagopoulos, Y; Makropoulos, C; Mimikou, M

    2011-10-01

    Two kinds of agricultural Best Management Practices (BMPs) were examined with respect to cost-effectiveness (CE) in reducing sediment, nitrates-nitrogen (NO(3)-N) and total phosphorus (TP) losses to surface waters of the Arachtos catchment in Western Greece. The establishment of filter strips at the edge of fields and a non-structural measure, namely fertilization reduction in alfalfa, combined with contour farming and zero-tillage in corn and reduction of animal numbers in pastureland, were evaluated. The Soil and Water Assessment Tool (SWAT) model was used as the non-point-source (NPS) estimator, while a simple economic component was developed estimating BMP implementation cost as the mean annual expenses needed to undertake and operate the practice for a 5-year period. After each BMP implementation, the ratio of their CE in reducing pollution was calculated for each Hydrologic Response Unit (HRU) separately, for each agricultural land use type entirely and for the whole catchment. The results at the HRU scale are presented comprehensively on a map, demonstrating the spatial differentiation of CE ratios across the catchment that enhances the identification of locations where each BMP is most advisable for implementation. Based on the analysis, a catchment management solution of affordable total cost would include the expensive measure of filter strips in corn and only in a small number of pastureland fields, in combination with the profitable measure of reducing fertilization to alfalfa fields. When examined for its impact on river loads at the outlet, the latter measure led to a 20 tn or 8% annual decrease of TP from the baseline with savings of 15€/kg of pollutant reduction. Filter strips in corn fields reduced annual sediments by 66 Ktn or 5%, NO(3)-N by 71 tn or 9.5% and TP by 27 tn or 10%, with an additional cost of 3.1 €/tn, 3.3 €/kg and 8.1 €/kg of each pollutant respectively. The study concludes that considerable reductions of several

  3. Phosphorus, sulfur and pyridine

    OpenAIRE

    Schönberger, Stefanie

    2013-01-01

    The synthesis of distinct neutral or anionic P,S compounds in solution provides a great challenge for chemists. Due to the similarity in the energies of the P–P, P–S and S–S bonds nearly solely a mixture of compounds with different composition and charge is obtained. Our interest focuses on the system consisting of phosphorus, sulfur and pyridine, with the aim of a greater selectivity of P,S compounds in solution. The combination of these three components offers the opportunity...

  4. Cost-effectiveness analysis of online hemodiafiltration versus high-flux hemodialysis

    Directory of Open Access Journals (Sweden)

    Ramponi F

    2016-09-01

    Full Text Available Francesco Ramponi,1,2 Claudio Ronco,1,3 Giacomo Mason,1 Enrico Rettore,4 Daniele Marcelli,5,6 Francesca Martino,1,3 Mauro Neri,1,7 Alejandro Martin-Malo,8 Bernard Canaud,5,9 Francesco Locatelli10 1International Renal Research Institute (IRRIV, San Bortolo Hospital, Vicenza, 2Department of Economics and Management, University of Padova, Padova, 3Department of Nephrology, San Bortolo Hospital, Vicenza, 4Department of Sociology and Social Research, University of Trento, FBK-IRVAPP & IZA, Trento, Italy; 5Europe, Middle East, Africa and Latin America Medical Board, Fresenius Medical Care,, Bad Homburg, Germany; 6Danube University, Krems, Austria; 7Department of Management and Engineering, University of Padova, Vicenza, Italy; 8Nephrology Unit, Reina Sofia University Hospital, Córdoba, Spain; 9School of Medicine, Montpellier University, Montpellier, France; 10Department of Nephrology, Manzoni Hospital, Lecco, Italy Background: Clinical studies suggest that hemodiafiltration (HDF may lead to better clinical outcomes than high-flux hemodialysis (HF-HD, but concerns have been raised about the cost-effectiveness of HDF versus HF-HD. Aim of this study was to investigate whether clinical benefits, in terms of longer survival and better health-related quality of life, are worth the possibly higher costs of HDF compared to HF-HD.Methods: The analysis comprised a simulation based on the combined results of previous published studies, with the following steps: 1 estimation of the survival function of HF-HD patients from a clinical trial and of HDF patients using the risk reduction estimated in a meta-analysis; 2 simulation of the survival of the same sample of patients as if allocated to HF-HD or HDF using three-state Markov models; and 3 application of state-specific health-related quality of life coefficients and differential costs derived from the literature. Several Monte Carlo simulations were performed, including simulations for patients with different

  5. 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.

  6. Simulating soil phosphorus dynamics for a phosphorus loss quantification tool.

    Science.gov (United States)

    Vadas, Peter A; Joern, Brad C; Moore, Philip A

    2012-01-01

    Pollution of fresh waters by agricultural phosphorus (P) is a water quality concern. Because soils can contribute significantly to P loss in runoff, it is important to assess how management affects soil P status over time, which is often done with models. Our objective was to describe and validate soil P dynamics in the Annual P Loss Estimator (APLE) model. APLE is a user-friendly spreadsheet model that simulates P loss in runoff and soil P dynamics over 10 yr for a given set of runoff, erosion, and management conditions. For soil P dynamics, APLE simulates two layers in the topsoil, each with three inorganic P pools and one organic P pool. It simulates P additions to soil from manure and fertilizer, distribution among pools, mixing between layers due to tillage and bioturbation, leaching between and out of layers, crop P removal, and loss by surface runoff and erosion. We used soil P data from 25 published studies to validate APLE's soil P processes. Our results show that APLE reliably simulated soil P dynamics for a wide range of soil properties, soil depths, P application sources and rates, durations, soil P contents, and management practices. We validated APLE specifically for situations where soil P was increasing from excessive P inputs, where soil P was decreasing due to greater outputs than inputs, and where soil P stratification occurred in no-till and pasture soils. Successful simulations demonstrate APLE's potential to be applied to major management scenarios related to soil P loss in runoff and erosion. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  7. 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...

  8. Towards a closed phosphorus cycle

    NARCIS (Netherlands)

    Keyzer, M.A.

    2010-01-01

    Summary: This paper stresses the need to address upcoming scarcity of phosphorus, a mineral nutrient that is essential for all life on Earth. Agricultural crops obtain phosphorus from the pool in the soil that can be replenished by recycling of organic material, or by application of inorganic

  9. Cost-Effectiveness of a Nonpharmacological Intervention in Pediatric Burn Care.

    Science.gov (United States)

    Brown, Nadia J; David, Michael; Cuttle, Leila; Kimble, Roy M; Rodger, Sylvia; Higashi, Hideki

    2015-07-01

    To report the cost-effectiveness of a tailored handheld computerized procedural preparation and distraction intervention (Ditto) used during pediatric burn wound care in comparison to standard practice. An economic evaluation was performed alongside a randomized controlled trial of 75 children aged 4 to 13 years who presented with a burn to the Royal Children's Hospital, Brisbane, Australia. Participants were randomized to either the Ditto intervention (n = 35) or standard practice (n = 40) to measure the effect of the intervention on days taken for burns to re-epithelialize. Direct medical, direct nonmedical, and indirect cost data during burn re-epithelialization were extracted from the randomized controlled trial data and combined with scar management cost data obtained retrospectively from medical charts. Nonparametric bootstrapping was used to estimate statistical uncertainty in cost and effect differences and cost-effectiveness ratios. On average, the Ditto intervention reduced the time to re-epithelialize by 3 days at AU$194 less cost for each patient compared with standard practice. The incremental cost-effectiveness plane showed that 78% of the simulated results were within the more effective and less costly quadrant and 22% were in the more effective and more costly quadrant, suggesting a 78% probability that the Ditto intervention dominates standard practice (i.e., cost-saving). At a willingness-to-pay threshold of AU$120, there is a 95% probability that the Ditto intervention is cost-effective (or cost-saving) against standard care. This economic evaluation showed the Ditto intervention to be highly cost-effective against standard practice at a minimal cost for the significant benefits gained, supporting the implementation of the Ditto intervention during burn wound care. Copyright © 2015. Published by Elsevier Inc.

  10. Attributes of system testing which promote cost-effectiveness

    International Nuclear Information System (INIS)

    Martin, L.C.

    1975-01-01

    A brief overview of conventional EMP testing activity examines attributes of overall systems tests which promote cost-effectiveness. The general framework represents an EMP-oriented systems test as a portion of a planned program to design, produce, and field system elements. As such, all so-called system tests should play appropriate cost-effective roles in this program, and the objective here is to disclose such roles. The intrinsic worth of such tests depends not only upon placing proper values on the outcomes, but also upon the possible eventual consequences of not doing tests. A relative worth measure is required. Attributes of EMP system testing over the range of potential activity which encompasses research and development, production, field handling, verification, evaluation, and others are reviewed and examined. Thus, the relative worth, in a cost-effective sense, is provided by relating such attributes to the overall program objectives so that values can be placed on the outcomes for tradeoff purposes

  11. 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.

  12. 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...

  13. 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.

  14. Effectiveness and cost effectiveness of counselling in primary care.

    Science.gov (United States)

    Bower, P; Rowland, N; Mellor, C l; Heywood, P; Godfrey, C; Hardy, R

    2002-01-01

    Counsellors are prevalent in primary care settings. However, there are concerns about the clinical and cost-effectiveness of the treatments they provide, compared with alternatives such as usual care from the general practitioner, medication or other psychological therapies. To assess the effectiveness and cost effectiveness of counselling in primary care by reviewing cost and outcome data in randomised controlled trials, controlled clinical trials and controlled patient preference trials of counselling interventions in primary care, for patients with psychological and psychosocial problems considered suitable for counselling. The original search strategy included electronic searching of databases (including the CCDAN Register of RCTs and CCTs) along with handsearching of a specialist journal. Published and unpublished sources (clinical trials, books, dissertations, agency reports etc.) were searched, and their reference lists scanned to uncover further controlled trials. Contact was made with subject experts and CCDAN members in order to uncover further trials. For the updated review, searches were restricted to those databases judged to be high yield in the first version of the review: MEDLINE, EMBASE, PSYCLIT and CINAHL, the Cochrane Controlled Trials register and the CCDAN trials register. All controlled trials comparing counselling in primary care with other treatments for patients with psychological and psychosocial problems considered suitable for counselling. Trials completed before the end of June 2001 were included in the review. Data were extracted using a standardised data extraction sheet. The relevant data were entered into the Review Manager software. Trials were quality rated, using CCDAN criteria, to assess the extent to which their design and conduct were likely to have prevented systematic error. Continuous measures of outcome were combined using standardised mean differences. An overall effect size was calculated for each outcome with 95

  15. Cost-effectiveness of osteo-odonto keratoprosthesis in Singapore.

    Science.gov (United States)

    Dong, Di; Tan, Anna; Mehta, Jodhbir S; Tan, Donald; Finkelstein, Eric Andrew

    2014-01-01

    To determine the long-term cost-effectiveness of osteo-odonto keratoprosthesis (OOKP) relative to no treatment among patients with end-stage corneal and ocular surface diseases in Singapore. Cost-effectiveness analysis based on data from a retrospective cohort study. From a health system perspective, we calculated the incremental cost-effectiveness ratio of OOKP treatment relative to no treatment over a 30-year horizon, based on data from a cohort of 23 patients who underwent OOKP surgery between 2004 and 2009 at Singapore National Eye Centre. Preoperative and postoperative vision-related quality-of-life values were estimated from patients' visual outcomes and were used to calculate the gain in quality-adjusted life years (QALYs) resulting from OOKP treatment. Unsubsidized costs for surgery, consultations, examinations, medications, follow-up visits, and treatments for complications were retrieved from patients' bills to estimate the total costs associated with OOKP treatment. Sensitivity analyses were conducted to test the robustness of the model. Over a 30-year period, OOKP treatment, compared with no treatment, improved QALYs by 3.991 among patients with end-stage corneal and ocular surface diseases at an additional cost of S$67 840 (US$55 150), resulting in an incremental cost-effectiveness ratio of S$17 000/QALY (US$13 820/QALY). Based on commonly cited cost-effectiveness benchmarks, the OOKP is a cost-effective treatment for patients with end-stage corneal and ocular surface diseases. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Is individualized medicine more cost-effective? A systematic review.

    Science.gov (United States)

    Hatz, Maximilian H M; Schremser, Katharina; Rogowski, Wolf H

    2014-05-01

    Individualized medicine (IM) is a rapidly evolving field that is associated with both visions of more effective care at lower costs and fears of highly priced, low-value interventions. It is unclear which view is supported by the current evidence. Our objective was to systematically review the health economic evidence related to IM and to derive general statements on its cost-effectiveness. A literature search of MEDLINE database for English- and German-language studies was conducted. Cost-effectiveness and cost-utility studies for technologies meeting the MEDLINE medical subject headings (MeSH) definition of IM (genetically targeted interventions) were reviewed. This was followed by a standardized extraction of general study characteristics and cost-effectiveness results. Most of the 84 studies included in the synthesis were from the USA (n = 43, 51 %), cost-utility studies (n = 66, 79 %), and published since 2005 (n = 60, 71 %). The results ranged from dominant to dominated. The median value (cost-utility studies) was calculated to be rounded $US22,000 per quality-adjusted life year (QALY) gained (adjusted to $US, year 2008 values), which is equal to the rounded median cost-effectiveness in the peer-reviewed English-language literature according to a recent review. Many studies reported more than one strategy of IM with highly varying cost-effectiveness ratios. Generally, results differed according to test type, and tests for disease prognosis or screening appeared to be more favorable than tests to stratify patients by response or by risk of adverse effects. However, these results were not significant. Different definitions of IM could have been used. Quality assessment of the studies was restricted to analyzing transparency. IM neither seems to display superior cost-effectiveness than other types of medical interventions nor to be economically inferior. Instead, rather than 'whether' healthcare was individualized, the question of 'how' it was individualized was

  17. 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.

  18. 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

  19. The distribution of phosphorus in Popes Creek, VA, and in the Pocomoke River, MD: Two watersheds with different land management practices in the Chesapeake Bay Basin

    Science.gov (United States)

    Simon, N.S.; Bricker, O.P.; Newell, W.; McCoy, J.; Morawe, R.

    2005-01-01

    This paper compares phosphorus (P) concentrations in sediments from two watersheds, one with, and one without, intensive animal agriculture. The watersheds are in the coastal plain of the Chesapeake Bay and have similar physiographic characteristics. Agriculture in the Pocomoke River, MD, watershed supplied 2.7 percent of all broiler chickens produced in the USA in 1997. Poultry litter is an abundant, local source of manure for crops. Broiler chickens are not produced in the Popes Creek, VA, watershed and poultry manure is, therefore, not a major source of fertilizer. The largest concentrations of P in sediment samples are found in floodplain and main-stem bottom sediment in both watersheds. Concentrations of total P and P extracted with 1N HCl are significantly larger in main-stem bottom sediments from the Pocomoke River than in main-stem bottom sediments from Popes Creek. Larger concentrations of P are associated with what are potentially redox sensitive iron oxyhydroxides in sediment samples from the Pocomoke River watershed than are associated with what are potentially redox sensitive iron oxyhydroxides in sediment samples from the Popes Creek watershed. Data for P and iron (Fe) concentrations in sediments from the Popes Creek watershed provide a numerical framework (baseline) with which to compare P and Fe concentrations in sediment from the Pocomoke River watershed. ?? Springer 2005.

  20. Cost-effectiveness analysis of left atrial appendage occlusion compared with pharmacological strategies for stroke prevention in atrial fibrillation.

    Science.gov (United States)

    Lee, Vivian Wing-Yan; Tsai, Ronald Bing-Ching; Chow, Ines Hang-Iao; Yan, Bryan Ping-Yen; Kaya, Mehmet Gungor; Park, Jai-Wun; Lam, Yat-Yin

    2016-08-31

    Transcatheter left atrial appendage occlusion (LAAO) is a promising therapy for stroke prophylaxis in non-valvular atrial fibrillation (NVAF) but its cost-effectiveness remains understudied. This study evaluated the cost-effectiveness of LAAO for stroke prophylaxis in NVAF. A Markov decision analytic model was used to compare the cost-effectiveness of LAAO with 7 pharmacological strategies: aspirin alone, clopidogrel plus aspirin, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban. Outcome measures included quality-adjusted life years (QALYs), lifetime costs and incremental cost-effectiveness ratios (ICERs). Base-case data were derived from ACTIVE, RE-LY, ARISTOTLE, ROCKET-AF, PROTECT-AF and PREVAIL trials. One-way sensitivity analysis varied by CHADS2 score, HAS-BLED score, time horizons, and LAAO costs; and probabilistic sensitivity analysis using 10,000 Monte Carlo simulations was conducted to assess parameter uncertainty. LAAO was considered cost-effective compared with aspirin, clopidogrel plus aspirin, and warfarin, with ICER of US$5,115, $2,447, and $6,298 per QALY gained, respectively. LAAO was dominant (i.e. less costly but more effective) compared to other strategies. Sensitivity analysis demonstrated favorable ICERs of LAAO against other strategies in varied CHADS2 score, HAS-BLED score, time horizons (5 to 15 years) and LAAO costs. LAAO was cost-effective in 86.24 % of 10,000 simulations using a threshold of US$50,000/QALY. Transcatheter LAAO is cost-effective for prevention of stroke in NVAF compared with 7 pharmacological strategies. The transcatheter left atrial appendage occlusion (LAAO) is considered cost-effective against the standard 7 oral pharmacological strategies including acetylsalicylic acid (ASA) alone, clopidogrel plus ASA, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban for stroke prophylaxis in non-valvular atrial fibrillation management.

  1. Phosphorus Loadings to the World's Largest Lakes: Sources and Trends

    Science.gov (United States)

    Fink, Gabriel; Alcamo, Joseph; Flörke, Martina; Reder, Klara

    2018-04-01

    Eutrophication is a major water quality issue in lakes worldwide and is principally caused by the loadings of phosphorus from catchment areas. It follows that to develop strategies to mitigate eutrophication, we must have a good understanding of the amount, sources, and trends of phosphorus pollution. This paper provides the first consistent and harmonious estimates of current phosphorus loadings to the world's largest 100 lakes, along with the sources of these loadings and their trends. These estimates provide a perspective on the extent of lake eutrophication worldwide, as well as potential input to the evaluation and management of eutrophication in these lakes. We take a modeling approach and apply the WorldQual model for these estimates. The advantage of this approach is that it allows us to fill in large gaps in observational data. From the analysis, we find that about 66 of the 100 lakes are located in developing countries and their catchments have a much larger average phosphorus yield than the lake catchments in developed countries (11.1 versus 0.7 kg TP km-2 year-1). Second, the main source of phosphorus to the examined lakes is inorganic fertilizer (47% of total). Third, between 2005-2010 and 1990-1994, phosphorus pollution increased at 50 out of 100 lakes. Sixty percent of lakes with increasing pollution are in developing countries. P pollution changed primarily due to changing P fertilizer use. In conclusion, we show that the risk of P-stimulated eutrophication is higher in developing countries.

  2. Establishing Cost-Effective Allocation of Proton Therapy for Breast Irradiation

    International Nuclear Information System (INIS)

    Mailhot Vega, Raymond B.; Ishaq, Omar; Raldow, Ann; Perez, Carmen A.; Jimenez, Rachel; Scherrer-Crosbie, Marielle; Bussiere, Marc; Taghian, Alphonse; Sher, David J.; MacDonald, Shannon M.

    2016-01-01

    Purpose: Cardiac toxicity due to conventional breast radiation therapy (RT) has been extensively reported, and it affects both the life expectancy and quality of life of affected women. Given the favorable oncologic outcomes in most women irradiated for breast cancer, it is increasingly paramount to minimize treatment side effects and improve survivorship for these patients. Proton RT offers promise in limiting heart dose, but the modality is costly and access is limited. Using cost-effectiveness analysis, we provide a decision-making tool to help determine which breast cancer patients may benefit from proton RT referral. Methods and Materials: A Markov cohort model was constructed to compare the cost-effectiveness of proton versus photon RT for breast cancer management. The model was analyzed for different strata of women based on age (40 years, 50 years, and 60 years) and the presence or lack of cardiac risk factors (CRFs). Model entrants could have 1 of 3 health states: healthy, alive with coronary heart disease (CHD), or dead. Base-case analysis assumed CHD was managed medically. No difference in tumor control was assumed between arms. Probabilistic sensitivity analysis was performed to test model robustness and the influence of including catheterization as a downstream possibility within the health state of CHD. Results: Proton RT was not cost-effective in women without CRFs or a mean heart dose (MHD) <5 Gy. Base-case analysis noted cost-effectiveness for proton RT in women with ≥1 CRF at an approximate minimum MHD of 6 Gy with a willingness-to-pay threshold of $100,000/quality-adjusted life-year. For women with ≥1 CRF, probabilistic sensitivity analysis noted the preference of proton RT for an MHD ≥5 Gy with a similar willingness-to-pay threshold. Conclusions: Despite the cost of treatment, scenarios do exist whereby proton therapy is cost-effective. Referral for proton therapy may be cost-effective for patients with ≥1 CRF in cases for which

  3. Establishing Cost-Effective Allocation of Proton Therapy for Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Mailhot Vega, Raymond B.; Ishaq, Omar [Department of Radiation Oncology, NYU School of Medicine, New York, New York (United States); Raldow, Ann [Radiation Oncology Program, Harvard University, Boston, Massachusetts (United States); Perez, Carmen A. [Department of Radiation Oncology, NYU School of Medicine, New York, New York (United States); Jimenez, Rachel [Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts (United States); Scherrer-Crosbie, Marielle [Cardiovascular Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts (United States); Bussiere, Marc; Taghian, Alphonse [Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts (United States); Sher, David J. [Department of Radiation Oncology, University of Texas Southwestern Medical Center, San Antonio, Texas (United States); MacDonald, Shannon M., E-mail: smacdonald@partners.org [Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2016-05-01

    Purpose: Cardiac toxicity due to conventional breast radiation therapy (RT) has been extensively reported, and it affects both the life expectancy and quality of life of affected women. Given the favorable oncologic outcomes in most women irradiated for breast cancer, it is increasingly paramount to minimize treatment side effects and improve survivorship for these patients. Proton RT offers promise in limiting heart dose, but the modality is costly and access is limited. Using cost-effectiveness analysis, we provide a decision-making tool to help determine which breast cancer patients may benefit from proton RT referral. Methods and Materials: A Markov cohort model was constructed to compare the cost-effectiveness of proton versus photon RT for breast cancer management. The model was analyzed for different strata of women based on age (40 years, 50 years, and 60 years) and the presence or lack of cardiac risk factors (CRFs). Model entrants could have 1 of 3 health states: healthy, alive with coronary heart disease (CHD), or dead. Base-case analysis assumed CHD was managed medically. No difference in tumor control was assumed between arms. Probabilistic sensitivity analysis was performed to test model robustness and the influence of including catheterization as a downstream possibility within the health state of CHD. Results: Proton RT was not cost-effective in women without CRFs or a mean heart dose (MHD) <5 Gy. Base-case analysis noted cost-effectiveness for proton RT in women with ≥1 CRF at an approximate minimum MHD of 6 Gy with a willingness-to-pay threshold of $100,000/quality-adjusted life-year. For women with ≥1 CRF, probabilistic sensitivity analysis noted the preference of proton RT for an MHD ≥5 Gy with a similar willingness-to-pay threshold. Conclusions: Despite the cost of treatment, scenarios do exist whereby proton therapy is cost-effective. Referral for proton therapy may be cost-effective for patients with ≥1 CRF in cases for which

  4. A standard methodology for cost-effectiveness analysis of new environmental technologies

    International Nuclear Information System (INIS)

    Booth, S.R.; Trocki, L.K.; Bowling, L.

    1994-01-01

    This paper outlines a methodology that is being applied to assess the cost-effectiveness of new environmental technologies under development by EM-50, DOE. Performance, total system effects, and life-cycle costs are all considered in the methodology to compare new technologies with existing or base-line technologies. An example of performance characterization is given in the paper. Sources of data for cost estimates and technology characterizations also appear in the paper. The Department of Energy (DOE) is facing a massive clean up effort of waste sites that contain hazardous, radioactive, or mixed materials. DOE has recognized that improvements in environmental restoration and waste management methods can potentially save the taxpayers billions of dollars as older, less-effective technologies are displaced. Consequently, DOE has targeted significant funding to search for new technologies and to test and demonstrate them in rapid and cost-effective manner with the goal of applying them quickly to address environmental problems

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

    Energy Technology Data Exchange (ETDEWEB)

    Busche, S.; Hockett, S.

    2010-06-01

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

  6. Insuring against earthquakes: simulating the cost-effectiveness of disaster preparedness.

    Science.gov (United States)

    de Hoop, Thomas; Ruben, Ruerd

    2010-04-01

    Ex-ante measures to improve risk preparedness for natural disasters are generally considered to be more effective than ex-post measures. Nevertheless, most resources are allocated after an event in geographical areas that are vulnerable to natural disasters. This paper analyses the cost-effectiveness of ex-ante adaptation measures in the wake of earthquakes and provides an assessment of the future role of private and public agencies in disaster risk management. The study uses a simulation model approach to evaluate consumption losses after earthquakes under different scenarios of intervention. Particular attention is given to the role of activity diversification measures in enhancing disaster preparedness and the contributions of (targeted) microcredit and education programmes for reconstruction following a disaster. Whereas the former measures are far more cost-effective, missing markets and perverse incentives tend to make ex-post measures a preferred option, thus occasioning underinvestment in ex-ante adaptation initiatives.

  7. A literature review of the cost-effectiveness of nuclear medicine

    International Nuclear Information System (INIS)

    Carter, J.

    1995-01-01

    Nuclear medicine is a medical speciality that uses tiny quantities of radioactivity to produce diagnostic images. It also has a role in therapy for some thyroid diseases and certain tumours. Surveys have shown that nuclear medicine procedures are used significantly less in the UK than in many other countries in Europe. One reason may be that there is inadequate information about the clinical utility of these techniques, particularly their cost-effectiveness in clinical management. To establish what evidence was currently available about the cost-effectiveness of nuclear medicine, the British Nuclear Medicine Society commissioned a worldwide literature review in diseases of the heart, kidney, lung, bone, brain, bowel and thyroid. This volume summarises the findings of the independent study and gives details of the background, clinical utility and limitations of the different nuclear medicine procedures used in the diagnosis and treatment of each disease reviewed. (author)

  8. Skeletal traction and intramedullary nailing cost-effectiveness

    African Journals Online (AJOL)

    In the operative group 24 patients had union with one delayed union while in the traction group 12 patients had union, 9 with mal union and 4 delayed union. Conclusion: Intramedullary nailing is more cost-effective than skeletal traction. It met the dominant strategy, because it was significantly less costly than skeletal ...

  9. Cost Effectiveness of Premium Versus Regular Gasoline in MCPS Buses.

    Science.gov (United States)

    Baacke, Clifford M.; Frankel, Steven M.

    The primary question posed in this study is whether premium or regular gasoline is more cost effective for the Montgomery County Public School (MCPS) bus fleet, as a whole, when miles-per-gallon, cost-per-gallon, and repair costs associated with mileage are considered. On average, both miles-per-gallon, and repair costs-per-mile favor premium…

  10. 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...

  11. Pressure relieving support surfaces (PRESSURE) trial: cost effectiveness analysis.

    Science.gov (United States)

    Iglesias, Cynthia; Nixon, Jane; Cranny, Gillian; Nelson, E Andrea; Hawkins, Kim; Phillips, Angela; Torgerson, David; Mason, Su; Cullum, Nicky

    2006-06-17

    To assess the cost effectiveness of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers in patients admitted to hospital. Cost effectiveness analysis carried out alongside the pressure relieving support surfaces (PRESSURE) trial; a multicentre UK based pragmatic randomised controlled trial. 11 hospitals in six UK NHS trusts. Intention to treat population comprising 1971 participants. Kaplan Meier estimates of restricted mean time to development of pressure ulcers and total costs for treatment in hospital. Alternating pressure mattresses were associated with lower overall costs (283.6 pounds sterling per patient on average, 95% conf