The effect of health literacy on knowledge and receipt of colorectal cancer screening: a survey study

Directory of Open Access Journals (Sweden)

Pignone Michael P

2007-03-01

Full Text Available Abstract Background An estimated one-half of Americans have limited health literacy skills. Low literacy has been associated with less receipt of preventive services, but its impact on colorectal cancer (CRC screening is unclear. We sought to determine whether low literacy affects patients' knowledge or receipt of CRC screening. Methods Pilot survey study of patients aged 50 years and older at a large, university-affiliated internal medicine practice. We assessed patients' knowledge and receipt of CRC screening, basic sociodemographic information, and health literacy level. We defined limited literacy as reading below the ninth grade level as determined by the Rapid Estimate of Adult Literacy in Medicine. Bivariate analyses and exact logistic regression were used to determine the association of limited health literacy with knowledge and receipt of CRC screening. Results We approached 105 patients to yield our target sample of 50 completing the survey (recruitment rate 48%. Most subjects were female (72%, African-American (58%, and had household incomes less than $25,000 (87%. Overall, 48% of patients had limited literacy skills (95% CI 35% to 61%. Limited literacy patients were less likely than adequate literacy patients to be able to name or describe any CRC screening test (50% vs. 96%, p Conclusion Patients with limited literacy skills are less likely to be knowledgeable of CRC screening compared to adequate literacy patients. Primary care providers should ensure patients' understanding of CRC screening when discussing screening options. Further research is needed to determine if educating low literacy patients about CRC screening can increase screening rates.

Cost-effectiveness of programs to eliminate disparities in elderly vaccination rates in the United States.

Science.gov (United States)

Michaelidis, Constantinos I; Zimmerman, Richard K; Nowalk, Mary Patricia; Smith, Kenneth J

2014-07-15

There are disparities in influenza and pneumococcal vaccination rates among elderly minority groups and little guidance as to which intervention or combination of interventions to eliminate these disparities is likely to be most cost-effective. Here, we evaluate the cost-effectiveness of four hypothetical vaccination programs designed to eliminate disparities in elderly vaccination rates and differing in the number of interventions. We developed a Markov model in which we assumed a healthcare system perspective, 10-year vaccination program and lifetime time horizon. The cohort was the combined African-American and Hispanic 65 year-old birth cohort in the United States in 2009. We evaluated five different vaccination strategies: no vaccination program and four vaccination programs that varied from "low intensity" to "very high intensity" based on the number of interventions deployed in each program, their cumulative cost and their cumulative impact on elderly minority influenza and pneumococcal vaccination rates. The very high intensity vaccination program ($24,479/quality-adjusted life year; QALY) was preferred at willingness-to-pay-thresholds of $50,000 and $100,000/QALY and prevented 37,178 influenza cases, 342 influenza deaths, 1,158 invasive pneumococcal disease (IPD) cases and 174 IPD deaths over the birth cohort's lifetime. In one-way sensitivity analyses, the very high intensity program only became cost-prohibitive (>$100,000/QALY) at less likely values for the influenza vaccination rates achieved in year 10 of the high intensity (>73.5%) or very high intensity (eliminate disparities in elderly minority vaccination rates and including four interventions would be cost-effective.

Cost-Effectiveness of One-Time Hepatitis C Screening Strategies Among Adolescents and Young Adults in Primary Care Settings.

Science.gov (United States)

Assoumou, Sabrina A; Tasillo, Abriana; Leff, Jared A; Schackman, Bruce R; Drainoni, Mari-Lynn; Horsburgh, C Robert; Barry, M Anita; Regis, Craig; Kim, Arthur Y; Marshall, Alison; Saxena, Sheel; Smith, Peter C; Linas, Benjamin P

2018-01-18

High hepatitis C virus (HCV) rates have been reported in young people who inject drugs (PWID). We evaluated the clinical benefit and cost-effectiveness of testing among youth seen in communities with a high overall number of reported HCV cases. We developed a decision analytic model to project quality-adjusted life years (QALYs), costs (2016 US$), and incremental cost-effectiveness ratios (ICERs) of 9 strategies for 1-time testing among 15- to 30-year-olds seen at urban community health centers. Strategies differed in 3 ways: targeted vs routine testing, rapid finger stick vs standard venipuncture, and ordered by physician vs by counselor/tester using standing orders. We performed deterministic and probabilistic sensitivity analyses (PSA) to evaluate uncertainty. Compared to targeted risk-based testing (current standard of care), routine testing increased the lifetime medical cost by $80 and discounted QALYs by 0.0013 per person. Across all strategies, rapid testing provided higher QALYs at a lower cost per QALY gained and was always preferred. Counselor-initiated routine rapid testing was associated with an ICER of $71000/QALY gained. Results were sensitive to offer and result receipt rates. Counselor-initiated routine rapid testing was cost-effective (ICER 26 cases per 100 person-years, or reflex confirmatory testing followed all reactive venipuncture diagnostics. In PSA, routine rapid testing was the optimal strategy in 90% of simulations. Routine rapid HCV testing among 15- to 30-year-olds may be cost-effective when the prevalence of PWID is >0.59%. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Mitigating costs and the preemptive effect of federal rate orders

International Nuclear Information System (INIS)

Darr, F.P.

1992-01-01

The role of federalism in the regulation of energy production is a long-standing problem. This article is divided into five parts. Following a summary of the case 'New Orleans Public Service, Inc. v. Council of New Orleans' (NOPSI) in Part I the article addresses the statutory and interpretive foundations of the filed rate doctrine described in Part II. Part III discusses the Supreme Court's extension of the doctrine into greater federal management of retail rates and introduces the reaction of the lower courts to the Supreme Court's decisions. Part IV analyzes the NOPSI exception requiring a utility to mitigate the effects of a FERC order in light of the policy distinctions inherent in the filed rate doctrine and the recognized eceptions. Part V addresses a related policy issue of the appropriate venue for challenging state orders to deny costs arising from federal orders. 153 refs

77 FR 53769 - Receipts-Based, Small Business Size Standard; Confirmation of Effective Date

Science.gov (United States)

2012-09-04

... Flexibility Act of 1980, as amended. The NRC is increasing its receipts-based, small business size standard from $6.5 million to $7 million to conform to the standard set by the Small Business Administration...-Based, Small Business Size Standard; Confirmation of Effective Date AGENCY: Nuclear Regulatory...

Changes in Adolescents' Receipt of Sex Education, 2006-2013.

Science.gov (United States)

Lindberg, Laura Duberstein; Maddow-Zimet, Isaac; Boonstra, Heather

2016-06-01

Updated estimates of adolescents' receipt of sex education are needed to monitor changing access to information. Using nationally representative data from the 2006-2010 and 2011-2013 National Survey of Family Growth, we estimated changes over time in adolescents' receipt of sex education from formal sources and from parents and differentials in these trends by adolescents' gender, race/ethnicity, age, and place of residence. Between 2006-2010 and 2011-2013, there were significant declines in adolescent females' receipt of formal instruction about birth control (70% to 60%), saying no to sex (89% to 82%), sexually transmitted disease (94% to 90%), and HIV/AIDS (89% to 86%). There was a significant decline in males' receipt of instruction about birth control (61% to 55%). Declines were concentrated among adolescents living in nonmetropolitan areas. The proportion of adolescents talking with their parents about sex education topics did not change significantly. Twenty-one percent of females and 35% of males did not receive instruction about methods of birth control from either formal sources or a parent. Declines in receipt of formal sex education and low rates of parental communication may leave adolescents without instruction, particularly in nonmetropolitan areas. More effort is needed to understand this decline and to explore adolescents' potential other sources of reproductive health information. Copyright © 2016 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Effects of Variable Production Rate and Time-Dependent Holding Cost for Complementary Products in Supply Chain Model

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Mitali Sarkar

2017-01-01

Full Text Available Recently, a major trend is going to redesign a production system by controlling or making variable the production rate within some fixed interval to maintain the optimal level. This strategy is more effective when the holding cost is time-dependent as it is interrelated with holding duration of products and rate of production. An effort is made to make a supply chain model (SCM to show the joint effect of variable production rate and time-varying holding cost for specific type of complementary products, where those products are made by two different manufacturers and a common retailer makes them bundle and sells bundles to end customers. Demand of each product is specified by stochastic reservation prices with a known potential market size. Those players of the SCM are considered with unequal power. Stackelberg game approach is employed to obtain global optimum solution of the model. An illustrative numerical example, graphical representation, and managerial insights are given to illustrate the model. Results prove that variable production rate and time-dependent holding cost save more than existing literature.

Medicare charge-receipt data: results for South Dakota.

Science.gov (United States)

Lamfers, Randall; Miller, Nathan; Nettleman, Mary D

2013-10-01

The 2013 release of 2011 financial information by the Centers for Medicare and Medicaid Services (CMS) caused concern because some hospitals had charges that appeared to be exorbitantly high compared to reimbursement rates. Charges and receipts for South Dakota were compared to national data. The study was restricted to nine discharge codes likely to be seen by an adult hospitalist service. South Dakota hospitals had a lower charge-to-receipt ratio than the national average (p Dakota was 2.74 compared to 3.75 nationally. South Dakota charged 29 percent less for these discharge codes and received 3 percent lower reimbursement than the national average. The relatively low charge-to-receipt ratio and low charges in South Dakota are encouraging. Unfortunately, the only South Dakotans likely to be asked to pay full charges are the uninsured, who thus face bills that are much higher than insurance companies pay for the insured population. This leaves uninsured patients and hospitals with trying to negotiate discounts or waivers on an individual basis, which is an inefficient and problematic approach for both parties.

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

Directory of Open Access Journals (Sweden)

Joakim Ramsberg

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

Cost-effectiveness of a potential future Helicobacter pylori vaccine in the Netherlands: the impact of varying the discount rate for health.

Science.gov (United States)

de Vries, Robin; Klok, Rogier M; Brouwers, Jacobus R B J; Postma, Maarten J

2009-02-05

To estimate the cost-effectiveness of a potential Helicobacter pylori (HP) vaccine for the Dutch situation, we developed a Markov model. Several HP prevalence scenarios were assessed. Additionally, we assessed the impact of the discount rate for health on the outcomes, as this influence can be profound for vaccines. When applying the current discount rate of 1.5% for health, the expected cost-effectiveness of HP vaccination is estimated below the informal Dutch threshold of euro 20,000/LYG when the HP prevalence is assumed > or =20% in the Dutch population. In conclusion, we showed that HP vaccination could possibly be a cost-effective intervention. However, this depends to a large extend on the prevalence of HP in the population. Furthermore, we showed the large impact of the discount rate for health on the cost-effectiveness of a HP vaccination program, illustrative for other vaccination programs.

7 CFR 735.302 - Paper warehouse receipts.

Science.gov (United States)

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Paper warehouse receipts. 735.302 Section 735.302... § 735.302 Paper warehouse receipts. Paper warehouse receipts must be issued as follows: (a) On distinctive paper specified by DACO; (b) Printed by a printer authorized by DACO; and (c) Issued, identified...

Association between parent attitudes and receipt of human papillomavirus vaccine in adolescents.

Science.gov (United States)

VanWormer, Jeffrey J; Bendixsen, Casper G; Vickers, Elizabeth R; Stokley, Shannon; McNeil, Michael M; Gee, Julianne; Belongia, Edward A; McLean, Huong Q

2017-10-02

Human papillomavirus (HPV) vaccine coverage rates remain low. This is believed to reflect parental hesitancy, but few studies have examined how changes in parents' attitudes impact HPV vaccine uptake. This study examined the association between changes in parents' vaccine attitudes and HPV vaccine receipt in their adolescent children. A baseline and 1-year follow-up survey of HPV vaccine attitudes was administered to parents of 11-17 year olds who had not completed the HPV vaccine series. Changes in attitudinal scores (barriers, harms, ineffectiveness, and uncertainties) from the Carolina HPV Immunization Attitudes and Beliefs Scale were assessed. Two outcomes were measured (in parents' adolescent children) over an 18-month period and analyzed using multivariable regression; receipt of next scheduled HPV vaccine dose and 3-dose series completion. There were 221 parents who completed the baseline survey (11% response rate) and 164 with available follow-up data; 60% of their adolescent children received a next HPV vaccine dose and 38% completed the vaccine series at follow-up. Decrease in parents' uncertainties was a significant predictor of vaccine receipt, with each 1-point reduction in uncertainties score associated with 4.9 higher odds of receipt of the next vaccine dose. Higher baseline harms score was the only significant predictor of lower series completion. Reductions in parents' uncertainties appeared to result in greater likelihood of their children receiving the HPV vaccine. Only baseline concerns about vaccine harms were associated with lower series completion rate. Education for parents should emphasize the HPV vaccine's safety profile.

Association between parent attitudes and receipt of human papillomavirus vaccine in adolescents

Directory of Open Access Journals (Sweden)

Jeffrey J. VanWormer

2017-10-01

Full Text Available Abstract Background Human papillomavirus (HPV vaccine coverage rates remain low. This is believed to reflect parental hesitancy, but few studies have examined how changes in parents’ attitudes impact HPV vaccine uptake. This study examined the association between changes in parents’ vaccine attitudes and HPV vaccine receipt in their adolescent children. Methods A baseline and 1-year follow-up survey of HPV vaccine attitudes was administered to parents of 11–17 year olds who had not completed the HPV vaccine series. Changes in attitudinal scores (barriers, harms, ineffectiveness, and uncertainties from the Carolina HPV Immunization Attitudes and Beliefs Scale were assessed. Two outcomes were measured (in parents’ adolescent children over an 18-month period and analyzed using multivariable regression; receipt of next scheduled HPV vaccine dose and 3-dose series completion. Results There were 221 parents who completed the baseline survey (11% response rate and 164 with available follow-up data; 60% of their adolescent children received a next HPV vaccine dose and 38% completed the vaccine series at follow-up. Decrease in parents’ uncertainties was a significant predictor of vaccine receipt, with each 1-point reduction in uncertainties score associated with 4.9 higher odds of receipt of the next vaccine dose. Higher baseline harms score was the only significant predictor of lower series completion. Conclusions Reductions in parents’ uncertainties appeared to result in greater likelihood of their children receiving the HPV vaccine. Only baseline concerns about vaccine harms were associated with lower series completion rate. Education for parents should emphasize the HPV vaccine’s safety profile.

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...

Life cycle costing with a discount rate

Science.gov (United States)

Posner, E. C.

1978-01-01

This article studies life cycle costing for a capability needed for the indefinite future, and specifically investigates the dependence of optimal policies on the discount rate chosen. The two costs considered are reprocurement cost and maintenance and operations (M and O) cost. The procurement price is assumed known, and the M and O costs are assumed to be a known function, in fact, a non-decreasing function, of the time since last reprocurement. The problem is to choose the optimum reprocurement time so as to minimize the quotient of the total cost over a reprocurement period divided by the period. Or one could assume a discount rate and try to minimize the total discounted costs into the indefinite future. It is shown that the optimum policy in the presence of a small discount rate hardly depends on the discount rate at all, and leads to essentially the same policy as in the case in which discounting is not considered.

Relationship between Receipt of a Social Protection Grant for a Child and Second Pregnancy Rates among South African Women: A Cohort Study.

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Molly Rosenberg

Full Text Available Social protection programs issuing cash grants to caregivers of young children may influence fertility. Grant-related income could foster economic independence and/or increase access to job prospects, education, and health services, resulting in lower pregnancy rates. In the other direction, these programs may motivate family expansion in order to receive larger grants. Here, we estimate the net effect of these countervailing mechanisms among rural South African women.We constructed a retrospective cohort of 4845 women who first became eligible for the Child Support Grant with the birth of their first child between 1998 and 2008, with data originally collected by the Agincourt Health and Socio-Demographic Surveillance System in Mpumalanga province, South Africa. We fit Cox regression models to estimate the hazard of second pregnancy in women who reported grant receipt after birth of first child, relative to non-recipients. As a secondary analysis to explore the potential for grant loss to incentivize second pregnancy, we exploited a natural experiment created by a 2003 expansion of the program's age eligibility criterion from age seven to nine. We compared second pregnancy rates between (i women with children age seven or eight in 2002 (recently aged out of grant eligibility to (ii women with children age seven or eight in 2003 (remained grant-eligible.The adjusted hazard ratio for the association between grant exposure and second pregnancy was 0.66 (95% CI: 0.58, 0.75. Women with first children who aged out of grant eligibility in 2002 had similar second pregnancy rates to women with first children who remained grant-eligible in 2003 [IRR (95% CI: 0.9 (0.5, 1.4].Across both primary and secondary analyses, we found no evidence that the Child Support Grant incentivizes pregnancy. In harmony with South African population policy, receipt of the Child Support Grant may result in longer spacing between pregnancies.

Cost-Effectiveness of a Program to Eliminate Disparities in Pneumococcal Vaccination Rates in Elderly Minority Populations: An Exploratory Analysis

Science.gov (United States)

Michaelidis, Constantinos I.; Zimmerman, Richard K.; Nowalk, Mary Patricia; Smith, Kenneth J.

2013-01-01

Objective Invasive pneumococcal disease is a major cause of preventable morbidity and mortality in the United States, particularly among the elderly (>65 years). There are large racial disparities in pneumococcal vaccination rates in this population. Here, we estimate the cost-effectiveness of a hypothetical national vaccination intervention program designed to eliminate racial disparities in pneumococcal vaccination in the elderly. Methods In an exploratory analysis, a Markov decision-analysis model was developed, taking a societal perspective and assuming a 1-year cycle length, 10-year vaccination program duration, and lifetime time horizon. In the base-case analysis, it was conservatively assumed that vaccination program promotion costs were $10 per targeted minority elder per year, regardless of prior vaccination status and resulted in the elderly African American and Hispanic pneumococcal vaccination rate matching the elderly Caucasian vaccination rate (65%) in year 10 of the program. Results The incremental cost-effectiveness of the vaccination program relative to no program was $45,161 per quality-adjusted life-year gained in the base-case analysis. In probabilistic sensitivity analyses, the likelihood of the vaccination program being cost-effective at willingness-to-pay thresholds of $50,000 and $100,000 per quality-adjusted life-year gained was 64% and 100%, respectively. Conclusions In a conservative analysis biased against the vaccination program, a national vaccination intervention program to ameliorate racial disparities in pneumococcal vaccination would be cost-effective. PMID:23538183

Rate-cost tradeoffs in control

KAUST Repository

Kostina, Victoria

2017-02-13

Consider a distributed control problem with a communication channel connecting the observer of a linear stochastic system to the controller. The goal of the controller is minimize a quadratic cost function. The most basic special case of that cost function is the mean-square deviation of the system state from the desired state. We study the fundamental tradeoff between the communication rate r bits/sec and the limsup of the expected cost b, and show a lower bound on the rate necessary to attain b. The bound applies as long as the system noise has a probability density function. If target cost b is not too large, that bound can be closely approached by a simple lattice quantization scheme that only quantizes the innovation, that is, the difference between the controller\\'s belief about the current state and the true state.

The effect of inflation rate on the cost of medical waste management system

Science.gov (United States)

Jolanta Walery, Maria

2017-11-01

This paper describes the optimization study aimed to analyse the impact of the parameter describing the inflation rate on the cost of the system and its structure. The study was conducted on the example of the analysis of medical waste management system in north-eastern Poland, in the Podlaskie Province. The scope of operational research carried out under the optimization study was divided into two stages of optimization calculations with assumed technical and economic parameters of the system. In the first stage, the lowest cost of functioning of the analysed system was generated, whereas in the second one the influence of the input parameter of the system, i.e. the inflation rate on the economic efficiency index (E) and the spatial structure of the system was determined. With the assumed inflation rate in the range of 1.00 to 1.12, the highest cost of the system was achieved at the level of PLN 2022.20/t (increase of economic efficiency index E by ca. 27% in comparison with run 1, with inflation rate = 1.12).

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.)

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.)

Warehouse receipts functioning to reduce market risk

Directory of Open Access Journals (Sweden)

Jovičić Daliborka

2014-01-01

Full Text Available Cereal production underlies the market risk to a great extent due to its elastic demand. Prices of grain have cyclic movements and significant decline in the harvest periods as a result of insufficient supply and high demand. The very specificity of agricultural production leads to the fact that agricultures are forced to sell their products at unfavorable conditions in order to resume production. The Public Warehouses System allows the agriculturers, who were previously unable to use the bank loans to finance the continuation of their production, to efficiently acquire the necessary funds, by the support of the warehouse receipts which serve as collaterals. Based on the results obtained by applying statistical methods (variance and standard deviation, as a measure of market risk under the assumption that warehouse receipts' prices will approximately follow the overall consumer price index, it can be concluded that the warehouse receipts trade will have a significant impact on risk reduction in cereal production. Positive effects can be manifested through the stabilization of prices, reduction of cyclic movements in the production of basic grains and, in the final stage, on the country's food security.

The role of interest and inflation rates in life-cycle cost analysis

Science.gov (United States)

Eisenberger, I.; Remer, D. S.; Lorden, G.

1978-01-01

The effect of projected interest and inflation rates on life cycle cost calculations is discussed and a method is proposed for making such calculations which replaces these rates by a single parameter. Besides simplifying the analysis, the method clarifies the roles of these rates. An analysis of historical interest and inflation rates from 1950 to 1976 shows that the proposed method can be expected to yield very good projections of life cycle cost even if the rates themselves fluctuate considerably.

Rate-cost tradeoffs in control

KAUST Repository

Kostina, Victoria; Hassibi, Babak

2017-01-01

function is the mean-square deviation of the system state from the desired state. We study the fundamental tradeoff between the communication rate r bits/sec and the limsup of the expected cost b, and show a lower bound on the rate necessary to attain b

Analysis of the Correlation between the Fodder Receipts and the Economical Performances of the Pig Breeding Units

Directory of Open Access Journals (Sweden)

Adrian Anica-Popa

2015-09-01

Full Text Available Respecting the European Union normative regarding the average weight of carcasses processed in the slaughter-houses, as well as the quality of the delivered meat, impose the search for the optimum variants for pig breeding. The present study aims at the identification of the correlations between the fodder receipts and the performances of the pig breeding farms through the pursuit of the effects of different fodder variants on the daily weight increase, on the moment when the optimum sacrifice weight is reached, and on the probability to reach a certain level of increase in weight. There are presented several considerations regarding the performance expressed with the help of the profit, the commercial profitability ratio, the profitability ratio of the consumed resources. Based on the results of the research, several conclusions are presented, regarding the influences of the fodder receipts on the production cost and of the performances of the pig breeding farms, as well as future research directions.

Capitals Cost and the Investments Actualisation Rate

Directory of Open Access Journals (Sweden)

Ion Stancu

2006-02-01

Full Text Available In this article, the author has assumed himself an assignment somehow ostentatious but useful, we believe, naming the one to illustrate by means of figures, the influence of both leverage and economic growth over the cost of capital, cost which will be used in capital budgeting. This synthesis is meant to be a forthcoming approach to a later investigation of the problems raised by the estimation of the cost of capital in the specific conditions of both the financial market in Romania and the quality of the economic-financial information, information available for this estimation. The discount rate for an investment project (kinv with a risk equal to the risk undertaken by the enterprise and financed within the firm’s capital structure itself (having the same leverage is equal to the (weighted average cost of capital in the respective risk class (k. Under these circumstances, it is interesting to find out this opportunity cost of capital invested in a medium-sized enterprise: a with investments in rebuilding the productive capacity, all equity financed; b with investments in rebuilding the productive capacity, financed both by equity and debt; c with new investments, all equity financed; d with new investments, financed both by equity and debt. Under these conditions, we estimate the effect of both the leverage and economic growth over the cost of capital (kec and kc to be able to determine in the end the discount rate of the analyzed investment (kinv: for enterprises with only maintaining investments (g = 0, unlevered (U and levered (L; for enterprises with growing investments (g > 0, unlevered (U and levered (L.

Capitals Cost and the Investments Actualisation Rate

Directory of Open Access Journals (Sweden)

Ion Stancu

2006-04-01

Full Text Available In this article, the author has assumed himself an assignment somehow ostentatious but useful, we believe, naming the one to illustrate by means of figures, the influence of both leverage and economic growth over the cost of capital, cost which will be used in capital budgeting. This synthesis is meant to be a forthcoming approach to a later investigation of the problems raised by the estimation of the cost of capital in the specific conditions of both the financial market in Romania and the quality of the economic-financial information, information available for this estimation. The discount rate for an investment project (kinv with a risk equal to the risk undertaken by the enterprise and financed within the firm’s capital structure itself (having the same leverage is equal to the (weighted average cost of capital in the respective risk class (k. Under these circumstances, it is interesting to find out this opportunity cost of capital invested in a medium-sized enterprise: a with investments in rebuilding the productive capacity, all equity financed; b with investments in rebuilding the productive capacity, financed both by equity and debt; c with new investments, all equity financed; d with new investments, financed both by equity and debt. Under these conditions, we estimate the effect of both the leverage and economic growth over the cost of capital (kec and kc to be able to determine in the end the discount rate of the analyzed investment (kinv: for enterprises with only maintaining investments (g = 0, unlevered (U and levered (L; for enterprises with growing investments (g > 0, unlevered (U and levered (L.

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.

DEPENDENCE OF ENERGY EFFICIENCY AND COST OF PRODUCTION

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D. Sklyarov

2016-01-01

Full Text Available Economic systems exist on condition of receipt and spending of energy. Energy consumption is a necessary condition for the existence and functioning of the economic systems of any scale: macroeconomics, microeconomics, regional economy or the world economy.The economic system operates on the scale at which it is able to produce energy and get access to energy. Moreover, receipt and consumption of energy in the operation of the economic system is mainly determined by, the level of energy production from energy sources, since this level is determined by the level of energy consumption by industries and enterprises of the economy.Currently, the economic system does not produce energy in reserve. Thus, the question of energy effi ciency and energy saving was always acute.The article describes the energy efficiency and energy saving effect on the cost of production. Were used two methods: “costs and release” matrix and “price - value added” matrix. The result is the equation of dependence of energy efficiency and costs.

Cost of nuclear power generation judged by power rate

International Nuclear Information System (INIS)

Hirai, Takaharu

1981-01-01

According to estimation guidance, power rates in general are the proper cost plus the specific compensation and adjustment addition. However, the current system of power rates is of power-source development promotion type involving its tax. The structure of power rate determination must be restudied now especially in connection of nuclear power generation. The cost of nuclear power generation as viewed from power rate is discussed as follows: the fear of military application of power plants, rising plant construction costs, the loophole in fuel cost calculation, unreasonable unit power cost, depreciation and repair cost, business compensation, undue business compensation in nuclear power, the costs of nuclear waste management, doubt concerning nuclear power cost, personnel, pumping-up and power transmission costs in nuclear power, energy balance analysis, nuclear power viewed in entropy, the suppression of power consumption. (J.P.N.)

US Cannery Receipts

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The data set contains receipts of tuna destined for canning, from both domestic and imported sources, at cannery locations within the 50 states, Puerto Rico, and...

48 CFR 52.216-15 - Predetermined Indirect Cost Rates.

Science.gov (United States)

2010-10-01

.... (c) Allowability of costs and acceptability of cost allocation methods shall be determined in...) the period for which the rates apply, and (4) the specific items treated as direct costs or any changes in the items previously agreed to be direct costs. The indirect cost rate agreement shall not...

Cost, affordability and cost-effectiveness of strategies to control tuberculosis in countries with high HIV prevalence

Directory of Open Access Journals (Sweden)

Williams Brian G

2005-12-01

Full Text Available Abstract Background The HIV epidemic has caused a dramatic increase in tuberculosis (TB in East and southern Africa. Several strategies have the potential to reduce the burden of TB in high HIV prevalence settings, and cost and cost-effectiveness analyses can help to prioritize them when budget constraints exist. However, published cost and cost-effectiveness studies are limited. Methods Our objective was to compare the cost, affordability and cost-effectiveness of seven strategies for reducing the burden of TB in countries with high HIV prevalence. A compartmental difference equation model of TB and HIV and recent cost data were used to assess the costs (year 2003 US$ prices and effects (TB cases averted, deaths averted, DALYs gained of these strategies in Kenya during the period 2004–2023. Results The three lowest cost and most cost-effective strategies were improving TB cure rates, improving TB case detection rates, and improving both together. The incremental cost of combined improvements to case detection and cure was below US$15 million per year (7.5% of year 2000 government health expenditure; the mean cost per DALY gained of these three strategies ranged from US$18 to US$34. Antiretroviral therapy (ART had the highest incremental costs, which by 2007 could be as large as total government health expenditures in year 2000. ART could also gain more DALYs than the other strategies, at a cost per DALY gained of around US$260 to US$530. Both the costs and effects of treatment for latent tuberculosis infection (TLTI for HIV+ individuals were low; the cost per DALY gained ranged from about US$85 to US$370. Averting one HIV infection for less than US$250 would be as cost-effective as improving TB case detection and cure rates to WHO target levels. Conclusion To reduce the burden of TB in high HIV prevalence settings, the immediate goal should be to increase TB case detection rates and, to the extent possible, improve TB cure rates, preferably

27 CFR 28.290 - Receipt in foreign trade zone.

Science.gov (United States)

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Receipt in foreign trade zone. 28.290 Section 28.290 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE... in Foreign-Trade Zone § 28.290 Receipt in foreign trade zone. On receipt at the zone, the shipment...

Machine cost analysis using the traditional machine-rate method and ChargeOut!

Science.gov (United States)

E. M. (Ted) Bilek

2009-01-01

Forestry operations require ever more use of expensive capital equipment. Mechanization is frequently necessary to perform cost-effective and safe operations. Increased capital should mean more sophisticated capital costing methodologies. However the machine rate method, which is the costing methodology most frequently used, dates back to 1942. CHARGEOUT!, a recently...

27 CFR 28.286 - Receipt in customs bonded warehouse.

Science.gov (United States)

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Receipt in customs bonded... in Customs Bonded Warehouse § 28.286 Receipt in customs bonded warehouse. On receipt of the distilled spirits or wine and the related TTB Form 5100.11 or 5110.30 as the case may be, the customs officer in...

Costs and effects in lumbar spinal fusion

DEFF Research Database (Denmark)

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

2007-01-01

of the Dallas Pain Questionnaire and the Low Back Pain Rating Scale at baseline and 2 years postoperatively. Regression models were used to reveal determinants for costs and effects. Costs and effects were analyzed as a net-benefit measure to reveal determinants for cost-effectiveness, and finally, adjusted...... areas. Multi-level fusion and surgical technique significantly affected the net-benefit as well. Surprisingly, no correlation was found between treatment costs and treatment effects. Incremental analysis suggested that the probability of posterior instrumentation being cost-effective was limited......Although cost-effectiveness is becoming the foremost evaluative criterion within health service management of spine surgery, scientific knowledge about cost-patterns and cost-effectiveness is limited. The aims of this study were (1) to establish an activity-based method for costing at the patient...

Real Time Business Analytics for Buying or Selling Transaction on Commodity Warehouse Receipt System

Science.gov (United States)

Djatna, Taufik; Teniwut, Wellem A.; Hairiyah, Nina; Marimin

2017-10-01

The requirement for smooth information such as buying and selling is essential for commodity warehouse receipt system such as dried seaweed and their stakeholders to transact for an operational transaction. Transactions of buying or selling a commodity warehouse receipt system are a risky process due to the fluctuations in dynamic commodity prices. An integrated system to determine the condition of the real time was needed to make a decision-making transaction by the owner or prospective buyer. The primary motivation of this study is to propose computational methods to trace market tendency for either buying or selling processes. The empirical results reveal that feature selection gain ratio and k-NN outperforms other forecasting models, implying that the proposed approach is a promising alternative to the stock market tendency of warehouse receipt document exploration with accurate level rate is 95.03%.

Shipments/receipts resolution program

International Nuclear Information System (INIS)

Davis, F.B.

1988-01-01

Savannah River Plant (SRP) has initiated an aggressive program aimed at improving shipper/receiver (S/R) posture. The site is routinely involved in 800 nuclear material transfers/year. This many transactions between facilities provides many opportunities for resolving S/R differences. Resolution of S/R differences requires considerable effort from both DOE offices and contractors, presents legitimate safeguards concerns if the receiving quantity is less than the quantity shipped, and must be resolved for shipments to continue. This paper discusses the programs in place at SRP to resolve S/R differences. S/R agreements provide a method of communicating between the shipping and receiving facilities and protect both facilities by eliminating misunderstandings. Nondestructive assay (NDA) instrumentation allows the facility to obtain an accountability quality value for receipt before the material is processed. More accurate and precise analytical techniques are in use wherever SRP does not have the capability to measure a shipment or receipt by NDA. S/R values are graphed to identify trends and/or biases that may not have exceeded any error limits. The central Material Control and Accountability (MCandA) division has become more involved in analyzing the data from shipments and receipts including the calculation of limits of error (LOE's), instrument biases, and analyzing trends

21 CFR 606.165 - Distribution and receipt; procedures and records.

Science.gov (United States)

2010-04-01

... SERVICES (CONTINUED) BIOLOGICS CURRENT GOOD MANUFACTURING PRACTICE FOR BLOOD AND BLOOD COMPONENTS Records and Reports § 606.165 Distribution and receipt; procedures and records. (a) Distribution and receipt... 21 Food and Drugs 7 2010-04-01 2010-04-01 false Distribution and receipt; procedures and records...

28 CFR 802.26 - Receipt of demand.

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Receipt of demand. 802.26 Section 802.26... DISCLOSURE OF RECORDS Subpoenas or Other Legal Demands for Testimony or the Production or Disclosure of Records or Other Information § 802.26 Receipt of demand. If, in connection with a proceeding to which the...

49 CFR 594.9 - Fee for reimbursement of bond processing costs and costs for processing offers of cash deposits...

Science.gov (United States)

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Fee for reimbursement of bond processing costs and costs for processing offers of cash deposits or obligations of the United States in lieu of sureties on... indirect costs the agency incurs for receipt, processing, handling, and disbursement of cash deposits or...

Expanding Post-Harvest Finance Through Warehouse Receipts and Related Instruments

OpenAIRE

Baldwin, Marisa; Bryla, Erin; Langenbucher, Anja

2006-01-01

Warehouse receipt financing and similar types of collateralized lending provide an alternative to traditional lending requirements of banks and other financiers and could provide opportunities to expand this lending in emerging economies for agricultural trade. The main contents include: what is warehouse receipt financing; what is the value of warehouse receipt financing; other collater...

A 'cost-effective' probabilistic model to select the dominant factors affecting the variation of the component failure rate

International Nuclear Information System (INIS)

Kirchsteiger, C.

1992-11-01

Within the framework of a Probabilistic Safety Assessment (PSA), the component failure rate λ is a key parameter in the sense that the study of its behavior gives the essential information for estimating the current values as well as the trends in the failure probabilities of interest. Since there is an infinite variety of possible underlying factors which might cause changes in λ (e.g. operating time, maintenance practices, component environment, etc.), an 'importance ranking' process of these factors is considered most desirable to prioritize research efforts. To be 'cost-effective', the modeling effort must be small, i.e. essentially involving no estimation of additional parameters other than λ. In this paper, using a multivariate data analysis technique and various statistical measures, such a 'cost-effective' screening process has been developed. Dominant factors affecting the failure rate of any components of interest can easily be identified and the appropriateness of current research plans (e.g. on the necessity of performing aging studies) can be validated. (author)

Cost-effectiveness of hysteroscopy screening for infertile women.

Science.gov (United States)

Kasius, Jenneke C; Eijkemans, René J C; Mol, Ben W J; Fauser, Bart C J M; Fatemi, Human M; Broekmans, Frank J M

2013-06-01

This study assessed the cost-effectiveness of office hysteroscopy screening prior to IVF. Therefore, the cost-effectiveness of two distinct strategies - hysteroscopy after two failed IVF cycles (Failedhyst) and routine hysteroscopy prior to IVF (Routinehyst) - was compared with the reference strategy of no hysteroscopy (Nohyst). When present, intrauterine pathology was treated during hysteroscopy. Two models were constructed and evaluated in a decision analysis. In model I, all patients had an increase in pregnancy rate after screening hysteroscopy prior to IVF; in model II, only patients with intrauterine pathology would benefit. For each strategy, the total costs and live birth rates after a total of three IVF cycles were assessed. For model I (all patients benefit from hysteroscopy), Routinehyst was always cost-effective compared with Nohyst or Failedhyst. For the Routinehyst strategy, a monetary profit would be obtained in the case where hysteroscopy would increase the live birth rate after IVF by ≥ 2.8%. In model II (only patients with pathology benefit from hysteroscopy), Routinehyst also dominated Failedhyst. However, hysteroscopy performance resulted in considerable costs. In conclusion, the application of a routine hysteroscopy prior to IVF could be cost-effective. However, randomized trials confirming the effectiveness of hysteroscopy are needed. Copyright © 2013 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

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.

Cost-Effectiveness of the 'One4All' HIV Linkage Intervention in Guangxi Zhuang Autonomous Region, China.

Directory of Open Access Journals (Sweden)

Xiao Zang

Full Text Available In Guangxi Zhuang Autonomous Region, China, an estimated 80% of newly-identified antiretroviral therapy (ART-eligible patients are not engaged in ART. Delayed ART uptake ultimately translates into high rates of HIV morbidity, mortality, and transmission. To enhance HIV testing receipt and subsequent treatment uptake in Guangxi, the Chinese Center for Disease Control and Prevention (CDC executed a cluster-randomized trial to assess the effectiveness and cost-effectiveness of a streamlined HIV testing algorithm (the One4All intervention in 12 county-level hospitals.To determine the incremental cost-effectiveness of the One4All intervention delivered at county hospitals in Guangxi, China, compared to the current standard of care (SOC.Health System.1-, 5-and 25-years.We adapted a dynamic, compartmental HIV transmission model to simulate HIV transmission and progression in Guangxi, China and identify the economic impact and health benefits of implementing the One4All intervention in all Guangxi hospitals. The One4All intervention algorithm entails rapid point-of-care HIV screening, CD4 and viral load testing of individuals presenting for HIV screening, with same-day results and linkage to counselling. We populated the model with data from the One4All trial (CTN-0056, China CDC HIV registry and published reports. Model outcomes were HIV incidence, mortality, costs, quality-adjusted life years (QALYs, and the incremental cost-effectiveness ratio (ICER of the One4All intervention compared to SOC.The One4All testing intervention was more costly than SOC (CNY 2,182 vs. CNY 846, but facilitated earlier ART access, resulting in delayed disease progression and mortality. Over a 25-year time horizon, we estimated that introducing One4All in Guangxi would result in 802 averted HIV cases and 1629 averted deaths at an ICER of CNY 11,678 per QALY gained. Sensitivity analysis revealed that One4All remained cost-effective at even minimal levels of effectiveness

A Cross-Sectional Study of the Association between Infant Hepatitis B Vaccine Exposure in Boys and the Risk of Adverse Effects as Measured by Receipt of Special Education Services

Directory of Open Access Journals (Sweden)

David A. Geier

2018-01-01

Full Text Available The National Center for Education Statistics reported that between 1990–2005 the number of children receiving special education services (SES rose significantly, and then, from 2004–2012, the number declined significantly. This coincided with the introduction of Thimerosal-containing hepatitis B vaccine in 1991, and the subsequent introduction of Thimerosal-reduced hepatitis B vaccine in the early 2000s. This study examined the potential relationship between infant exposure to mercury from three doses of Thimerosal-containing hepatitis B vaccine and the risk of boys being adversely affected (as measured by receipt of SES. This cross-sectional study examined 1192 boys (weighted n = 24,537,123 7–8 years of age (born: 1994–2007 from the combined 2001–2014 National Health and Nutritional Examination Survey (NHANES. Survey logistic regression modeling revealed that an exposed population receiving three doses of infant Thimerosal-containing hepatitis B vaccine (weighted n = 11,186,579, in comparison to an unexposed population (weighted n = 704,254, were at an increased risk of receipt of SES. This association was robust (crude odds ratio = 10.143, p = 0.0232, even when considering covariates, such as race and socioeconomic status (adjusted odds ratio = 9.234, p = 0.0259. Survey frequency modeling revealed that receipt of SES for the population that was exposed to three doses of Thimerosal-containing hepatitis B vaccine in infancy (12.91% was significantly higher than the unexposed population (1.44% (prevalence ratio = 8.96, p = 0.006, prevalence attributable rate = 0.1147. Despite the limitation of this cross-sectional study not being able to ascribe a direct cause-and-effect relationship between exposure and outcome, it is estimated that an additional 1.2 million boys received SES with excess education costs of about United States (US $180 billion associated with exposure to Thimerosal-containing hepatitis B vaccine. By contrast, exposure

A Cross-Sectional Study of the Association between Infant Hepatitis B Vaccine Exposure in Boys and the Risk of Adverse Effects as Measured by Receipt of Special Education Services.

Science.gov (United States)

Geier, David A; Kern, Janet K; Homme, Kristin G; Geier, Mark R

2018-01-12

The National Center for Education Statistics reported that between 1990-2005 the number of children receiving special education services (SES) rose significantly, and then, from 2004-2012, the number declined significantly. This coincided with the introduction of Thimerosal-containing hepatitis B vaccine in 1991, and the subsequent introduction of Thimerosal-reduced hepatitis B vaccine in the early 2000s. This study examined the potential relationship between infant exposure to mercury from three doses of Thimerosal-containing hepatitis B vaccine and the risk of boys being adversely affected (as measured by receipt of SES). This cross-sectional study examined 1192 boys (weighted n = 24,537,123) 7-8 years of age (born: 1994-2007) from the combined 2001-2014 National Health and Nutritional Examination Survey (NHANES). Survey logistic regression modeling revealed that an exposed population receiving three doses of infant Thimerosal-containing hepatitis B vaccine (weighted n = 11,186,579), in comparison to an unexposed population (weighted n = 704,254), were at an increased risk of receipt of SES. This association was robust (crude odds ratio = 10.143, p = 0.0232), even when considering covariates, such as race and socioeconomic status (adjusted odds ratio = 9.234, p = 0.0259). Survey frequency modeling revealed that receipt of SES for the population that was exposed to three doses of Thimerosal-containing hepatitis B vaccine in infancy (12.91%) was significantly higher than the unexposed population (1.44%) (prevalence ratio = 8.96, p = 0.006, prevalence attributable rate = 0.1147). Despite the limitation of this cross-sectional study not being able to ascribe a direct cause-and-effect relationship between exposure and outcome, it is estimated that an additional 1.2 million boys received SES with excess education costs of about United States (US) $180 billion associated with exposure to Thimerosal-containing hepatitis B vaccine. By contrast, exposure to Thimerosal

Environmental costs and resource planning consequences: New England electric's rating and weighting approach

International Nuclear Information System (INIS)

Destribats, A.F.; Hutchinson, M.A.; Stout, T.M.; White, D.S.

1990-01-01

In mid 1989, the New England Electric System (NEES or Company) began an effort to reflect the potential environmental externalities of new resources in its long range planning process. Having examined several methods for incorporating externalities, including cost of control, the Company adopted a rating and weighting approach. Not strictly quantitative nor qualitative, the rating and weighting approach provided a means to apply an environmental score to all new resources considered for the Company's long range resource plan, NEESPLAN 1990. A maximum environmental cost penalty of fifteen percent was applied to the resource considered for inclusion in the plan that posed the highest amount of potential environmental degradation. All other resources received a smaller penalty that was based on the ratio of their environmental score to the highest score. Application of this penalty tended to improve the cost-effectiveness of demand-side programs and worsen some supply-side options' cost-effectiveness. Both the rating and weighting approach employed by NEES and its application in the long range planning process have been the subject of several critical reviews. Having stated that the advantages of the rating and weighting approach include its easy reviewability and flexibility to be modified as better information becomes available, the Company has subsequently revised the approach to address the comments made by reviewers. The purpose of this paper is to describe the rating and weighting approach, its recent revisions, and the effect of the revised methodology on the Company's long range resource plan

48 CFR 242.803 - Disallowing costs after incurrence.

Science.gov (United States)

2010-10-01

... from contractors; (B) Approving interim vouchers for provisional payment (this includes approving the... interim vouchers for provisional payment to the disbursing office for contractors with approved billing... of Costs 242.803 Disallowing costs after incurrence. (a) Contracting officer receipt of vouchers...

Services Receipt Following Veteran Outpatients' Positive Screen for Homelessness.

Science.gov (United States)

Montgomery, Ann E; Dichter, Melissa E; Thomasson, Arwin M; Roberts, Christopher B

2016-03-01

The Veterans Health Administration seeks to reduce homelessness among Veterans by identifying, and providing prevention and supportive services to, patients with housing concerns. The objectives of this study were to assess the proportion of Veterans Health Administration patients who received homeless or social work services within 6 months of a positive screen for homelessness or risk in the Veterans Health Administration and the demographic and clinical characteristics that predicted services utilization. Data were from a cohort of 27,403 Veteran outpatients who screened positive for homelessness or risk between November 1, 2012 and January 31, 2013. During 2013, AORs were calculated using a mixed-effects logistic regression to estimate the likelihood of patients' receipt of VHA homeless or social work services based on demographic and clinical characteristics. The majority of patients received services within 6 months post-screening; predictors of services utilization varied by gender. Among women, diagnosis of drug abuse and psychosis predicted receipt of services, being unmarried increased the odds of using services among those screening positive for homelessness, and a diagnosis of post-traumatic stress disorder increased the odds of receiving services for at-risk women. Among men, being younger, unmarried, not service-connected/Medicaid-eligible, and having a medical or behavioral health condition predicted receipt of services. Receipt of housing support services among Veterans post-homelessness screening differs by patient demographic and clinical characteristics. Future research should investigate the role that primary and secondary prevention interventions play in Veterans' resolution of risk for homelessness and experience of homelessness. Published by Elsevier Inc.

Bisphenol A in supermarket receipts and its exposure to human in Shenzhen, China.

Science.gov (United States)

Lu, Shao-You; Chang, Wen-Jing; Sojinu, Samuel O; Ni, Hong-Gang

2013-08-01

Paper receipt has been documented as one major source of bisphenol A (BPA) for human exposure but little has been done by researchers to elaborate the potential health risk caused by handling paper receipt up to date. In the present study, BPA was analyzed in 42 supermarket receipts collected from Shenzhen, China. BPA was detected in all samples at concentrations ranging from 2.58 to 14.7mgg(-1). In most cases, the total amount of BPA on the receipt was at least one thousand times the amount found in the epoxy lining of a food can, another controversial use of the chemical. The estimated daily intakes (EDI) of BPA via handling of supermarket receipt ranged from 2 to 347μgday(-1) (mean, 40.4μgday(-1)) for a supermarket cashier and from 0.24 to 3.98μgday(-1) (mean, 0.69μgday(-1)) for general population. Based on the cumulative probability distribution of the calculated daily exposure to BPA via handling supermarket receipt, the EDI at the 0.1th and 1th percentile for supermarket cashier and general population, were already larger than 100ng (kgbw)(-1)day(-1), while at the 0.2th and 71th percentile, the EDI for both populations reached 1000ng (kgbw)(-1)day(-1). Considering the adverse endocrine disruptive effects of BPA and the dosage exposure level (from tens to hundreds ng (kgbw)(-1)day(-1)), human exposure to BPA in Shenzhen deserves more attention. Sensitivity analysis result showed that the handling time and frequency of supermarket receipts are the most important variables that contributed to most of the total variance of exposure. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

The impact of HMO penetration on the rate of hospital cost inflation, 1985-1993.

Science.gov (United States)

Gaskin, D J; Hadley, J

1997-01-01

This paper provides evidence that growth in health maintenance organization (HMO) enrollment slows hospital cost inflation. During the period 1985-1993, hospitals in areas with high rates of HMO penetration and growth had a slower rate of growth in expenses (8.3%) than hospitals in low penetration areas (11.2%). From 1992-1993, HMO growth lowered the rate of hospital cost inflation by .34 to 3.40 percentage points, depending on the base-year level and the annual change in HMO penetration. Declines in Medicare Prospective Payment System (PPS) margins also lowered hospital cost inflation; over the time period, annual hospital cost inflation was reduced by .38 percentage points. The estimates imply that the cumulative effect of HMO growth on hospital costs has been a $56.2 billion reduction (in 1993 dollars).

Effect of construction time, interest rate, and inflation on the capital cost of nuclear power plants

International Nuclear Information System (INIS)

Abel, P.S.; Greybeck, E.M.; Omberg, R.P.

1981-09-01

Cost estimates for nuclear power plants currently under construction are on the order of four billion dollars. It will be shown, in this paper, that this is a direct consequence of relatively high inflation rates and relatively long construction times. If either inflation rates or construction times, or a combination thereof, should decrease significantly, cost estimates for nuclear power plants could return to approximately two billion dollars

46 CFR 560.5 - Receipt of relevant information.

Science.gov (United States)

2010-10-01

... 46 Shipping 9 2010-10-01 2010-10-01 false Receipt of relevant information. 560.5 Section 560.5... FOREIGN PORTS § 560.5 Receipt of relevant information. (a) In making its decision on matters arising under... submissions should be supported by affidavits of fact and memorandum of law. Relevant information may include...

An Adjusted Discount Rate Model for Fuel Cycle Cost Estimation

Energy Technology Data Exchange (ETDEWEB)

Kim, S. K.; Kang, G. B.; Ko, W. I. [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2013-10-15

Owing to the diverse nuclear fuel cycle options available, including direct disposal, it is necessary to select the optimum nuclear fuel cycles in consideration of the political and social environments as well as the technical stability and economic efficiency of each country. Economic efficiency is therefore one of the significant evaluation standards. In particular, because nuclear fuel cycle cost may vary in each country, and the estimated cost usually prevails over the real cost, when evaluating the economic efficiency, any existing uncertainty needs to be removed when possible to produce reliable cost information. Many countries still do not have reprocessing facilities, and no globally commercialized HLW (High-level waste) repository is available. A nuclear fuel cycle cost estimation model is therefore inevitably subject to uncertainty. This paper analyzes the uncertainty arising out of a nuclear fuel cycle cost evaluation from the viewpoint of a cost estimation model. Compared to the same discount rate model, the nuclear fuel cycle cost of a different discount rate model is reduced because the generation quantity as denominator in Equation has been discounted. Namely, if the discount rate reduces in the back-end process of the nuclear fuel cycle, the nuclear fuel cycle cost is also reduced. Further, it was found that the cost of the same discount rate model is overestimated compared with the different discount rate model as a whole.

An Adjusted Discount Rate Model for Fuel Cycle Cost Estimation

International Nuclear Information System (INIS)

Kim, S. K.; Kang, G. B.; Ko, W. I.

2013-01-01

Owing to the diverse nuclear fuel cycle options available, including direct disposal, it is necessary to select the optimum nuclear fuel cycles in consideration of the political and social environments as well as the technical stability and economic efficiency of each country. Economic efficiency is therefore one of the significant evaluation standards. In particular, because nuclear fuel cycle cost may vary in each country, and the estimated cost usually prevails over the real cost, when evaluating the economic efficiency, any existing uncertainty needs to be removed when possible to produce reliable cost information. Many countries still do not have reprocessing facilities, and no globally commercialized HLW (High-level waste) repository is available. A nuclear fuel cycle cost estimation model is therefore inevitably subject to uncertainty. This paper analyzes the uncertainty arising out of a nuclear fuel cycle cost evaluation from the viewpoint of a cost estimation model. Compared to the same discount rate model, the nuclear fuel cycle cost of a different discount rate model is reduced because the generation quantity as denominator in Equation has been discounted. Namely, if the discount rate reduces in the back-end process of the nuclear fuel cycle, the nuclear fuel cycle cost is also reduced. Further, it was found that the cost of the same discount rate model is overestimated compared with the different discount rate model as a whole

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)

Antisocial personality disorder is associated with receipt of physical disability benefits in substance abuse treatment patients.

Science.gov (United States)

Byrne, Shannon A; Cherniack, Martin G; Petry, Nancy M

2013-09-01

Opioid dependence is growing at an alarming rate in the United States, and opioid dependent patients have substantial medical, as well as psychiatric, conditions that impact their ability to work. This study evaluated the association between antisocial personality disorder (ASPD) and receipt of physical disability payments in methadone maintenance patients. Using data from 115 drug and alcohol abusing methadone maintained patients participating in two clinical trials, baseline characteristics of individuals receiving (n=22) and those not receiving (n=93) physical disability benefits were compared, and a logistic regression evaluated unique predictors of disability status. Both an ASPD diagnosis and severity of medical problems were significant predictors of disability receipt, ps<.05. After controlling for other variables that differed between groups, patients with ASPD were more than five times likelier to receive physical disability benefits than patients without ASPD (odds ratio=5.66; 95% confidence interval=1.58-20.28). These results demonstrate a role of ASPD in the receipt of disability benefits in substance abusers and suggest the need for greater understanding of the reasons for high rates of physical disability benefits in this population. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

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.

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.

Percentage of Fast-Track Receipts

Data.gov (United States)

Social Security Administration — The dataset provides the percentage of fast-track receipts by state during the reporting fiscal year. Fast-tracked cases consist of those cases identified as Quick...

Factors influencing access to education, decision making, and receipt of preferred dialysis modality in unplanned dialysis start patients.

Science.gov (United States)

Machowska, Anna; Alscher, Mark Dominik; Reddy Vanga, Satyanarayana; Koch, Michael; Aarup, Michael; Qureshi, Abdul Rashid; Lindholm, Bengt; Rutherford, Peter A

2016-01-01

Unplanned dialysis start (UPS) leads to worse clinical outcomes than planned start, and only a minority of patients ever receive education on this topic and are able to make a modality choice, particularly for home dialysis. This study aimed to determine the predictive factors for patients receiving education, making a decision, and receiving their preferred modality choice in UPS patients following a UPS educational program (UPS-EP). The Offering Patients Therapy Options in Unplanned Start (OPTiONS) study examined the impact of the implementation of a specific UPS-EP, including decision support tools and pathway improvement on dialysis modality choice. Linear regression models were used to examine the factors predicting three key steps: referral and receipt of UPS-EP, modality decision making, and actual delivery of preferred modality choice. A simple economic assessment was performed to examine the potential benefit of implementing UPS-EP in terms of dialysis costs. The majority of UPS patients could receive UPS-EP (214/270 patients) and were able to make a decision (177/214), although not all patients received their preferred choice (159/177). Regression analysis demonstrated that the initial dialysis modality was a predictive factor for referral and receipt of UPS-EP and modality decision making. In contrast, age was a predictor for referral and receipt of UPS-EP only, and comorbidity was not a predictor for any step, except for myocardial infarction, which was a weak predictor for lower likelihood of receiving preferred modality. Country practices predicted UPS-EP receipt and decision making. Economic analysis demonstrated the potential benefit of UPS-EP implementation because dialysis modality costs were associated with modality distribution driven by patient preference. Education and decision support can allow UPS patients to understand their options and choose dialysis modality, and attention needs to be focused on ensuring equity of access to educational

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

Hospital cost-containment strategies that earn the respect of rating agencies.

Science.gov (United States)

Dopoulos, Jason

2016-01-01

To confirm that hospitals have the necessary structures and strategies in place to reduce costs and secure future market share, credit rating agencies analyze a variety of quantitative and qualitative criteria, including: Salaries and benefits, bad debt, age of plant and depreciation, and other line items that may point to inefficiencies in a hospital's expense structure. Cost-benefit analyses, strategic plans, and leadership qualities that show the long-term value of expense cuts, capital investments, and mergers and acquisitions. Cost-effective and clinically appropriate shifts in a hospital's outpatient-to-inpatient ratio. Liquidity and market share.

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...

Spent fuel receipt scenarios study

International Nuclear Information System (INIS)

Ballou, L.B.; Montan, D.N.; Revelli, M.A.

1990-09-01

This study reports on the results of an assignment from the DOE Office of Civilian Radioactive Waste Management to evaluate of the effects of different scenarios for receipt of spent fuel on the potential performance of the waste packages in the proposed Yucca Mountain high-level waste repository. The initial evaluations were performed and an interim letter report was prepared during the fall of 1988. Subsequently, the scope of work was expanded and additional analyses were conducted in 1989. This report combines the results of the two phases of the activity. This study is a part of a broader effort to investigate the options available to the DOE and the nuclear utilities for selection of spent fuel for acceptance into the Federal Waste Management System for disposal. Each major element of the system has evaluated the effects of various options on its own operations, with the objective of providing the basis for performing system-wide trade-offs and determining an optimum acceptance scenario. Therefore, this study considers different scenarios for receipt of spent fuel by the repository only from the narrow perspective of their effect on the very-near-field temperatures in the repository following permanent closure. This report is organized into three main sections. The balance of this section is devoted to a statement of the study objective, a summary of the assumptions. The second section of the report contains a discussion of the major elements of the study. The third section summarizes the results of the study and draws some conclusions from them. The appendices include copies of the waste acceptance schedule and the existing and projected spent fuel inventory that were used in the study. 10 refs., 27 figs

Female fitness optimum at intermediate mating rates under traumatic mating.

Directory of Open Access Journals (Sweden)

Rolanda Lange

Full Text Available Traumatic mating behaviors often bear signatures of sexual conflict and are then typically considered a male strategy to circumvent female choice mechanisms. In an extravagant mating ritual, the hermaphroditic sea slug Siphopteron quadrispinosum pierces the integument of their mating partners with a syringe-like penile stylet that injects prostate fluids. Traumatic injection is followed by the insertion of a spiny penis into the partner's gonopore to transfer sperm. Despite traumatic mating, field mating rates exceed those required for female fertilization insurance, possibly because costs imposed on females are balanced by direct or indirect benefits of multiple sperm receipt. To test this idea, we exposed animals to a relevant range of mating opportunity regimes and assessed the effects on mating behavior and proxies of female fitness. We find penis intromission duration to decrease with mating rates, and a female fecundity maximum at intermediate mating rates. The latter finding indicates that benefits beyond fertilization insurance can make higher mating rates also beneficial from a female perspective in this traumatically mating species.

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.

26 CFR 1.993-6 - Definition of gross receipts.

Science.gov (United States)

2010-04-01

... 26 Internal Revenue 10 2010-04-01 2010-04-01 false Definition of gross receipts. 1.993-6 Section 1.993-6 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES Domestic International Sales Corporations § 1.993-6 Definition of gross receipts. (a...

Receipt of Caregiving and Fall Risk in US Community-dwelling Older Adults.

Science.gov (United States)

Hoffman, Geoffrey J; Hays, Ron D; Wallace, Steven P; Shapiro, Martin F; Yakusheva, Olga; Ettner, Susan L

2017-04-01

Falls and fall-related injuries (FRI) are common and costly occurrences among older adults living in the community, with increased risk for those with physical and cognitive limitations. Caregivers provide support for older adults with physical functioning limitations, which are associated with fall risk. Using the 2004-2012 waves of the Health and Retirement Study, we examined whether receipt of low (0-13 weekly hours) and high levels (≥14 weekly hours) of informal care or any formal care is associated with lower risk of falls and FRIs among community-dwelling older adults. We additionally tested whether serious physical functioning (≥3 activities of daily living) or cognitive limitations moderated this relationship. Caregiving receipt categories were jointly significant in predicting noninjurious falls (P=0.03) but not FRIs (P=0.30). High levels of informal care category (P=0.001) and formal care (Pfall risk relative to low levels of informal care. Among individuals with ≥3 activities of daily living, fall risks were reduced by 21% for those receiving high levels of informal care; additionally, FRIs were reduced by 42% and 58% for those receiving high levels of informal care and any formal care. High levels of informal care receipt were also associated with a 54% FRI risk reduction among the cognitively impaired. Fall risk reductions among older adults occurred predominantly among those with significant physical and cognitive limitations. Accordingly, policy efforts involving fall prevention should target populations with increased physical functioning and cognitive limitations. They should also reduce financial barriers to informal and formal caregiving.

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.

Pavlovian reward prediction and receipt in schizophrenia: relationship to anhedonia.

Directory of Open Access Journals (Sweden)

Erin C Dowd

Full Text Available Reward processing abnormalities have been implicated in the pathophysiology of negative symptoms such as anhedonia and avolition in schizophrenia. However, studies examining neural responses to reward anticipation and receipt have largely relied on instrumental tasks, which may confound reward processing abnormalities with deficits in response selection and execution. 25 chronic, medicated outpatients with schizophrenia and 20 healthy controls underwent functional magnetic resonance imaging using a pavlovian reward prediction paradigm with no response requirements. Subjects passively viewed cues that predicted subsequent receipt of monetary reward or non-reward, and blood-oxygen-level-dependent signal was measured at the time of cue presentation and receipt. At the group level, neural responses to both reward anticipation and receipt were largely similar between groups. At the time of cue presentation, striatal anticipatory responses did not differ between patients and controls. Right anterior insula demonstrated greater activation for nonreward than reward cues in controls, and for reward than nonreward cues in patients. At the time of receipt, robust responses to receipt of reward vs. nonreward were seen in striatum, midbrain, and frontal cortex in both groups. Furthermore, both groups demonstrated responses to unexpected versus expected outcomes in cortical areas including bilateral dorsolateral prefrontal cortex. Individual difference analyses in patients revealed an association between physical anhedonia and activity in ventral striatum and ventromedial prefrontal cortex during anticipation of reward, in which greater anhedonia severity was associated with reduced activation to money versus no-money cues. In ventromedial prefrontal cortex, this relationship held among both controls and patients, suggesting a relationship between anticipatory activity and anhedonia irrespective of diagnosis. These findings suggest that in the absence of

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

Science.gov (United States)

John, Denny; Parikh, Rajul

2017-07-01

Population-based screening for glaucoma has been demonstrated to be cost-effective if targeted at high-risk groups such as older adults and those with a family history of glaucoma, and through use of a technician for conducting initial assessment rather than a medical specialist. This study attempts to investigate the cost-effectiveness of a hypothetical community screening and subsequent treatment programme for glaucoma in comparison with current practice (i.e. with no screening programme but with some opportunistic case finding) in the urban areas of India. A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in the urban areas of India. Screening and treatment costs were obtained from an administrator of a tertiary eye hospital in India. The probabilities for the screening pathway were derived from published literature and expert opinion. The glaucoma prevalence rates for urban areas were adapted from the Chennai Glaucoma Study findings. A decision-analytical model using TreeAge Pro 2015 was built to model events, costs and treatment pathways. One-way sensitivity analyses were conducted. The introduction of a community screening programme for glaucoma is likely to be cost-effective, the estimated incremental cost-effectiveness ratio (ICER) values being 10,668.68 when compared with no screening programme and would treat an additional 4443 cases and prevent 1790 person-years of blindness over a 10-year period in the urban areas of India. Sensitivity analyses revealed that glaucoma prevalence rates across various age groups, screening uptake rate, follow-up compliance after screening, treatment costs and utility values of health states associated with medical and surgical treatment of glaucoma had an impact on the ICER values of the screening programme. In comparison with current practice (i.e. without a screening programme but with some opportunistic case finding

Cost-effectiveness of screening for asymptomatic carotid atherosclerotic disease.

Science.gov (United States)

Derdeyn, C P; Powers, W J

1996-11-01

The value of screening for asymptomatic carotid stenosis has become an important issue with the recently reported beneficial effect of endarterectomy. The purpose of this study is to evaluate the cost-effectiveness of using Doppler ultrasound as a screening tool to select subjects for arteriography and subsequent surgery. A computer model was developed to simulate the cost-effectiveness of screening a cohort of 1000 men during a 20-year period. The primary outcome measure was incremental present-value dollar expenditures for screening and treatment per incremental present-value quality-adjusted life-year (QALY) saved. Estimates of disease prevalence and arteriographic and surgical complication rates were obtained from the literature. Probabilities of stroke and death with surgical and medical treatment were obtained from published clinical trials. Doppler ultrasound sensitivity and specificity were obtained through review of local experience. Estimates of costs were obtained from local Medicare reimbursement data. A one-time screening program of a population with a high prevalence (20%) of > or = 60% stenosis cost $35130 per incremental QALY gained. Decreased surgical benefit or increased annual discount rate was detrimental, resulting in lost QALYs. Annual screening cost $457773 per incremental QALY gained. In a low-prevalence (4%) population, one-time screening cost $52588 per QALY gained, while annual screening was detrimental. The cost-effectiveness of a one-time screening program for an asymptomatic population with a high prevalence of carotid stenosis may be cost-effective. Annual screening is detrimental. The most sensitive variables in this simulation model were long-term stroke risk reduction after surgery and annual discount rate for accumulated costs and QALYs.

77 FR 39442 - Receipts-Based, Small Business Size Standard

Science.gov (United States)

2012-07-03

... RIN 3150-AJ14 [NRC-2012-0062] Receipts-Based, Small Business Size Standard AGENCY: Nuclear Regulatory... Regulatory Flexibility Act of 1980, as amended. The NRC is proposing to increase its receipts-based, small business size standard from $6.5 million to $7 million to conform to the standard set by the Small Business...

77 FR 39385 - Receipts-Based, Small Business Size Standard

Science.gov (United States)

2012-07-03

.... The NRC is increasing its receipts-based, small business size standard from $6.5 million to $7 million...-based, small business size standard increasing from $6.5 million to $7.0 million. This adjustment is to... regulatory programs. The NRC is increasing its receipts-based, small business size standard from $6.5 million...

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.

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.

Effectiveness and cost-effectiveness of serum B-type natriuretic peptide testing and monitoring in patients with heart failure in primary and secondary care: an evidence synthesis, cohort study and cost-effectiveness model.

Science.gov (United States)

Pufulete, Maria; Maishman, Rachel; Dabner, Lucy; Mohiuddin, Syed; Hollingworth, William; Rogers, Chris A; Higgins, Julian; Dayer, Mark; Macleod, John; Purdy, Sarah; McDonagh, Theresa; Nightingale, Angus; Williams, Rachael; Reeves, Barnaby C

2017-08-01

Heart failure (HF) affects around 500,000 people in the UK. HF medications are frequently underprescribed and B-type natriuretic peptide (BNP)-guided therapy may help to optimise treatment. To evaluate the clinical effectiveness and cost-effectiveness of BNP-guided therapy compared with symptom-guided therapy in HF patients. Systematic review, cohort study and cost-effectiveness model. A literature review and usual care in the NHS. (a) HF patients in randomised controlled trials (RCTs) of BNP-guided therapy; and (b) patients having usual care for HF in the NHS. Systematic review : BNP-guided therapy or symptom-guided therapy in primary or secondary care. Cohort study : BNP monitored (≥ 6 months' follow-up and three or more BNP tests and two or more tests per year), BNP tested (≥ 1 tests but not BNP monitored) or never tested. Cost-effectiveness model : BNP-guided therapy in specialist clinics. Mortality, hospital admission (all cause and HF related) and adverse events; and quality-adjusted life-years (QALYs) for the cost-effectiveness model. Systematic review : Individual participant or aggregate data from eligible RCTs. Cohort study : The Clinical Practice Research Datalink, Hospital Episode Statistics and National Heart Failure Audit (NHFA). A systematic literature search (five databases, trial registries, grey literature and reference lists of publications) for published and unpublished RCTs. Five RCTs contributed individual participant data (IPD) and eight RCTs contributed aggregate data (1536 participants were randomised to BNP-guided therapy and 1538 participants were randomised to symptom-guided therapy). For all-cause mortality, the hazard ratio (HR) for BNP-guided therapy was 0.87 [95% confidence interval (CI) 0.73 to 1.04]. Patients who were aged Chris A Rogers' and Maria Pufulete's time contributing to the study. Syed Mohiuddin's time is supported by the NIHR Collaboration for Leadership in Applied Health Research and Care West at University

39 CFR 2.2 - Agent for receipt of process.

Science.gov (United States)

2010-07-01

... 39 Postal Service 1 2010-07-01 2010-07-01 false Agent for receipt of process. 2.2 Section 2.2 Postal Service UNITED STATES POSTAL SERVICE THE BOARD OF GOVERNORS OF THE U.S. POSTAL SERVICE GENERAL AND TECHNICAL PROVISIONS (ARTICLE II) § 2.2 Agent for receipt of process. The General Counsel of the Postal...

Veneer-log production and receipts, North Central Region, 1976.

Science.gov (United States)

James E. Blyth; Jerold T. Hahn

1978-01-01

Shows 1976 veneer-log production and receipts by species in the Lake States (Michigan, Minnesota, and Wisconsin) and in the Central States (Illinois, Indiana, Iowa, and Missouri). Comparisons are made with similar data for 1974. Includes tables showing veneer-log production and receipts (for selected years) since 1946 in the Lake States and since 1956 in the Central...

Veneer-log production and receipts, North Central Region, 1974.

Science.gov (United States)

James E. Blyth; Jerold T. Hahn

1976-01-01

Shows 1974 veneer-log production and receipts by species in the Lake States (Michigan, Minnesota, and Wisconsin) and in the Central States (Illinois, Indiana, Iowa, and Missouri). Comparisons are made with similar data for 1972. Includes tables showing veneer-log production and receipts (for selected years) since 1946 in the Lake States and since 1956 in the Central...

Cost and cost-effectiveness of newborn home visits: findings from the Newhints cluster-randomised controlled trial in rural Ghana.

Science.gov (United States)

Pitt, Catherine; Tawiah, Theresa; Soremekun, Seyi; ten Asbroek, Augustinus H A; Manu, Alexander; Tawiah-Agyemang, Charlotte; Hill, Zelee; Owusu-Agyei, Seth; Kirkwood, Betty R; Hanson, Kara

2016-01-01

Every year, 2·9 million newborn babies die worldwide. A meta-analysis of four cluster-randomised controlled trials estimated that home visits by trained community members in programme settings in Ghana and south Asia reduced neonatal mortality by 12% (95% CI 5-18). We aimed to estimate the costs and cost-effectiveness of newborn home visits in a programme setting. We prospectively collected detailed cost data alongside the Newhints trial, which tested the effect of a home-visits intervention in seven districts in rural Ghana and showed a reduction of 8% (95% CI -12 to 25%) in neonatal mortality. The intervention consisted of a package of home visits to pregnant women and their babies in the first week of life by community-based surveillance volunteers. We calculated incremental cost-effectiveness ratios (ICERs) with Monte Carlo simulation and one-way sensitivity analyses and characterised uncertainty with cost-effectiveness planes and cost-effectiveness acceptability curves. We then modelled the potential cost-effectiveness for baseline neonatal mortality rates of 20-60 deaths per 1000 livebirths with use of a meta-analysis of effectiveness estimates. In the 49 zones randomly allocated to receive the Newhints intervention, a mean of 407 (SD 18) community-based surveillance volunteers undertook home visits for 7848 pregnant women who gave birth to 7786 live babies in 2009. Annual economic cost of implementation was US$203 998, or $0·53 per person. In the base-case analysis, the Newhints intervention cost a mean of $10 343 (95% CI 2963 to -7674) per newborn life saved, or $352 (95% CI 104 to -268) per discounted life-year saved, and had a 72% chance of being highly cost effective with respect to Ghana's 2009 gross domestic product per person. Key determinants of cost-effectiveness were the discount rate, protective effectiveness, baseline neonatal mortality rate, and implementation costs. In the scenarios modelled with the meta-analysis results, the ICER

Validating self-reported food expenditures against food store and eating-out receipts.

Science.gov (United States)

Tang, W; Aggarwal, A; Liu, Z; Acheson, M; Rehm, C D; Moudon, A V; Drewnowski, A

2016-03-01

To compare objective food store and eating-out receipts with self-reported household food expenditures. The Seattle Obesity Study II was based on a representative sample of King County adults, Washington, USA. Self-reported household food expenditures were modeled on the Flexible Consumer Behavior Survey (FCBS) Module from 2007 to 2009 National Health and Nutrition Examination Survey (NHANES). Objective food expenditure data were collected using receipts. Self-reported food expenditures for 447 participants were compared with receipts using paired t-tests, Bland-Altman plots and κ-statistics. Bias by sociodemographics was also examined. Self-reported expenditures closely matched with objective receipt data. Paired t-tests showed no significant differences between receipts and self-reported data on total food expenditures, expenditures at food stores or eating out. However, the highest-income strata showed weaker agreement. Bland-Altman plots confirmed no significant bias across both methods-mean difference: 6.4; agreement limits: -123.5 to 143.4 for total food expenditures, mean difference 5.7 for food stores and mean difference 1.7 for eating out. The κ-statistics showed good agreement for each (κ 0.51, 0.41 and 0.49 respectively. Households with higher education and income had significantly more number of receipts and higher food expenditures. Self-reported food expenditures using NHANES questions, both for food stores and eating out, serve as a decent proxy for objective household food expenditures from receipts. This method should be used with caution among high-income populations, or with high food expenditures. This is the first validation of the FCBS food expenditures question using food store and eating-out receipts.

Low-cost photonic sensors for carbon dioxide exchange rate measurement

Science.gov (United States)

Bieda, Marcin S.; Sobotka, Piotr; Lesiak, Piotr; Woliński, Tomasz R.

2017-10-01

Carbon dioxide (CO2) measurement has an important role in atmosphere monitoring. Usually, two types of measurements are carried out. The first one is based on gas concentration measurement while the second involves gas exchange rate measurement between earth surface and atmosphere [1]. There are several methods which allow gas concentration measurement. However, most of them require expensive instrumentation or large devices (i.e. gas chambers). In order to precisely measure either CO2 concentration or CO2 exchange rate, preferably a sensors network should be used. These sensors must have small dimensions, low power consumption, and they should be cost-effective. Therefore, this creates a great demand for a robust low-power and low-cost CO2 sensor [2,3]. As a solution, we propose a photonic sensor that can measure CO2 concentration and also can be used to measure gas exchange by using the Eddy covariance method [1].

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

Science.gov (United States)

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

2014-01-01

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

How rebates, copayments, and administration costs affect the cost-effectiveness of osteoporosis therapies.

Science.gov (United States)

Ferko, Nicole C; Borisova, Natalie; Airia, Parisa; Grima, Daniel T; Thompson, Melissa F

2012-11-01

Because of rising drug expenditures, cost considerations have become essential, necessitating the requirement for cost-effectiveness analyses for managed care organizations (MCOs). The study objective is to examine the impact of various drug-cost components, in addition to wholesale acquisition cost (WAC), on the cost-effectiveness of osteoporosis therapies. A Markov model of osteoporosis was used to exemplify different drug cost scenarios. We examined the effect of varying rebates for oral bisphosphonates--risedronate and ibandronate--as well as considering the impact of varying copayments and administration costs for intravenous zoledronate. The population modeled was 1,000 American women, > or = 50 years with osteoporosis. Patients were followed for 1 year to reflect an annual budget review of formularies by MCOs. The cost of therapy was based on an adjusted WAC, and is referred to as net drug cost. The total annual cost incurred by an MCO for each drug regimen was calculated using the net drug cost and fracture cost. We estimated cost on a quality adjusted life year (QALY) basis. When considering different rebates, results for risedronate versus ibandronate vary from cost-savings (i.e., costs less and more effective) to approximately $70,000 per QALY. With no risedronate rebate, an ibandronate rebate of approximately 65% is required before cost per QALY surpasses $50,000. With rebates greater than 25% for risedronate, irrespective of ibandronate rebates, results become cost-saving. Results also showed the magnitude of cost savings to the MCO varied by as much as 65% when considering no administration cost and the highest coinsurance rate for zoledronate. Our study showed that cost-effectiveness varies considerably when factors in addition to the WAC are considered. This paper provides recommendations for pharmaceutical manufacturers and MCOs when developing and interpreting such analyses.

A Cost-Effectiveness Analysis of Gemcitabine plus Cisplatin Versus Gemcitabine Alone for Treatment of Advanced Biliary Tract Cancer in Japan.

Science.gov (United States)

Tsukiyama, Ikuto; Ejiri, Masayuki; Yamamoto, Yoshihiro; Nakao, Haruhisa; Yoneda, Masashi; Matsuura, Katsuhiko; Arakawa, Ichiro; Saito, Hiroko; Inoue, Tadao

2017-12-01

This study assessed the cost-effectiveness of combination treatment with gemcitabine and cisplatin compared to treatment with gemcitabine alone for advanced biliary tract cancer (BTC) in Japan. A monthly transmitted Markov model of three states was constructed based on the Japan BT-22 trial. Transition probabilities among the health states were derived from a trial conducted in Japan and converted to appropriate parameters for our model. The associated cost components, obtained from a receipt-based survey undertaken at the Aichi Medical University Hospital, were those related to inpatient care, outpatient care, and treatment for BTC. Costs for palliative care and treatment of adverse events were obtained from the National Health Insurance price list. We estimated cost-effectiveness per quality-adjusted life year (QALY) at a time horizon of 36 months. An annual discount of 3 % for both cost and outcome was considered. The base case outcomes indicated that combination therapy was less cost-effective than monotherapy when the incremental cost-effectiveness ratio (ICER) was approximately 14 million yen per QALY gained. The deterministic sensitivity analysis of the ICER revealed that the ICER of the base case was robust. A probabilistic analysis conducted with 10,000-time Monte Carlo simulations demonstrated efficacy at the willingness to pay threshold of 6 million yen per QALY gained for approximately 33 % of the population. In Japan, combination therapy is less cost-effective than monotherapy for treating advanced BTC, regardless of the statistical significance of the two therapies. Useful information on the cost-effectiveness of chemotherapy is much needed for the treatment of advanced BTC in Japan.

Will Changes to Medicare Payment Rates Alter Hospice's Cost-Saving Ability?

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Taylor, Donald H; Bhavsar, Nrupen A; Bull, Janet H; Kassner, Cordt T; Olson, Andrew; Boucher, Nathan A

2018-05-01

On January 1, 2016, Medicare implemented a new "two-tiered" model for hospice services, with per diem rates increased for days 1 through 60, decreased for days 61 and greater, and service intensity add-on payments made retrospectively for the last seven days of life. To estimate whether the Medicare hospice benefit's potential for cost savings will change as a result of the January 2016 change in payment structure. Analysis of decedents' claims records using propensity score matching, logistic regression, and sensitivity analysis. All age-eligible Medicare decedents who received care and died in North Carolina in calendar years 2009 and 2010. Costs to Medicare for hospice and other healthcare services. Medicare costs were reduced from hospice election until death using both 2009-2010 and new 2016 payment structures and rates. Mean cost savings were $1,527 with actual payment rates, and would have been $2,105 with the new payment rates (p payment rate change. Cost savings were found for all primary diagnoses analyzed except dementia.

Disability and employee benefits receipt: evidence from the U.S. Vocational Rehabilitation Services Program.

Science.gov (United States)

Sosulski, Marya R; Donnell, Chandra; Kim, Woo Jong

2012-01-01

Studies indicate positive effects of the U.S. Vocational Rehabilitation Services (VRS) in assisting people with disabilities to find independent employment. Underemployment continues to impact access to adequate health care and other benefits. Workers with disabilities receive fewer benefits, overall. With data from the Longitudinal Study of Vocational Rehabilitation Services Program (LSVRSP), the authors compare the rates of receipt of 6 types of benefits for people with physical, mental, and sensory impairments. Although those with physical disabilities are most likely to receive benefits, all groups lack adequate access to health care, sick leave, and vacation. The authors discuss implications for services provision in the current job market.

Cost-benefit analysis of decreased ventilation rates and radon exhalation from building materials

International Nuclear Information System (INIS)

Ericson, S.O.

1984-01-01

Decreased ventilation, achieved by weather stripping and other tightening measures, is the most cost effective way to energy conservation. A very low investment can result in a considerable decrease in ventilation rate. For a typical detached house in Sweden this can be equivalent to a decrease in oil consumption of 0.5 m 3 . At present price this corresponds to a saving of SEK 1200, 150 US dollars per annum. The contribution of the building materials to the concentration of radon in indoor air is approximately the inverse to air exchange rate. For a small change in ventilation rate and cost, in SEK/man Sv or US dollar/man Sv, is a function of ventilation rate, exhalation from building materials, the ratio between surface of walls, floor and ceiling to the volume of air. Thus, it is possible to find the specific ventilation rate where the marginal cost for a small increase in ventilation rate and the marginal reduction in radon concentration will give a specific amount of money for each man Sv. Examples are given. Conclusions are that for most building materials in a climate like the Swedish, there are other factors than exhalation of radon from building materials that sets the lower limit of recommendable ventilation rate. (Author)

Economic Indicators of the Farm Sector. Costs of Production, 1986.

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Economic Research Service (USDA), Washington, DC.

This report contains 121 tables that estimate the costs of production of various commodities on United States farms in 1986. The report first assesses costs and returns on a per-unit basis, such as one acre or one animal, under three sections of a budget: cash receipts, cash expenses, and economic costs. The budgets are based on national…

Can a Costly Intervention Be Cost-effective?

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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

Cost-effectiveness analysis of infant feeding strategies to prevent ...

African Journals Online (AJOL)

Changing feeding practices is beneficial, depending on context. Breastfeeding is dominant (less costly, more effective) in rural settings, whilst formula feeding is a dominant strategy in urban settings. Cost-effectiveness was most sensitive to proportion of women on lifelong antiretroviral therapy (ART) and infant mortality rate ...

Cost-related model for transit rates in electric power distribution networks

International Nuclear Information System (INIS)

Collstrand, F.

1994-02-01

The planned deregulation of the swedish electrical power market will require a new structure of the electrical energy rates. In this report different models of transit rates are studied. The report includes studies of literature and a proposal to a rate structure and is made specifically for Malmoe Energi AB. The differences between various methods of calculating the transfer cost are illustrated. Further, the build-up of the tariff structure and its base elements are discussed. The costs are divided on different categories of costumers and shows the cost for each customer. The new regulations should apply simultaneously to all networks, independent of the voltage level. The transit cost should be based on a number of basic elements: capital cost, operation and maintenance, losses, measuring and administration. Capital cost and operation and maintenance should be charged as power fees, the loss cost as an energy fee and the measuring and administration cost as a fixed fee. The customer bill should be split into two parts, one for the transit cost and one for the energy usage. 15 refs., 37 tabs., 6 figs

Cost-effectiveness of volumetric alcohol taxation in Australia.

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Byrnes, Joshua M; Cobiac, Linda J; Doran, Christopher M; Vos, Theo; Shakeshaft, Anthony P

2010-04-19

To estimate the potential health benefits and cost savings of an alcohol tax rate that applies equally to all alcoholic beverages based on their alcohol content (volumetric tax) and to compare the cost savings with the cost of implementation. Mathematical modelling of three scenarios of volumetric alcohol taxation for the population of Australia: (i) no change in deadweight loss, (ii) no change in tax revenue, and (iii) all alcoholic beverages taxed at the same rate as spirits. Estimated change in alcohol consumption, tax revenue and health benefit. The estimated cost of changing to a volumetric tax rate is $18 million. A volumetric tax that is deadweight loss-neutral would increase the cost of beer and wine and reduce the cost of spirits, resulting in an estimated annual increase in taxation revenue of $492 million and a 2.77% reduction in annual consumption of pure alcohol. The estimated net health gain would be 21 000 disability-adjusted life-years (DALYs), with potential cost offsets of $110 million per annum. A tax revenue-neutral scenario would result in an 0.05% decrease in consumption, and a tax on all alcohol at a spirits rate would reduce consumption by 23.85% and increase revenue by $3094 million [corrected]. All volumetric tax scenarios would provide greater health benefits and cost savings to the health sector than the existing taxation system, based on current understandings of alcohol-related health effects. An equalized volumetric tax that would reduce beer and wine consumption while increasing the consumption of spirits would need to be approached with caution. Further research is required to examine whether alcohol-related health effects vary by type of alcoholic beverage independent of the amount of alcohol consumed to provide a strong evidence platform for alcohol taxation policies.

Cost-effectiveness of a potential future Helicobacter pylori vaccine in the Netherlands : The impact of varying the discount rate for health

NARCIS (Netherlands)

de Vries, Robin; Klok, Rogier M.; Brouwers, Jacobus R. B. J.; Postma, Maarten J.

2009-01-01

To estimate the cost-effectiveness of a potential Helicobacter pylori (HP) vaccine for the Dutch situation, we developed a Markov model. Several HP prevalence scenarios were assessed. Additionally, we assessed the impact of the discount rate for health on the outcomes, as this influence can be

Long-term cost-effectiveness of collaborative care (vs usual care) for people with depression and comorbid diabetes or cardiovascular disease: a Markov model informed by the COINCIDE randomised controlled trial.

Science.gov (United States)

Camacho, Elizabeth M; Ntais, Dionysios; Coventry, Peter; Bower, Peter; Lovell, Karina; Chew-Graham, Carolyn; Baguley, Clare; Gask, Linda; Dickens, Chris; Davies, Linda M

2016-10-07

To evaluate the long-term cost-effectiveness of collaborative care (vs usual care) for treating depression in patients with diabetes and/or coronary heart disease (CHD). 36 primary care general practices in North West England. 387 participants completed baseline assessment (collaborative care: 191; usual care: 196) and full or partial 4-month follow-up data were captured for 350 (collaborative care: 170; usual care: 180). 62% of participants were male, 14% were non-white. Participants were aged ≥18 years, listed on a Quality and Outcomes Framework register for CHD and/or type 1 or 2 diabetes mellitus, with persistent depressive symptoms. Patients with psychosis or type I/II bipolar disorder, actively suicidal, in receipt of services for substance misuse, or already in receipt of psychological therapy for depression were excluded. Collaborative care consisted of evidence-based low-intensity psychological treatments, delivered over 3 months and case management by a practice nurse and a Psychological Well Being Practitioner. As planned, the primary measure of cost-effectiveness was the incremental cost-effectiveness ratio (cost per quality-adjusted life year (QALY)). A Markov model was constructed to extrapolate the trial results from short-term to long-term (24 months). The mean cost per participant of collaborative care was £317 (95% CI 284 to 350). Over 24 months, it was estimated that collaborative care was associated with greater healthcare usage costs (net cost £674 (95% CI -30 953 to 38 853)) and QALYs (net QALY gain 0.04 (95% CI -0.46 to 0.54)) than usual care, resulting in a cost per QALY gained of £16 123, and a likelihood of being cost-effective of 0.54 (willingness to pay threshold of £20 000). Collaborative care is a potentially cost-effective long-term treatment for depression in patients with comorbid physical and mental illness. The estimated cost per QALY gained was below the threshold recommended by English decision

The analysis of cost-effectiveness of implant and conventional fixed dental prosthesis.

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Chun, June Sang; Har, Alix; Lim, Hyun-Pil; Lim, Hoi-Jeong

2016-02-01

This study conducted an analysis of cost-effectiveness of the implant and conventional fixed dental prosthesis (CFDP) from a single treatment perspective. The Markov model for cost-effectiveness analysis of the implant and CFDP was carried out over maximum 50 years. The probabilistic sensitivity analysis was performed by the 10,000 Monte-Carlo simulations, and cost-effectiveness acceptability curves (CEAC) were also presented. The results from meta-analysis studies were used to determine the survival rates and complication rates of the implant and CFDP. Data regarding the cost of each treatment method were collected from University Dental Hospital and Statistics Korea for 2013. Using the results of the patient satisfaction survey study, quality-adjusted prosthesis year (QAPY) of the implant and CFDP strategy was evaluated with annual discount rate. When only the direct cost was considered, implants were more cost-effective when the willingness to pay (WTP) was more than 10,000 won at 10(th) year after the treatment, and more cost-effective regardless of the WTP from 20(th) year after the prosthodontic treatment. When the indirect cost was added to the direct cost, implants were more cost-effective only when the WTP was more than 75,000 won at the 10(th) year after the prosthodontic treatment, more than 35,000 won at the 20(th) year after prosthodontic treatment. The CFDP was more cost-effective unless the WTP was more than 75,000 won at the 10(th) year after prosthodontic treatment. But the cost-effectivenss tendency changed from CFDP to implant as time passed.

On the cost-effectiveness of Carbon ion radiation therapy for skull base chordoma

International Nuclear Information System (INIS)

Jaekel, Oliver; Land, Beate; Combs, Stephanie Elisabeth; Schulz-Ertner, Daniela; Debus, Juergen

2007-01-01

Aim: The cost-effectiveness of Carbon ion radiotherapy (RT) for patients with skull base chordoma is analyzed. Materials and Methods: Primary treatment costs and costs for recurrent tumors are estimated. The costs for treatment of recurrent tumors were estimated using a sample of 10 patients presenting with recurrent chordoma at the base of skull at DKFZ. Using various scenarios for the local control rate and reimbursements of Carbon ion therapy the cost-effectiveness of ion therapy for these tumors is analyzed. Results: If local control rate for skull base chordoma achieved with carbon ion therapy exceeds 70.3%, the overall treatment costs for carbon RT are lower than for conventional RTI. The cost-effectiveness ratio for carbon RT is 2539 Euro per 1% increase in survival, or 7692 Euro per additional life year. Conclusion: Current results support the thesis that Carbon ion RT, although more expensive, is at least as cost-effective as advanced photon therapies for these patients. Ion RT, however, offers substantial benefits for the patients such as improved control rates and less severe side effects

Long-term effectiveness and cost-effectiveness of smoking cessation interventions in patients with COPD.

Science.gov (United States)

Hoogendoorn, Martine; Feenstra, Talitha L; Hoogenveen, Rudolf T; Rutten-van Mölken, Maureen P M H

2010-08-01

The aim of this study was to estimate the long-term (cost-) effectiveness of smoking cessation interventions for patients with chronic obstructive pulmonary disease (COPD). A systematic review was performed of randomised controlled trials on smoking cessation interventions in patients with COPD reporting 12-month biochemical validated abstinence rates. The different interventions were grouped into four categories: usual care, minimal counselling, intensive counselling and intensive counselling + pharmacotherapy ('pharmacotherapy'). For each category the average 12-month continuous abstinence rate and intervention costs were estimated. A dynamic population model for COPD was used to project the long-term (cost-) effectiveness (25 years) of 1-year implementation of the interventions for 50% of the patients with COPD who smoked compared with usual care. Uncertainty and one-way sensitivity analyses were performed for variations in the calculation of the abstinence rates, the type of projection, intervention costs and discount rates. Nine studies were selected. The average 12-month continuous abstinence rates were estimated to be 1.4% for usual care, 2.6% for minimal counselling, 6.0% for intensive counselling and 12.3% for pharmacotherapy. Compared with usual care, the costs per quality-adjusted life year (QALY) gained for minimal counselling, intensive counselling and pharmacotherapy were euro 16 900, euro 8200 and euro 2400, respectively. The results were most sensitive to variations in the estimation of the abstinence rates and discount rates. Compared with usual care, intensive counselling and pharmacotherapy resulted in low costs per QALY gained with ratios comparable to results for smoking cessation in the general population. Compared with intensive counselling, pharmacotherapy was cost saving and dominated the other interventions.

31 CFR 245.8 - Receipt or recovery of original check.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Receipt or recovery of original check... CHECKS § 245.8 Receipt or recovery of original check. (a) If the original check is received or recovered... of instructions with respect to the negotiability of such check. (b) If the original check is...

The role of cost-effectiveness analysis in developing nutrition policy.

Science.gov (United States)

Cobiac, Linda J; Veerman, Lennert; Vos, Theo

2013-01-01

Concern about the overconsumption of unhealthy foods is growing worldwide. With high global rates of noncommunicable diseases related to poor nutrition and projections of more rapid increases of rates in low- and middle-income countries, it is vital to identify effective but low-cost interventions. Cost-effectiveness studies show that individually targeted dietary interventions can be effective and cost-effective, but a growing number of modeling studies suggest that population-wide approaches may bring larger and more sustained benefits for population health at a lower cost to society. Mandatory regulation of salt in processed foods, in particular, is highly recommended. Future research should focus on lacunae in the current evidence base: effectiveness of interventions addressing the marketing, availability, and price of healthy and unhealthy foods; modeling health impacts of complex dietary changes and multi-intervention strategies; and modeling health implications in diverse subpopulations to identify interventions that will most efficiently and effectively reduce health inequalities.

Differences in Sickness Allowance Receipt between Swedish Speakers and Finnish Speakers in Finland

Directory of Open Access Journals (Sweden)

Kaarina S. Reini

2017-12-01

Full Text Available Previous research has documented lower disability retirement and mortality rates of Swedish speakers as compared with Finnish speakers in Finland. This paper is the first to compare the two language groups with regard to the receipt of sickness allowance, which is an objective health measure that reflects a less severe poor health condition. Register-based data covering the years 1988-2011 are used. We estimate logistic regression models with generalized estimating equations to account for repeated observations at the individual level. We find that Swedish-speaking men have approximately 30 percent lower odds of receiving sickness allowance than Finnish-speaking men, whereas the difference in women is about 15 percent. In correspondence with previous research on all-cause mortality at working ages, we find no language-group difference in sickness allowance receipt in the socially most successful subgroup of the population.

The cost effectiveness of pandemic influenza interventions: a pandemic severity based analysis.

Directory of Open Access Journals (Sweden)

George J Milne

Full Text Available BACKGROUND: The impact of a newly emerged influenza pandemic will depend on its transmissibility and severity. Understanding how these pandemic features impact on the effectiveness and cost effectiveness of alternative intervention strategies is important for pandemic planning. METHODS: A cost effectiveness analysis of a comprehensive range of social distancing and antiviral drug strategies intended to mitigate a future pandemic was conducted using a simulation model of a community of ∼30,000 in Australia. Six pandemic severity categories were defined based on case fatality ratio (CFR, using data from the 2009/2010 pandemic to relate hospitalisation rates to CFR. RESULTS: Intervention strategies combining school closure with antiviral treatment and prophylaxis are the most cost effective strategies in terms of cost per life year saved (LYS for all severity categories. The cost component in the cost per LYS ratio varies depending on pandemic severity: for a severe pandemic (CFR of 2.5% the cost is ∼$9 k per LYS; for a low severity pandemic (CFR of 0.1% this strategy costs ∼$58 k per LYS; for a pandemic with very low severity similar to the 2009 pandemic (CFR of 0.03% the cost is ∼$155 per LYS. With high severity pandemics (CFR >0.75% the most effective attack rate reduction strategies are also the most cost effective. During low severity pandemics costs are dominated by productivity losses due to illness and social distancing interventions, while for high severity pandemics costs are dominated by hospitalisation costs and productivity losses due to death. CONCLUSIONS: The most cost effective strategies for mitigating an influenza pandemic involve combining sustained social distancing with the use of antiviral agents. For low severity pandemics the most cost effective strategies involve antiviral treatment, prophylaxis and short durations of school closure; while these are cost effective they are less effective than other strategies in

The Cost Effectiveness of Pandemic Influenza Interventions: A Pandemic Severity Based Analysis

Science.gov (United States)

Milne, George J.; Halder, Nilimesh; Kelso, Joel K.

2013-01-01

Background The impact of a newly emerged influenza pandemic will depend on its transmissibility and severity. Understanding how these pandemic features impact on the effectiveness and cost effectiveness of alternative intervention strategies is important for pandemic planning. Methods A cost effectiveness analysis of a comprehensive range of social distancing and antiviral drug strategies intended to mitigate a future pandemic was conducted using a simulation model of a community of ∼30,000 in Australia. Six pandemic severity categories were defined based on case fatality ratio (CFR), using data from the 2009/2010 pandemic to relate hospitalisation rates to CFR. Results Intervention strategies combining school closure with antiviral treatment and prophylaxis are the most cost effective strategies in terms of cost per life year saved (LYS) for all severity categories. The cost component in the cost per LYS ratio varies depending on pandemic severity: for a severe pandemic (CFR of 2.5%) the cost is ∼$9 k per LYS; for a low severity pandemic (CFR of 0.1%) this strategy costs ∼$58 k per LYS; for a pandemic with very low severity similar to the 2009 pandemic (CFR of 0.03%) the cost is ∼$155 per LYS. With high severity pandemics (CFR >0.75%) the most effective attack rate reduction strategies are also the most cost effective. During low severity pandemics costs are dominated by productivity losses due to illness and social distancing interventions, while for high severity pandemics costs are dominated by hospitalisation costs and productivity losses due to death. Conclusions The most cost effective strategies for mitigating an influenza pandemic involve combining sustained social distancing with the use of antiviral agents. For low severity pandemics the most cost effective strategies involve antiviral treatment, prophylaxis and short durations of school closure; while these are cost effective they are less effective than other strategies in reducing the

Impact of side-effects of atypical antipsychotics on non-compliance, relapse and cost.

Science.gov (United States)

Mortimer, A; Williams, P; Meddis, D

2003-01-01

Atypical antipsychotics generally have milder side-effects than conventional antipsychotics, but also differ among themselves in this respect. This study aimed to compare the impact of different side-effect profiles of individual atypical antipsychotics on non-compliance, relapse and cost in schizophrenia. A state-transition model was built using literature data supplemented by expert opinion. The model found that quetiapine and ziprasidone were similar in estimated non-compliance and relapse rates. Olanzapine and risperidone had higher estimated non-compliance and relapse rates, and incremental, 1-year, per-patient direct costs, using US-based cost data, of approximately $530 (95% confidence interval [CI] approximately $275, $800), and approximately $485 (95% CI approximately $235, $800), respectively, compared with quetiapine. Incremental costs attributable to different side-effect profiles were highly significant. This study shows that differing side-effect profiles of the newer antipsychotic agents are likely to lead to different compliance rates, and consequent variation in relapse rates. The cost implications of these heterogenous clinical outcomes are substantial.

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

29 CFR 5.25 - Rate of contribution or cost for fringe benefits.

Science.gov (United States)

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Rate of contribution or cost for fringe benefits. 5.25... Fringe Benefits Provisions of the Davis-Bacon Act § 5.25 Rate of contribution or cost for fringe benefits... contribution or cost of fringe benefits. Only the amount of contributions or costs for fringe benefits which...

Cost-effectiveness analysis of lifestyle intervention in obese infertile women.

Science.gov (United States)

van Oers, A M; Mutsaerts, M A Q; Burggraaff, J M; Kuchenbecker, W K H; Perquin, D A M; Koks, C A M; van Golde, R; Kaaijk, E M; Schierbeek, J M; Klijn, N F; van Kasteren, Y M; Land, J A; Mol, B W J; Hoek, A; Groen, H

2017-07-01

What is the cost-effectiveness of lifestyle intervention preceding infertility treatment in obese infertile women? Lifestyle intervention preceding infertility treatment as compared to prompt infertility treatment in obese infertile women is not a cost-effective strategy in terms of healthy live birth rate within 24 months after randomization, but is more likely to be cost-effective using a longer follow-up period and live birth rate as endpoint. In infertile couples, obesity decreases conception chances. We previously showed that lifestyle intervention prior to infertility treatment in obese infertile women did not increase the healthy singleton vaginal live birth rate at term, but increased natural conceptions, especially in anovulatory women. Cost-effectiveness analyses could provide relevant additional information to guide decisions regarding offering a lifestyle intervention to obese infertile women. The cost-effectiveness of lifestyle intervention preceding infertility treatment compared to prompt infertility treatment was evaluated based on data of a previous RCT, the LIFEstyle study. The primary outcome for effectiveness was the vaginal birth of a healthy singleton at term within 24 months after randomization (the healthy live birth rate). The economic evaluation was performed from a hospital perspective and included direct medical costs of the lifestyle intervention, infertility treatments, medication and pregnancy in the intervention and control group. In addition, we performed exploratory cost-effectiveness analyses of scenarios with additional effectiveness outcomes (overall live birth within 24 months and overall live birth conceived within 24 months) and of subgroups, i.e. of ovulatory and anovulatory women, women birth rates were 27 and 35% in the intervention group and the control group, respectively (effect difference of -8.1%, P birth rate. Mean costs per healthy live birth event were €15 932 in the intervention group and €15 912 in the

27 CFR 24.231 - Receipt of spirits in sealed bulk containers.

Science.gov (United States)

2010-04-01

... TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS WINE Spirits § 24.231 Receipt of spirits in sealed bulk containers. The proprietor shall examine sealed bulk containers (packages) of spirits... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Receipt of spirits in...

Controllable deterioration rate for time-dependent demand and time-varying holding cost

Directory of Open Access Journals (Sweden)

Mishra Vinod Kumar

2014-01-01

Full Text Available In this paper, we develop an inventory model for non-instantaneous deteriorating items under the consideration of the facts: deterioration rate can be controlled by using the preservation technology (PT during deteriorating period, and holding cost and demand rate both are linear function of time, which was treated as constant in most of the deteriorating inventory models. So in this paper, we developed a deterministic inventory model for non-instantaneous deteriorating items in which both demand rate and holding cost are a linear function of time, deterioration rate is constant, backlogging rate is variable and depend on the length of the next replenishment, shortages are allowed and partially backlogged. The model is solved analytically by minimizing the total cost of the inventory system. The model can be applied to optimizing the total inventory cost of non-instantaneous deteriorating items inventory for the business enterprises, where the preservation technology is used to control the deterioration rate, and demand & holding cost both are a linear function of time.

Variation in Educational Services Receipt Among US Children With Developmental Conditions.

Science.gov (United States)

Lindly, Olivia J; Sinche, Brianna K; Zuckerman, Katharine E

2015-01-01

To examine the relationship between ease of access to needed community-based services (ease of access) and educational services receipt, and variation in educational services receipt by sociodemographic and need factors among a nationally representative sample of children with autism spectrum disorder (ASD), developmental delay (DD), and/or intellectual disability (ID). Data from the 2009-2010 National Survey of Children with Special Health Care Needs were linked to the 2011 Survey of Pathways to Diagnosis and Services on a sample of 3502 US children aged 6 to 17 years with ASD, DD, and/or ID. Descriptive statistics, chi-square tests, and multivariable logistic regression models were used to determine associations of educational services receipt with ease of access and sociodemographic and need factors. Among children with developmental conditions, nearly half (49.7%) lacked easy access to services, and 16.9% did not have an individualized education program (IEP). Among children with an IEP, those with ease of access were more likely to have an IEP that addressed parent concerns about the child's development and education than those unable to easily access services (adjusted odds ratio 2.77; 95% confidence interval 1.71-4.49). Need factors, including functional limitations status, care coordination need, developmental condition type, and early intervention receipt, were significantly associated with educational services receipt. Cross-systems initiatives facilitating service access remain important to ensuring the developmental needs of children with ASD, DD, and/or ID are met. Increased interprofessional collaboration promoting quality educational services receipt for children diagnosed with developmental conditions may further reduce disparities. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Rate control is more cost-effective than rhythm control for patients with persistent atrial fibrillation - results from the RAte Control versus Electrical cardioversion (RACE) study

NARCIS (Netherlands)

Hagens, VE; Vermeulen, KM; TenVergert, EM; Van Veldhuisen, JGP; Bosker, HA; Kamp, O; Kingma, JH; Tijssen, JGP; Crijns, HJGM; Van Gelder, IC

Aims To evaluate costs between a rate and rhythm control strategy in persistent atrial. fibrillation. Methods and results In a prospective substudy of RACE (Rate control versus electrical cardioversion for persistent atrial. fibrillation) in 428 of the total 522 patients (206 rate control and 222

Costs of Producing Milk, 1975-84. Agricultural Economic Report Number 569.

Science.gov (United States)

Betts, Carolyn

Costs of producing milk rose 53 percent between 1975 and 1984 to $13.57 per hundredweight, whereas cash (out-of-pocket) costs rose 56 percent to $10.64 per hundredweight. Cash receipts, which measure gross production value, peaked in 1981 at $14.94 per hundredweight compared with $9.23 in 1975. Production costs in the Pacific region were more than…

Transmission service charges: cost allocation and rate design

International Nuclear Information System (INIS)

Poray, A. T.

2000-01-01

The application of the Ontario Hydro Networks Company (OHNC) to the Ontario Energy Board to seek approval for cost allocation and rate design methodology to recover revenue requirements for the provision of transmission services in Ontario are summarized. Insights that led to the arguments made in support of the application are also described. The paper contains an overview of plans for the operation of the transmission system, the agreement between Ontario Hydro Services Company (OHSC) and the Independent Market Operator (IMO), the stakeholder consultation process by OHNC to develop the transmission cost allocation and rate design methodology, a discussion of the major rate design issues, a summary of stakeholder opinions and a summary of OHNC's final proposal for transmission pricing. Public hearings on the OHNC application were held between February 16 and March 20, 2000. Final decision by the OEB is expected sometime in May 2000

Potential cost to Western Australia of proposed patient co-payments according to healthcare organisational structure: A preliminary analysis.

Science.gov (United States)

Millar, J Alasdair; Millar, Robyn C

2014-01-01

The Australian federal government has proposed an AUD $7 patient co-payment for a general practitioner (GP) consultation. One effect of the co-payment may be that patients will seek assistance at public hospital emergency departments (EDs), where currently there is no user charge. We studied the possible financial impact of patient diversion on the Western Australia (WA) health budget. We constructed a spreadsheet model of changes in annual cash flows including the co-payment, GP fees for service, and rates of diversion to emergency departments with additional marginal costs for ED attendance. Changes in WA cash flows are the aggregate of marginal ED costs of treating diverted patients and added expenditure in fees paid to rural doctors who also man local emergency centres. The estimated costs to WA are AUD $6.3 million, $35.9 million and $87.4 million at 1, 5, and 10 per cent diversion, respectively. Commonwealth receipts increase and expenditure on Medicare benefits declines. A diversion of patients from GP surgeries to ED in WA caused by the co-payment will result in increased costs to the state, which may be substantial, and will reduce net costs to the Commonwealth.

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

78 FR 5781 - Cost-Sharing Rates for Pharmacy Benefits Program of the TRICARE Program

Science.gov (United States)

2013-01-28

... DEPARTMENT OF DEFENSE Office of the Secretary Cost-Sharing Rates for Pharmacy Benefits Program of... to cost-sharing rates to the TRICARE Pharmacy Benefits Program. SUMMARY: This notice is to advise interested parties of cost-sharing rate change for the Pharmacy Benefits Program. DATES: The cost-sharing...

The Cost-Effectiveness of Anterior Cruciate Ligament Reconstruction in Competitive Athletes.

Science.gov (United States)

Stewart, Bruce A; Momaya, Amit M; Silverstein, Marc D; Lintner, David

2017-01-01

Competitive athletes value the ability to return to competitive play after the treatment of anterior cruciate ligament (ACL) injuries. ACL reconstruction has high success rates for return to play, but some studies indicate that patients may do well with nonoperative physical therapy treatment. To evaluate the cost-effectiveness of the treatment of acute ACL tears with either initial surgical reconstruction or physical therapy in competitive athletes. Economic and decision analysis; Level of evidence, 2. The incremental cost, incremental effectiveness, and incremental cost-effectiveness ratio (ICER) of ACL reconstruction compared with physical therapy were calculated from a cost-effectiveness analysis of ACL reconstruction compared with physical therapy for the initial management of acute ACL injuries in competitive athletes. The ACL reconstruction strategy and the physical therapy strategy were represented as Markov models. Costs and quality-adjusted life-years (QALYs) were evaluated over a 6-year time horizon and were analyzed from a societal perspective. Quality of life and probabilities of clinical outcomes were obtained from the peer-reviewed literature, and costs were compiled from a large academic hospital in the United States. One-way, 2-way, and probabilistic sensitivity analyses were used to assess the effect of uncertainty in variables on the ICER of ACL reconstruction. The ICER of ACL reconstruction compared with physical therapy was $22,702 per QALY gained. The ICER was most sensitive to the quality of life of returning to play or not returning to play, costs, and duration of follow-up but relatively insensitive to the rates and costs of complications, probabilities of return to play for both operative and nonoperative treatments, and discount rate. ACL reconstruction is a cost-effective strategy for competitive athletes with an ACL injury.

Cost-effectiveness of routine imaging of suspected appendicitis.

Science.gov (United States)

D'Souza, N; Marsden, M; Bottomley, S; Nagarajah, N; Scutt, F; Toh, S

2018-01-01

Introduction The misdiagnosis of appendicitis and consequent removal of a normal appendix occurs in one in five patients in the UK. On the contrary, in healthcare systems with routine cross-sectional imaging of suspected appendicitis, the negative appendicectomy rate is around 5%. If we could reduce the rate in the UK to similar numbers, would this be cost effective? This study aimed to calculate the financial impact of negative appendicectomy at the Queen Alexandra Hospital and to explore whether a policy of routine imaging of such patients could reduce hospital costs. Materials and methods We performed a retrospective analysis of all appendicectomies over a 1-year period at our institution. Data were extracted on outcomes including appendix histology, operative time and length of stay to calculate the negative appendicectomy rate and to analyse costs. Results A total of 531 patients over 5 years of age had an appendicectomy. The negative appendicectomy rate was 22% (115/531). The additional financial costs of negative appendicectomy to the hospital during this period were £270,861. Universal imaging of all patients with right iliac fossa pain that could result in a 5% negative appendicectomy rate would cost between £67,200 and £165,600 per year but could save £33,896 (magnetic resonance imaging), £105,896 (computed tomography) or £132,296 (ultrasound) depending on imaging modality used. Conclusions Negative appendicectomy is still too frequent and results in additional financial burden to the health service. Routine imaging of patients with suspected appendicitis would not only reduce the negative appendicectomy rate but could lead to cost savings and a better service for our patients.

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

Science.gov (United States)

Gomez, G B; Dowdy, D W; Bastos, M L; Zwerling, A; Sweeney, S; Foster, N; Trajman, A; Islam, M A; Kapiga, S; Sinanovic, E; Knight, G M; White, R G; Wells, W A; Cobelens, F G; Vassall, A

2016-12-01

Despite improvements in treatment success rates for tuberculosis (TB), current six-month regimen duration remains a challenge for many National TB Programmes, health systems, and patients. There is increasing investment in the development of shortened regimens with a number of candidates in phase 3 trials. We developed an individual-based decision analytic model to assess the cost-effectiveness of a hypothetical four-month regimen for first-line treatment of TB, assuming non-inferiority to current regimens of six-month duration. The model was populated using extensive, empirically-collected data to estimate the economic impact on both health systems and patients of regimen shortening for first-line TB treatment in South Africa, Brazil, Bangladesh, and Tanzania. We explicitly considered 'real world' constraints such as sub-optimal guideline adherence. From a societal perspective, a shortened regimen, priced at USD1 per day, could be a cost-saving option in South Africa, Brazil, and Tanzania, but would not be cost-effective in Bangladesh when compared to one gross domestic product (GDP) per capita. Incorporating 'real world' constraints reduces cost-effectiveness. Patient-incurred costs could be reduced in all settings. From a health service perspective, increased drug costs need to be balanced against decreased delivery costs. The new regimen would remain a cost-effective option, when compared to each countries' GDP per capita, even if new drugs cost up to USD7.5 and USD53.8 per day in South Africa and Brazil; this threshold was above USD1 in Tanzania and under USD1 in Bangladesh. Reducing the duration of first-line TB treatment has the potential for substantial economic gains from a patient perspective. The potential economic gains for health services may also be important, but will be context-specific and dependent on the appropriate pricing of any new regimen.

Time-driven activity-based costing of low-dose-rate and high-dose-rate brachytherapy for low-risk prostate cancer.

Science.gov (United States)

Ilg, Annette M; Laviana, Aaron A; Kamrava, Mitchell; Veruttipong, Darlene; Steinberg, Michael; Park, Sang-June; Burke, Michael A; Niedzwiecki, Douglas; Kupelian, Patrick A; Saigal, Christopher

Cost estimates through traditional hospital accounting systems are often arbitrary and ambiguous. We used time-driven activity-based costing (TDABC) to determine the true cost of low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy for prostate cancer and demonstrate opportunities for cost containment at an academic referral center. We implemented TDABC for patients treated with I-125, preplanned LDR and computed tomography based HDR brachytherapy with two implants from initial consultation through 12-month followup. We constructed detailed process maps for provision of both HDR and LDR. Personnel, space, equipment, and material costs of each step were identified and used to derive capacity cost rates, defined as price per minute. Each capacity cost rate was then multiplied by the relevant process time and products were summed to determine total cost of care. The calculated cost to deliver HDR was greater than LDR by $2,668.86 ($9,538 vs. $6,869). The first and second HDR treatment day cost $3,999.67 and $3,955.67, whereas LDR was delivered on one treatment day and cost $3,887.55. The greatest overall cost driver for both LDR and HDR was personnel at 65.6% ($4,506.82) and 67.0% ($6,387.27) of the total cost. After personnel costs, disposable materials contributed the second most for LDR ($1,920.66, 28.0%) and for HDR ($2,295.94, 24.0%). With TDABC, the true costs to deliver LDR and HDR from the health system perspective were derived. Analysis by physicians and hospital administrators regarding the cost of care afforded redesign opportunities including delivering HDR as one implant. Our work underscores the need to assess clinical outcomes to understand the true difference in value between these modalities. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

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

48 CFR 42.803 - Disallowing costs after incurrence.

Science.gov (United States)

2010-10-01

... officers receive vouchers directly from the contractor and, with or without auditor assistance, approve or... agency. (b) Auditor receipt of vouchers. (1) When authorized by agency regulations, the contract auditor... payment those vouchers found acceptable, and (iii) suspend payment of questionable costs. The auditor...

CONSIDERATIONS ON THE TRENDS OF INTERNATIONAL TOURISM RECEIPTS

Directory of Open Access Journals (Sweden)

Agatha POPESCU

2014-12-01

Full Text Available The paper aimed to analyze the evolution of tourism receipts at world level and by geographical area and in the main countries of tourist interest. In the period 1980-2012, the tourism income increased 10.14 times. In 2012, it accounted for USD Billion 1,075, to which Europe contributed by 42.58 %, Asia and the Pacific by 30.13 % and the Americas by 19.77 %. The USA, Spain, France, China, Macau, Italy, Germany, United Kingdom, Hong Kong and Australia are the top 10 countries according to the receipts, earning USD Billion 508.8, which represented 47.55 % of the world tourism income in 2012. The European countries with the highest contribution to tourism revenue are: Spain 12.21 %, France 11.72 %, Italy 8.99 %, Germany 8.32 %, United Kingdom 7.94 %, Turkey 5.60 %, Austria 4.12 %, Switzerland 3.62 %, Sweden 3.36 % and The Netherlands 3.03 %. Their contribution to Europe tourism receipts was 68.97 % in 2012. As a conclusion, international tourism is a very dynamic field of activity with a high contribution to the development of the world economy.

Estimating the effect of mastitis on the profitability of Irish dairy farms.

Science.gov (United States)

Geary, U; Lopez-Villalobos, N; Begley, N; McCoy, F; O'Brien, B; O'Grady, L; Shalloo, L

2012-07-01

The objective of this paper was to estimate the effect of the costs of mastitis on the profitability of Irish dairy farms as indicated by various ranges of bulk milk somatic cell count (BMSCC). Data were collected from 4 sources and included milk production losses, cases treated, and on-farm practices around mastitis management. The Moorepark Dairy Systems Model, which simulates dairying systems inside the farm gate, was used to carry out the analysis. The cost components of mastitis that affect farm profitability and that were included in the model were milk losses, culling, diagnostic testing, treatment, veterinary attention, discarded milk, and penalties. Farms were grouped by 5 BMSCC thresholds of ≤ 100,000, 100,001-200,000, 200,001-300,000, 300,001-400,000, and > 400,000 cells/mL. The ≤ 100,000 cells/mL threshold was taken as the baseline and the other 4 thresholds were compared relative to this baseline. For a 40-ha farm, the analysis found that as BMSCC increased, milk receipts decreased from €148,843 at a BMSCC 400,000 cells/mL. In addition, as BMSCC increased, livestock receipts increased by 17%, from €43,304 at a BMSCC 400,000 cells/mL. This reflected the higher replacement rates as BMSCC increased and the associated cull cow value. Total farm receipts decreased from €192,147 at the baseline ( 400,000 cells/mL. Total farm costs increased as BMSCC increased, reflecting treatment, veterinary, diagnostic testing, and replacement heifer costs. At the baseline, total farm costs were €161,085, increasing to €177,343 at a BMSCC > 400,000 cells/mL. Net farm profit decreased as BMSCC increased, from €31,252/yr at the baseline to €11,748/yr at a BMSCC > 400,000 cells/mL. This analysis highlights the impact that mastitis has on the profitability of Irish dairy farms. The analysis presented here can be used to develop a "cost of mastitis" tool for use on Irish dairy farms to motivate farmers to acknowledge the scale of the problem, realize the value

Societal costs in displaced transverse olecranon fractures: using decision analysis tools to find the most cost-effective strategy between tension band wiring and locked plating.

Science.gov (United States)

Francis, Tittu; Washington, Travis; Srivastava, Karan; Moutzouros, Vasilios; Makhni, Eric C; Hakeos, William

2017-11-01

Tension band wiring (TBW) and locked plating are common treatment options for Mayo IIA olecranon fractures. Clinical trials have shown excellent functional outcomes with both techniques. Although TBW implants are significantly less expensive than a locked olecranon plate, TBW often requires an additional operation for implant removal. To choose the most cost-effective treatment strategy, surgeons must understand how implant costs and return to the operating room influence the most cost-effective strategy. This cost-effective analysis study explored the optimal treatment strategies by using decision analysis tools. An expected-value decision tree was constructed to estimate costs based on the 2 implant choices. Values for critical variables, such as implant removal rate, were obtained from the literature. A Monte Carlo simulation consisting of 100,000 trials was used to incorporate variability in medical costs and implant removal rates. Sensitivity analysis and strategy tables were used to show how different variables influence the most cost-effective strategy. TBW was the most cost-effective strategy, with a cost savings of approximately $1300. TBW was also the dominant strategy by being the most cost-effective solution in 63% of the Monte Carlo trials. Sensitivity analysis identified implant costs for plate fixation and surgical costs for implant removal as the most sensitive parameters influencing the cost-effective strategy. Strategy tables showed the most cost-effective solution as 2 parameters vary simultaneously. TBW is the most cost-effective strategy in treating Mayo IIA olecranon fractures despite a higher rate of return to the operating room. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Changes in Adolescents' Receipt of Sex Education, 2006–2013

OpenAIRE

Lindberg, Laura Duberstein; Maddow-Zimet, Isaac; Boonstra, Heather

2016-01-01

Purpose Updated estimates of adolescents? receipt of sex education are needed to monitor changing access to information. Methods Using nationally representative data from the 2006?2010 and 2011?2013 National Survey of Family Growth, we estimated changes over time in adolescents? receipt of sex education from formal sources and from parents and differentials in these trends by adolescents? gender, race/ethnicity, age, and place of residence. Results Between 2006?2010 and 2011?2013, there were ...

Cost-Effectiveness of Elderly Health Examination Program: The Example of Hypertension Screening

Directory of Open Access Journals (Sweden)

Bing-Hwa Deng

2007-01-01

Full Text Available The National Health Insurance (NHI and social welfare agencies have implemented the Elderly Health Examination Program (EHEP for years. No study has ever attempted to evaluate whether this program is cost-effective. The purposes of this study were, firstly, to understand the prevalence and incidence rates of hypertension and, secondly, to estimate the cost and effectiveness of the EHEP, focusing on hypertension screening. The data sources were: (1 hypertension and clinical information derived from the 1996 and 1997 EHEP, which was used to generate prevalence and incidence rates of hypertension; and (2 claim data of the NHI that included treatment costs of stroke patients (in-and outpatients. Hypothetical models were used to evaluate the cost-effectiveness of the hypertension screening program in various conditions. Sensitivity analysis was also employed to evaluate the effect of each estimation indicator on the cost and effectiveness of the hypertension screening program. A total of 28.3% of the elderly population in Kaohsiung (25,174 of 88,812 participated in the 1996 EHEP; 14,915 of them participated in the following 1997 EHEP, with a retention rate of 59.3%. Criteria from the Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI (systolic blood pressure/diastolic blood pressure ≥ 160/95mmHg or taking antihypertensive drugs were used; we found that prevalence and incidence rates of hypertension were 24.6% and 6.6%, respectively. Hypertension rates are increasing in the aging process as shown in both prevalence and incidence models. In comparison with non-participants, the prevalence model indicates that each hypertension patient who had attended the EHEP not only saved NT$34,570–34,890 in medical and associated costs, but also increased their lifespan by 128 days. The present findings suggest that the EHEP is a cost-effective program with health and social welfare policy

Effect of dementia on receipt of influenza vaccine: a cohort study in French older adults using administrative data: 2007-2012.

Science.gov (United States)

Gallini, Adeline; Coley, Nicola; Andrieu, Sandrine; Lapeyre-Mestre, Maryse; Gardette, Virginie

2017-08-01

Despite guidelines stating the vaccine benefit in this population, older adults with dementia may be less likely to receive influenza vaccine than cognitively intact older adults. But no study has yet reported on vaccine uptake in patients newly diagnosed with dementia or whether years since dementia diagnosis influences vaccine uptake. We conducted a cohort study in the French Health Insurance database (Echantillon Généraliste de Bénéficiaires) which contains hospital data and claims for a 1/97th random sample of the French population. Diseased subjects were ≥65 years and had a new record of dementia diagnosis between September 1, 2007, and August 31, 2008. Vaccine receipt was measured via influenza vaccine dispensing in community pharmacies. We described influenza vaccination rates up to 2011-2012 and estimated adjusted relative risks (aRR) for vaccine receipt each year using multivariate modified Poisson models controlling for sociodemographics, comorbidities, and health resources use. Four hundred and seven subjects with dementia (mean age 81.8 years, 69.3% females) and 4862 subjects (mean age 75.2 years, 61.3% females) without dementia were included. In 2008-2009, influenza vaccination prevalence was 70.0% (95% CI = [65.3-74.4]) and 70.2% (95% CI = [68.9-71.4]) in subjects with and without dementia, respectively (aRR = 0.93; 95% CI = [0.87-1.00]). In 2009-2010, the aRR was of the same magnitude (aRR = 0.96, 95% CI = [0.90-1.03]), but in 2010-2011 and 2011-2012, the aRR was 1.02 (95% CI = [0.94-1.11]) and 1.05 (95% CI = [0.96-1.14]), respectively. Subjects with dementia had a slightly nonsignificant lower receipt of influenza vaccine in the year following dementia diagnosis than subjects without dementia. In subsequent years, divergent trends were observed in vaccine uptake according to dementia status. © 2017 Société Française de Pharmacologie et de Thérapeutique.

Sequential Low Cost Interventions Double Hand Hygiene Rates ...

African Journals Online (AJOL)

Sequential Low Cost Interventions Double Hand Hygiene Rates Among Medical Teams in a Resource Limited Setting. Results of a Hand Hygiene Quality Improvement Project Conducted At University Teaching Hospital of Kigali (Chuk), Kigali, Rwanda.

Cost-effectiveness of norovirus vaccination in children in Peru.

Science.gov (United States)

Mirelman, Andrew J; Ballard, Sarah Blythe; Saito, Mayuko; Kosek, Margaret N; Gilman, Robert H

2015-06-17

With candidate norovirus (NV) vaccines in a rapid phase of development, assessment of the potential economic value of vaccine implementation will be necessary to aid health officials in vaccine implementation decisions. To date, no evaluations have been performed to evaluate the benefit of adopting NV vaccines for use in the childhood immunization programs of low- and middle-income countries. We used a Markov decision model to evaluate the cost-effectiveness of adding a two-dose NV vaccine to Peru's routine childhood immunization schedule using two recent estimates of NV incidence, one for a peri-urban region and one for a jungle region of the country. Using the peri-urban NV incidence estimate, the annual cost of vaccination would be $13.0 million, offset by $2.6 million in treatment savings. Overall, this would result in 473 total DALYs averted; 526,245 diarrhea cases averted;153,735 outpatient visits averted; and 414 hospitalizations averted between birth and the fifth year of life. The incremental cost-effectiveness ratio would be $21,415 per DALY averted; $19.86 per diarrhea case; $68.23 per outpatient visit; and $26,298 per hospitalization. Using the higher jungle NV incidence rates provided a lower cost per DALY of $10,135. The incremental cost per DALY with per-urban NV incidence is greater than three times the 2012 GDP per capita of Peru but the estimate drops below this threshold using the incidence from the jungle setting. In addition to the impact of incidence, sensitivity analysis showed that vaccine price and efficacy play a strong role in determining the level of cost-effectiveness. The introduction of a NV vaccine would prevent many healthcare outcomes in the Peru and potentially be cost-effective in scenarios with high NV incidence. The vaccine cost-effectiveness model could also be applied to the evaluation of NV vaccine cost-effectiveness in other countries. In resource-poor settings, where NV incidence rates are expected to be higher. Published

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.

Public Budget Database - Governmental receipts 1962-Current

Data.gov (United States)

Executive Office of the President — This file contains governmental receipts for 1962 through the current budget year, as well as four years of projections. It can be used to reproduce many of the...

Modelling cost-effectiveness of different vasectomy methods in India, Kenya, and Mexico

Directory of Open Access Journals (Sweden)

Seamans Yancy

2007-07-01

Full Text Available Abstract Background Vasectomy is generally considered a safe and effective method of permanent contraception. The historical effectiveness of vasectomy has been questioned by recent research results indicating that the most commonly used method of vasectomy – simple ligation and excision (L and E – appears to have a relatively high failure rate, with reported pregnancy rates as high as 4%. Updated methods such as fascial interposition (FI and thermal cautery can lower the rate of failure but may require additional financial investments and may not be appropriate for low-resource clinics. In order to better compare the cost-effectiveness of these different vasectomy methods, we modelled the costs of different vasectomy methods using cost data collected in India, Kenya, and Mexico and effectiveness data from the latest published research. Methods The costs associated with providing vasectomies were determined in each country through interviews with clinic staff. Costs collected were economic, direct, programme costs of fixed vasectomy services but did not include large capital expenses or general recurrent costs for the health care facility. Estimates of the time required to provide service were gained through interviews and training costs were based on the total costs of vasectomy training programmes in each country. Effectiveness data were obtained from recent published studies and comparative cost-effectiveness was determined using cost per couple years of protection (CYP. Results In each country, the labour to provide the vasectomy and follow-up services accounts for the greatest portion of the overall cost. Because each country almost exclusively used one vasectomy method at all of the clinics included in the study, we modelled costs based on the additional material, labour, and training costs required in each country. Using a model of a robust vasectomy program, more effective methods such as FI and thermal cautery reduce the cost per

Variations in living donor graft rates by dialysis clinic: effect on outcome and cost of chronic renal failure therapy.

Science.gov (United States)

Baltzan, M A; Ahmed, S; Baltzan, R B; Marshall, R P; Thoma, E L; Nicol, M F

1997-06-01

Examination of nephrology practice variations in living donor renal grafts to determine their influence on organ supply, quality, and cost of chronic renal failure therapy. Saskatchewan chronic dialysis, cadaveric, and living donor renal grafts in 1983-1994 inclusive. Saskatchewan has three dialysis (I, II, III) and one transplant clinic. In the period the renal graft incidences/million population by these dialysis clinics by organ source were; Cadaveric: 23.1, 23.2, 21.1 (p = ns). Living: 5.4, 21.7, 8.3 (I or III vs II p actuarial patient survival is 92% and B 44%. Series A ten-year actuarial graft survival (including regrafts) is 77% and B 39%. Rehabilitation rate in patients with functioning grafts is 88.5%. Province-wide extension of the Clinic II living-donor graft rate in 1983-1994 would have produced 160 more renal grafts or 59% of those receiving chronic dialysis in 1994. The annual maintenance for a graft with the initial grafting cost taken over five years was $10,825 and the dialysis cost $40,100. (1) nephrology practice variations caused a 2.5-4.0-fold difference in living donor renal graft rates, indicating patient education by the attending nephrologist influences the living donor transplantation rate, (2) with such education the combined living donor and the cadaveric organ supply virtually meets graft demand, (3) living donor renal grafts yield a better quantity and quality of life and better cost control than dialysis with their annual cost being one-quarter that for dialysis.

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

NARCIS (Netherlands)

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

2007-01-01

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

An inventory model of instantaneous deteriorating items with controllable deterioration rate for time dependent demand and holding cost

Directory of Open Access Journals (Sweden)

Vinod Kumar Mishra

2013-06-01

Full Text Available Purpose: The purpose of this paper to develop an inventory model for instantaneous deteriorating items with the consideration of the facts that the deterioration rate can be controlled by using the preservation technology (PT and the holding cost & demand rate both are linear function of time which was treated as constant in most of the deteriorating inventory model. Design/methodology/approach: Developed the mathematical equation of deterministic deteriorating inventory model in which demand rate and holding cost both is linear function of time, deterioration rate is constant, backlogging rate is variable and depend on the length of the next replenishment, shortages are allowed and partially backlogged and obtain an analytical solution which optimizes the total cost of the proposed inventory model. Findings: The model can be applied for optimizing the total inventory cost of deteriorating items inventory for such business enterprises where they use the preservation technology to control the deterioration rate under other assumptions of the model. Originality/value: The inventory system for deteriorating items has been an object of study for a long time, but little is known about the effect of investing in reducing the rate of product deterioration and their significant impact in the business. The proposed model is effective as well as efficient for the business organization that uses the preservation technology to reduce the deterioration rate of the instantaneous deteriorating items of the inventory.

Influence of the discount rate when comparing costs of different nuclear fuel cycles

International Nuclear Information System (INIS)

Le Dars, A.; Loaec, Ch.

2007-01-01

The article describes the methodology and technical economic results obtained by Cea in the DERECO project. This project was aimed at evaluating ground-breaking and intricate scenarios of the nuclear fuel cycle, and developed on the long term (150 years), in the context of France. All 5 scenarios studied assume that the reliance on nuclear energy will continue in order to satisfy the electricity demand. Despite uncertainties, the trends are breaking free from the analysis. It appears that the scenarios in which fourth generation fast reactors take part are globally more economical than the keeping to the present strategy of plutonium mono-recycling in PWR. The scenario in which fuel reprocessing is stopped has a total cost concerning the fuel cycle similar to that of the present strategy but the disposal cost is twice as high because of the necessity of disposing spent fuels directly in geological formations. The comparative costs of the different scenarios are set out and the influence of the discount rate is highlighted. One must keep in mind that the actualization theory entails a diminishing value for long term costs due to an unavoidable mechanical effect of the discount rate

Receipt and Perpetration of Intimate Partner Violence and Condomless Anal Intercourse Among Gay and Bisexual Men in Atlanta.

Science.gov (United States)

Stephenson, Rob; Finneran, Catherine

2017-08-01

Intimate partner violence (IPV) rates are disproportionately high among sexual minority populations, with increasing evident that gay men experience IPV at the same rates as heterosexual women. This study examines the relationship between self-reported condomless anal intercourse (CAI) and IPV among a sample of 750 gay and bisexual men. Participants answered questions regarding recent receipt and perpetration of IPV using the IPV-GBM Scale (Cronbach Alpha 0.90). Of the sample, 46.1% reported recent receipt of any type of IPV and 33.6% reported recent perpetration of any type of IPV. Overall, 55.1% of participants reported CAI at last sex. Significant associations were determined between several forms of IPV and increased odds of reporting CAI at last sex. These findings suggest that IPV may be a risk factor for CAI among men who have sex with men, and highlight the need to understand the IPV prevention and care needs of this population.

Congenital Heart Defects and Receipt of Special Education Services.

Science.gov (United States)

Riehle-Colarusso, Tiffany; Autry, Andrew; Razzaghi, Hilda; Boyle, Coleen A; Mahle, William T; Van Naarden Braun, Kim; Correa, Adolfo

2015-09-01

We investigated the prevalence of receipt of special education services among children with congenital heart defects (CHDs) compared with children without birth defects. Children born from 1982 to 2004 in metropolitan Atlanta with CHDs (n = 3744) were identified from a population-based birth defect surveillance program; children without birth defects (n = 860 715) were identified from birth certificates. Cohorts were linked to special education files for the 1992-2012 school years to identify special education services. Children with noncardiac defects or genetic syndromes were excluded; children with CHDs were classified by presence or absence of critical CHDs (ie, CHDs requiring intervention by age one year). We evaluated the prevalence of receipt of special education services and prevalence rate ratios using children without birth defects as a reference. Compared with children without birth defects, children with CHDs were 50% more likely to receive special education services overall (adjusted prevalence rate ratio [aPRR] = 1.5; 95% confidence interval [CI]: 1.4-1.7). Specifically, they had higher prevalence of several special education categories including: intellectual disability (aPRR = 3.8; 95% CI: 2.8-5.1), sensory impairment (aPRR = 3.0; 95% CI: 1.8-5.0), other health impairment (aPRR = 2.8; 95% CI: 2.2-3.5), significant developmental delay (aPRR = 1.9; 95% CI: 1.3-2.8), and specific learning disability (aPRR = 1.4; 95% CI: 1.1-1.7). For most special education services, the excess prevalence did not vary by presence of critical CHDs. Children with CHDs received special education services more often than children without birth defects. These findings highlight the need for special education services and the importance of developmental screening for all children with CHDs. Copyright © 2015 by the American Academy of Pediatrics.

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

NARCIS (Netherlands)

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

2008-01-01

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

The cost effectiveness of vancomycin for preventing infections after shoulder arthroplasty: a break-even analysis.

Science.gov (United States)

Hatch, M Daniel; Daniels, Stephen D; Glerum, Kimberly M; Higgins, Laurence D

2017-03-01

Increasing methicillin resistance and recognition of Propionibacterium acnes as a cause of infection in shoulder arthroplasty has led to the adoption of local vancomycin powder application as a more effective method to prevent expensive periprosthetic infections. However, no study has analyzed the cost effectiveness of vancomycin powder for preventing infection after shoulder replacement. Cost data for infection-related care of 16 patients treated for deep periprosthetic shoulder infection was collected from our institution for the break-even analysis. An equation was developed and applied to the data to determine how effective vancomycin powder would need to be at reducing a baseline infection rate to make prophylactic use cost effective. The efficacy of vancomycin (absolute risk reduction [ARR]) was evaluated at different unit costs, baseline infection rates, and average costs of treating infection. We determined vancomycin to be cost effective if the initial infection rate decreased by 0.04% (ARR). Using the current costs of vancomycin reported in the literature (range: $2.50/1000 mg to $44/1000 mg), we determined vancomycin to be cost effective with an ARR range of 0.01% at a cost of $2.50/1000 mg to 0.19% at $44/1000 mg. Baseline infection rate does not influence the ARR obtained at any specific cost of vancomycin or the cost of treating infection. We have derived and used a break-even equation to assess efficacy of prophylactic antibiotics during shoulder surgery. We further demonstrated the prophylactic administration of local vancomycin powder during shoulder arthroplasty to be a highly cost-effective practice. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Patients' costs and cost-effectiveness of tuberculosis treatment in DOTS and non-DOTS facilities in Rio de Janeiro, Brazil.

Directory of Open Access Journals (Sweden)

Ricardo Steffen

2010-11-01

Full Text Available Costs of tuberculosis diagnosis and treatment may represent a significant burden for the poor and for the health system in resource-poor countries.The aim of this study was to analyze patients' costs of tuberculosis care and to estimate the incremental cost-effectiveness ratio (ICER of the directly observed treatment (DOT strategy per completed treatment in Rio de Janeiro, Brazil.We interviewed 218 adult patients with bacteriologically confirmed pulmonary tuberculosis. Information on direct (out-of-pocket expenses and indirect (hours lost costs, loss in income and costs with extra help were gathered through a questionnaire. Healthcare system additional costs due to supervision of pill-intake were calculated considering staff salaries. Effectiveness was measured by treatment completion rate. The ICER of DOT compared to self-administered therapy (SAT was calculated.DOT increased costs during the treatment phase, while SAT increased costs in the pre-diagnostic phase, for both the patient and the health system. Treatment completion rates were 71% in SAT facilities and 79% in DOT facilities. Costs per completed treatment were US$ 194 for patients and U$ 189 for the health system in SAT facilities, compared to US$ 336 and US$ 726 in DOT facilities. The ICER was US$ 6,616 per completed DOT treatment compared to SAT.Costs incurred by TB patients are high in Rio de Janeiro, especially for those under DOT. The DOT strategy doubles patients' costs and increases by fourfold the health system costs per completed treatment. The additional costs for DOT may be one of the contributing factors to the completion rates below the targeted 85% recommended by WHO.

Timber harvesting with variable prices, costs and interest rates

International Nuclear Information System (INIS)

Penttinen, M.

2000-01-01

This papers solves the optimal harvesting time problem of a non- industrial private forest (NIPF) owner who typically has a forest management plan and merchantable forest stands. The optimal harvesting time is defined in a volatile market situation. The infinite period problem is also formulated to allow for variable stumpage prices and reforestation costs in a two-period framework, the first of which covers the near future with dynamic price and cost functions and the second the rest of the infinite future with trend price and cost functions. The existence and uniqueness of an optimal policy is demonstrated on the basis of the explicit quasi- concavity of the objective functions. First, the solutions are constructed with prices and costs dependent on stand age only. Both cases in which the same prices and costs hold for all periods and cases in which there are dynamic prices and costs in the first period and trend ones in subsequent periods are considered. Second, the age-dependent functions are multiplied separately by the calendar time dependent exponential terms. Solutions are provided both in the case with the same age-dependent functions and the case with dynamic functions for the first period and trend functions for the subsequent periods. The sensitivity and comparative static analyses are studied with respect to the interest rate, price and cost changes, both analytically and numerically. Optimal rotation solutions are presented with alternative competing volume growth functions. Final results are provided by a gross income growth function. Competing optimisation models are discussed, and alternative volume growth models and a value growth model are compared. The key notion of the research is the sensitivity and comparative static analysis of the optimal rotation solutions with respect to roundwood prices, reforestation costs and interest rates. Different local market parameter and alternative growth data estimates are applied in testing the impact of

Cost-effectiveness of alternative changes to a national blood collection service.

Science.gov (United States)

Willis, S; De Corte, K; Cairns, J A; Zia Sadique, M; Hawkins, N; Pennington, M; Cho, G; Roberts, D J; Miflin, G; Grieve, R

2018-05-16

To evaluate the cost-effectiveness of changing opening times, introducing a donor health report and reducing the minimum inter-donation interval for donors attending static centres. Evidence is required about the effect of changes to the blood collection service on costs and the frequency of donation. This study estimated the effect of changes to the blood collection service in England on the annual number of whole-blood donations by current donors. We used donors' responses to a stated preference survey, donor registry data on donation frequency and deferral rates from the INTERVAL trial. Costs measured were those anticipated to differ between strategies. We reported the cost per additional unit of blood collected for each strategy versus current practice. Strategies with a cost per additional unit of whole blood less than £30 (an estimate of the current cost of collection) were judged likely to be cost-effective. In static donor centres, extending opening times to evenings and weekends provided an additional unit of whole blood at a cost of £23 and £29, respectively. Introducing a health report cost £130 per additional unit of blood collected. Although the strategy of reducing the minimum inter-donation interval had the lowest cost per additional unit of blood collected (£10), this increased the rate of deferrals due to low haemoglobin (Hb). The introduction of a donor health report is unlikely to provide a sufficient increase in donation frequency to justify the additional costs. A more cost-effective change is to extend opening hours for blood collection at static centres. © 2018 The Authors. Transfusion Medicine published by John Wiley & Sons Ltd on behalf of British Blood Transfusion Society.

48 CFR 52.232-35 - Designation of Office for Government Receipt of Electronic Funds Transfer Information.

Science.gov (United States)

2010-10-01

... Government Receipt of Electronic Funds Transfer Information. 52.232-35 Section 52.232-35 Federal Acquisition... of Office for Government Receipt of Electronic Funds Transfer Information (MAY 1999) (a) As provided... CONTRACT CLAUSES Text of Provisions and Clauses 52.232-35 Designation of Office for Government Receipt of...

Costs and cost-effectiveness of different DOT strategies for the treatment of tuberculosis in Pakistan. Directly Observed Treatment.

Science.gov (United States)

Khan, M A; Walley, J D; Witter, S N; Imran, A; Safdar, N

2002-06-01

An economic study was conducted alongside a clinical trial at three sites in Pakistan to establish the costs and effectiveness of different strategies for implementing directly observed treatment (DOT) for tuberculosis. Patients were randomly allocated to one of three arms: DOTS with direct observation by health workers (at health centres or by community health workers); DOTS with direct observation by family members; and DOTS without direct observation. The clinical trial found no statistically significant difference in cure rate for the different arms. The economic study collected data on the full range of health service costs and patient costs of the different treatment arms. Data were also disaggregated by gender, rural and urban patients, by treatment site and by economic categories, to investigate the costs of the different strategies, their cost-effectiveness and the impact that they might have on patient compliance with treatment. The study found that direct observation by health centre-based health workers was the least cost-effective of the strategies tested (US dollars 310 per case cured). This is an interesting result, as this is the model recommended by the World Health Organization and International Union against Tuberculosis and Lung Disease. Attending health centres daily during the first 2 months generated high patient costs (direct and in terms of time lost), yet cure rates for this group fell below those of the non-observed group (58%, compared with 62%). One factor suggested by this study is that the high costs of attending may be deterring patients, and in particular, economically active patients who have most to lose from the time taken by direct observation. Without stronger evidence of benefits, it is hard to justify the costs to health services and patients that this type of direct observation imposes. The self-administered group came out as most cost-effective (164 dollars per case cured). The community health worker sub-group achieved the

Win some, lose some: parental hypertension and heart rate change in an incentive versus response cost paradigm.

Science.gov (United States)

Hastrup, J L; Johnson, C A; Hotchkiss, A P; Kraemer, D L

1986-11-01

Fowles (1983), citing evidence from separate studies, suggests that both incentive and response cost paradigms increase heart rate and should be subsumed under Gray's (1975) 'appetitive motivational system'. Shock avoidance and loss of reward (response cost) contingencies, while aversive, appear to evoke this motivational system; consequently both should elicit heart rate increases independent of anxiety. The present investigation compared magnitude of heart rate changes observed under conditions of winning and losing money. Results showed: no differences between incentive and response cost conditions; no effect of state anxiety on heart rate in these conditions, despite an elevation of state anxiety on the task day relative to a subsequent relaxation day assessment; and some evidence for the presence under both such appetitive conditions of cardiovascular hyperresponsivity among offspring of hypertensive parents. The results suggest a need for systematic parametric studies of experimental conditions.

Application of the TDABC model in the logistics process using different capacity cost rates

Directory of Open Access Journals (Sweden)

Paulo Afonso

2016-12-01

Full Text Available Purpose: The understanding of logistics process in terms of costs and profitability is a complex task and there is a need of more research and applied work on these issues. In this research project, the concepts underlying Time-Driven Activity Based Costing (TDABC have been used in the context of logistics costs. Design/methodology/approach: A Distribution Centre of wood and carpentry related materials has been studied. A multidisciplinary team has been composed to support the project including the researchers and three employees of the company responsible for accounting, logistics and warehousing. The design and implementation of the costing model asked for a deep understanding of the different tasks and processes that should be considered. Accordingly, a TDABC model for the logistics function was developed. Findings: The cost model presented here is supported on a series of time equations designed for the logistics function which allow the analysis and discussion of costs and profitability of different cost objects namely, products, clients, distribution channels, processes and activities. The cost of unused capacity and the effectiveness of logistics processes are also highlighted in this model. Research limitations/implications: In a case study, results and implications cannot be directly or immediately generalized. Nevertheless, the proposed time equations and cost model can be easily adapted to explain other types of logistics functions and it gives the foundations or other TDABC models with more than one capacity cost rate. Practical implications: The TDABC model developed in this case study can be used in similar cases and as a basis for the analysis of logistics costs in other logistics processes. Furthermore, managers can rely on the proposed approach to analyze products’ profitability and logistics cost structure.  Originality/value: In this case, different capacity cost rates were computed in order to reflect appropriately the

Application of the TDABC model in the logistics process using different capacity cost rates

International Nuclear Information System (INIS)

Afonso, Paulo; Santana, Alex

2016-01-01

Purpose: The understanding of logistics process in terms of costs and profitability is a complex task and there is a need of more research and applied work on these issues. In this research project, the concepts underlying Time-Driven Activity Based Costing (TDABC) have been used in the context of logistics costs. Design/methodology/approach: A Distribution Centre of wood and carpentry related materials has been studied. A multidisciplinary team has been composed to support the project including the researchers and three employees of the company responsible for accounting, logistics and warehousing. The design and implementation of the costing model asked for a deep understanding of the different tasks and processes that should be considered. Accordingly, a TDABC model for the logistics function was developed. Findings: The cost model presented here is supported on a series of time equations designed for the logistics function which allow the analysis and discussion of costs and profitability of different cost objects namely, products, clients, distribution channels, processes and activities. The cost of unused capacity and the effectiveness of logistics processes are also highlighted in this model. Research limitations/implications: In a case study, results and implications cannot be directly or immediately generalized. Nevertheless, the proposed time equations and cost model can be easily adapted to explain other types of logistics functions and it gives the foundations or other TDABC models with more than one capacity cost rate. Practical implications: The TDABC model developed in this case study can be used in similar cases and as a basis for the analysis of logistics costs in other logistics processes. Furthermore, managers can rely on the proposed approach to analyze products’ profitability and logistics cost structure. Originality/value: In this case, different capacity cost rates were computed in order to reflect appropriately the logistics function which

Application of the TDABC model in the logistics process using different capacity cost rates

Energy Technology Data Exchange (ETDEWEB)

Afonso, Paulo; Santana, Alex

2016-07-01

Purpose: The understanding of logistics process in terms of costs and profitability is a complex task and there is a need of more research and applied work on these issues. In this research project, the concepts underlying Time-Driven Activity Based Costing (TDABC) have been used in the context of logistics costs. Design/methodology/approach: A Distribution Centre of wood and carpentry related materials has been studied. A multidisciplinary team has been composed to support the project including the researchers and three employees of the company responsible for accounting, logistics and warehousing. The design and implementation of the costing model asked for a deep understanding of the different tasks and processes that should be considered. Accordingly, a TDABC model for the logistics function was developed. Findings: The cost model presented here is supported on a series of time equations designed for the logistics function which allow the analysis and discussion of costs and profitability of different cost objects namely, products, clients, distribution channels, processes and activities. The cost of unused capacity and the effectiveness of logistics processes are also highlighted in this model. Research limitations/implications: In a case study, results and implications cannot be directly or immediately generalized. Nevertheless, the proposed time equations and cost model can be easily adapted to explain other types of logistics functions and it gives the foundations or other TDABC models with more than one capacity cost rate. Practical implications: The TDABC model developed in this case study can be used in similar cases and as a basis for the analysis of logistics costs in other logistics processes. Furthermore, managers can rely on the proposed approach to analyze products’ profitability and logistics cost structure. Originality/value: In this case, different capacity cost rates were computed in order to reflect appropriately the logistics function which

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.

Effectiveness and cost-effectiveness of an awareness campaign for colorectal cancer: a mathematical modeling study.

Science.gov (United States)

Whyte, Sophie; Harnan, Susan

2014-06-01

A campaign to increase the awareness of the signs and symptoms of colorectal cancer (CRC) and encourage self-presentation to a GP was piloted in two regions of England in 2011. Short-term data from the pilot evaluation on campaign cost and changes in GP attendances/referrals, CRC incidence, and CRC screening uptake were available. The objective was to estimate the effectiveness and cost-effectiveness of a CRC awareness campaign by using a mathematical model which extrapolates short-term outcomes to predict long-term impacts on cancer mortality, quality-adjusted life-years (QALYs), and costs. A mathematical model representing England (aged 30+) for a lifetime horizon was developed. Long-term changes to cancer incidence, cancer stage distribution, cancer mortality, and QALYs were estimated. Costs were estimated incorporating costs associated with delivering the campaign, additional GP attendances, and changes in CRC treatment. Data from the pilot campaign suggested that the awareness campaign caused a 1-month 10 % increase in presentation rates. Based on this, the model predicted the campaign to cost £5.5 million, prevent 66 CRC deaths and gain 404 QALYs. The incremental cost-effectiveness ratio compared to "no campaign" was £13,496 per QALY. Results were sensitive to the magnitude and duration of the increase in presentation rates and to disease stage. The effectiveness and cost-effectiveness of a cancer awareness campaign can be estimated based on short-term data. Such predictions will aid policy makers in prioritizing between cancer control strategies. Future cost-effectiveness studies would benefit from campaign evaluations reporting as follows: data completeness, duration of impact, impact on emergency presentations, and comparison with non-intervention regions.

The Cost-Effectiveness of Antibiotic Prophylaxis for Patients at Risk of Infective Endocarditis.

Science.gov (United States)

Franklin, Matthew; Wailoo, Allan; Dayer, Mark J; Jones, Simon; Prendergast, Bernard; Baddour, Larry M; Lockhart, Peter B; Thornhill, Martin H

2016-11-15

In March 2008, the National Institute for Health and Care Excellence recommended stopping antibiotic prophylaxis (AP) for those at risk of infective endocarditis (IE) undergoing dental procedures in the United Kingdom, citing a lack of evidence of efficacy and cost-effectiveness. We have performed a new economic evaluation of AP on the basis of contemporary estimates of efficacy, adverse events, and resource implications. A decision analytic cost-effectiveness model was used. Health service costs and benefits (measured as quality-adjusted life-years) were estimated. Rates of IE before and after the National Institute for Health and Care Excellence guidance were available to estimate prophylactic efficacy. AP adverse event rates were derived from recent UK data, and resource implications were based on English Hospital Episode Statistics. AP was less costly and more effective than no AP for all patients at risk of IE. The results are sensitive to AP efficacy, but efficacy would have to be substantially lower for AP not to be cost-effective. AP was even more cost-effective in patients at high risk of IE. Only a marginal reduction in annual IE rates (1.44 cases in high-risk and 33 cases in all at-risk patients) would be required for AP to be considered cost-effective at £20 000 ($26 600) per quality-adjusted life-year. Annual cost savings of £5.5 to £8.2 million ($7.3-$10.9 million) and health gains >2600 quality-adjusted life-years could be achieved from reinstating AP in England. AP is cost-effective for preventing IE, particularly in those at high risk. These findings support the cost-effectiveness of guidelines recommending AP use in high-risk individuals. © 2016 The Authors.

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...

Quality assurance of Vari-source high dose rate (HDR) brachytherapy- remote after loader and cost effectiveness of Vari-source HDR- brachytherapy: NORI, Islamabad experience

International Nuclear Information System (INIS)

Ahmad, N.; Mahmood, H.; Jafri, S.R.A.

2004-01-01

A quality control of Vari-Source high dose rate (HDR) remote after loading brachytherapy machine was carried out and the cost effectiveness of HDR brachytherapy machine was also evaluated considering the cost of ten Iridium-192 wire sources at Nuclear Medicine, Oncology and Radiotherapy Institute (NORI), Islamabad, Pakistan. A total number of 253 intracavitary insertions were done in 98 patients from October 1996 to May 2001. The results of the quality control tests performed during 1996 to 2001 were within the acceptable limits. The cost effectiveness of Vari-Source HDR brachytherapy machine was also evaluated. The average cost per patient was calculated as US$ 491. Small number of patients was treated as the machine was used for gynecologic malignancies only. The objective was to assess the quality control status of HDR brachytherapy machine on patient treatment day, source exchange day and periodic day (monthly basis). It was found that the cost per patient can be minimized if other type of cancer patients are also treated on Vari-Source HDR machine. (author)

Evaluation of the effects of an offer of a monetary incentive on the rate of questionnaire return during follow-up of a clinical trial: a randomised study within a trial.

Science.gov (United States)

Hardy, Pollyanna; Bell, Jennifer L; Brocklehurst, Peter

2016-07-15

A systematic review on the use of incentives to promote questionnaire return in clinical trials suggest they are effective, but not all studies have sufficient funds to use them. Promising an incentive once data are returned can reduce the cost-burden of this approach, with possible further cost-savings if the offer were restricted to reminder letters only. This study aimed to evaluate the effect of promising a monetary incentive at first mailout versus a promise on reminder letters only. This was a randomised Study Within A Trial (SWAT) nested within BUMPES, a multicentre randomised controlled trial of maternal position in the late stage of labour in women with an epidural. The follow-up questionnaire asked for information on the women's health, wellbeing and health service use one year following the birth of their baby. Women who consented to be contacted were randomised to a promise of a monetary incentive at first mailout or a promise on reminder letters only. Women were given an option of completing the questionnaire on paper or on online. The incentive was posted out on receipt of a completed questionnaire. The primary outcome was the overall return rate, and secondary outcomes were the return rate without any chasing from the study office, and the total cost of the vouchers. A total of 1,029 women were randomised, 508 to the first mailout group and 518 to the reminder group. There was no evidence to suggest a difference between groups in the overall return rate (adjusted RR 1.03 (95 % CI 0.96 to 1.11), however the proportion returned without chasing was higher in the first mailout group (adjusted RR 1.22, 95 % CI 1.07 to 1.39). The total cost of the vouchers per participant was higher in the first mailout group (mean difference £4.56, 95 % CI £4.02 to £5.11). Offering a monetary incentive when a reminder is required could be cost-effective depending on the sample size of the study and the resources available to administer the reminder letters. The

The value-based medicine comparative effectiveness and cost-effectiveness of penetrating keratoplasty for keratoconus.

Science.gov (United States)

Roe, Richard H; Lass, Jonathan H; Brown, Gary C; Brown, Melissa M

2008-10-01

To perform a base case, comparative effectiveness, and cost-effectiveness (cost-utility) analysis of penetrating keratoplasty for patients with severe keratoconus. Visual acuity data were obtained from a large, retrospective multicenter study in which patients with keratoconus with less than 20/40 best corrected visual acuity and/or the inability to wear contact lenses underwent penetrating keratoplasty, with an average follow-up of 2.1 years. The results were combined with other retrospective studies investigating complication rates of penetrating keratoplasty. The data were then incorporated into a cost-utility model using patient preference-based, time trade-off utilities, computer-based decision analysis, and a net present value model to account for the time value of outcomes and money. The comparative effectiveness of the intervention is expressed in quality-of-life gain and QALYs (quality-adjusted life-years), and the cost-effectiveness results are expressed in the outcome of $/QALY (dollars spent per QALY). Penetrating keratoplasty in 1 eye for patients with severe keratoconus results in a comparative effectiveness (value gain) of 16.5% improvement in quality of life every day over the 44-year life expectancy of the average patient with severe keratoconus. Discounting the total value gain of 5.36 QALYs at a 3% annual discount rate yields 3.05 QALYs gained. The incremental cost for penetrating keratoplasty, including all complications, is $5934 ($5913 discounted at 3% per year). Thus, the incremental cost-utility (discounted at 3% annually) for this intervention is $5913/3.05 QALYs = $1942/QALY. If both eyes undergo corneal transplant, the total discounted value gain is 30% and the overall cost-utility is $2003. Surgery on the second eye confers a total discounted value gain of 2.5 QALYs, yielding a quality-of-life gain of 11.6% and a discounted cost-utility of $2238/QALY. Penetrating keratoplasty for patients with severe keratoconus seems to be a

Cost-Effectiveness of Increasing Influenza Vaccination Coverage in Adults with Type 2 Diabetes in Turkey.

Science.gov (United States)

Akın, Levent; Macabéo, Bérengère; Caliskan, Zafer; Altinel, Serdar; Satman, Ilhan

2016-01-01

In Turkey, the prevalence of diabetes is high but the influenza vaccination coverage rate (VCR) is low (9.1% in 2014), despite vaccination being recommended and reimbursed. This study evaluated the cost-effectiveness of increasing the influenza VCR of adults with type 2 diabetes in Turkey to 20%. A decision-analytic model was adapted to Turkey using data derived from published sources. Direct medical costs and indirect costs due to productivity loss were included in the societal perspective. The time horizon was set at 1 year to reflect the seasonality of influenza. Increasing the VCR for adults with type 2 diabetes to 20% is predicted to avert an additional 19,777 influenza cases, 2376 hospitalizations, and 236 deaths. Associated influenza costs avoided were estimated at more than 8.3 million Turkish Lira (TRY), while the cost of vaccination would be more than TRY 8.4 million. The incremental cost-effectiveness ratio was estimated at TRY 64/quality-adjusted life years, which is below the per capita gross domestic product of TRY 21,511 and therefore very cost-effective according to World Health Organization guidelines. Factors most influencing the incremental cost-effectiveness ratio were the excess hospitalization rate, inpatient cost, vaccine effectiveness against hospitalization, and influenza attack rate. Increasing the VCR to >20% was also estimated to be very cost-effective. Increasing the VCR for adults with type 2 diabetes in Turkey to ≥20% would be very cost-effective.

Cost-Effectiveness of the Freeze-All Policy.

Science.gov (United States)

Roque, Matheus; Valle, Marcello; Guimarães, Fernando; Sampaio, Marcos; Geber, Selmo

2015-08-01

To evaluate the cost-effectiveness of freeze-all cycles when compared to fresh embryo transfer. This was an observational study with a cost-effectiveness analysis. The analysis consisted of 530 intracytoplasmic sperm injection (ICSI) cycles in a private center in Brazil between January 2012 and December 2013. A total of 530 intracytoplasmic sperm injection (ICSI) cycles - 351 fresh embryo transfers and 179 freeze-all cycles - with a gonadotropin-releasing hormone (GnRH) antagonist protocol and day 3 embryo transfers. The pregnancy rate was 31.1% in the fresh group and 39.7% in the freeze-all group. We performed two scenario analyses for costs. In scenario 1, we included those costs associated with the ICSI cycle (monitoring during controlled ovarian stimulation [COS], oocyte retrieval, embryo transfer, IVF laboratory, and medical costs), embryo cryopreservation of supernumerary embryos, hormone measurements during COS and endometrial priming, medication use (during COS, endometrial priming, and luteal phase support), ultrasound scan for frozen- thawed embryo transfer (FET), obstetric ultrasounds, and miscarriage. The total cost (in USD) per pregnancy was statistically lower in the freeze-all cycles (19,156.73 ± 1,732.99) when compared to the fresh cycles (23,059.72 ± 2,347.02). Even in Scenario 2, when charging all of the patients in the freeze-all group for cryopreservation (regardless of supernumerary embryos) and for FET, the fresh cycles had a statistically significant increase in treatment costs per ongoing pregnancy. The results presented in this study suggest that the freeze-all policy is a cost-effective strategy when compared to fresh embryo transfer.

Marital Biography, Social Security Receipt, and Poverty.

Science.gov (United States)

Lin, I-Fen; Brown, Susan L; Hammersmith, Anna M

2017-01-01

Increasingly, older adults are unmarried, which could mean a larger share is at risk of economic disadvantage. Using data from the 2010 Health and Retirement Study, we chart the diverse range of marital biographies, capturing marital sequences and timing, of adults who are age eligible for Social Security and examine three indicators of economic well-being: Social Security receipt, Social Security benefit levels, and poverty status. Partnereds are disproportionately likely to receive Social Security and they enjoy relatively high Social Security benefits and very low poverty levels. Among singles, economic well-being varies by marital biography and gender. Gray divorced and never-married women face considerable economic insecurity. Their Social Security benefits are relatively low, and their poverty rates are quite high (over 25%), indicating Social Security alone is not sufficient to prevent these women from falling into poverty. By comparison, gray widoweds are the most advantaged singles.

Rate of transmission: a major determinant of the cost of clinical mastitis.

Science.gov (United States)

Down, P M; Green, M J; Hudson, C D

2013-10-01

The aim of this research was to use probabilistic sensitivity analysis to evaluate the relative importance of different components of a model designed to estimate the cost of clinical mastitis (CM). A particular focus was placed on the importance of pathogen transmission relative to other factors, such as milk price or treatment costs. A stochastic Monte Carlo model was developed to simulate a case of CM at the cow level and to calculate the associated costs for 5 defined treatment protocols. The 5 treatment protocols modeled were 3 d of antibiotic intramammary treatment, 5 d of antibiotic intramammary treatment, 3 d of intramammary and systemic antibiotic treatment, 3d of intramammary and systemic antibiotic treatment plus 1 d of nonsteroidal antiinflammatory drug treatment, and 5 d of intramammary and systemic antibiotic treatment. Uniform distributions were used throughout the model to enable investigation of the cost of CM over a spectrum of clinically realistic scenarios without specifying which scenario was more or less likely. A risk of transmission parameter distribution, based on literature values, was included to model the effect of pathogen transmission to uninfected cows, from cows that remained subclinically infected after treatment for CM. Spearman rank correlation coefficients were used to evaluate the relationships between model input values and the estimated cost of CM. Linear regression models were used to explore the effect that changes to specific independent variables had on the cost of CM. Risk of transmission was found to have the strongest association with the cost of CM, followed by bacteriological cure rate, cost of culling, and yield loss. Other factors such as milk price, cost of labor, and cost of medicines were of minimal influence in comparison. The cost of CM was similar for all 5 treatment protocols. The results from this study suggest that, when seeking to minimize the economic impact of CM in dairy herds, great emphasis should be

7 CFR 1421.107 - Warehouse receipts.

Science.gov (United States)

2010-01-01

.... The receipts must be negotiable and must represent a commodity that is the same quantity and quality... percent; (3) Grain sorghum: 14.0 percent; (4) Oats: 14.0 percent; (5) Rice: 14.0 percent; (6) Soybeans: 14...) Mustard Seed: 10.0 percent; (4) Rapeseed: 10.0 percent; (5) Safflower Seed: 10.0 percent; (6) Sunflower...

Vaccination strategies for future influenza pandemics: a severity-based cost effectiveness analysis.

Science.gov (United States)

Kelso, Joel K; Halder, Nilimesh; Milne, George J

2013-02-11

A critical issue in planning pandemic influenza mitigation strategies is the delay between the arrival of the pandemic in a community and the availability of an effective vaccine. The likely scenario, born out in the 2009 pandemic, is that a newly emerged influenza pandemic will have spread to most parts of the world before a vaccine matched to the pandemic strain is produced. For a severe pandemic, additional rapidly activated intervention measures will be required if high mortality rates are to be avoided. A simulation modelling study was conducted to examine the effectiveness and cost effectiveness of plausible combinations of social distancing, antiviral and vaccination interventions, assuming a delay of 6-months between arrival of an influenza pandemic and first availability of a vaccine. Three different pandemic scenarios were examined; mild, moderate and extreme, based on estimates of transmissibility and pathogenicity of the 2009, 1957 and 1918 influenza pandemics respectively. A range of different durations of social distancing were examined, and the sensitivity of the results to variation in the vaccination delay, ranging from 2 to 6 months, was analysed. Vaccination-only strategies were not cost effective for any pandemic scenario, saving few lives and incurring substantial vaccination costs. Vaccination coupled with long duration social distancing, antiviral treatment and antiviral prophylaxis was cost effective for moderate pandemics and extreme pandemics, where it saved lives while simultaneously reducing the total pandemic cost. Combined social distancing and antiviral interventions without vaccination were significantly less effective, since without vaccination a resurgence in case numbers occurred as soon as social distancing interventions were relaxed. When social distancing interventions were continued until at least the start of the vaccination campaign, attack rates and total costs were significantly lower, and increased rates of vaccination

5 CFR 302.301 - Receipt of applications.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Receipt of applications. 302.301 Section 302.301 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT... applications. (a) Each agency shall establish definite rules regarding the acceptance of applications for...

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.

Cost-Effectiveness of School-Based Prevention of Cannabis Use.

Science.gov (United States)

Deogan, Charlotte; Zarabi, Natalie; Stenström, Nils; Högberg, Pi; Skärstrand, Eva; Manrique-Garcia, Edison; Neovius, Kristian; Månsdotter, Anna

2015-10-01

Cannabis is the most frequently used illicit drug globally. Despite increasing evidence that cannabis use is associated with adverse health effects, the knowledge on preventative strategies is still limited. This study stemmed from a systematic review of effective prevention in which school-based programmes were identified as promising. The primary objective was to evaluate the cost effectiveness of Project ALERT (Adolescent, Learning, Experiences, Resistance, and Training), compared with ordinary ATOD (Alcohol, Tobacco, and Other Drug) education, among Swedish students in the eighth grade of compulsory school. The cost-effectiveness analysis was performed from the societal perspective with quality-adjusted life-years (QALYs) as an outcome (willingness-to-pay threshold €50,000) and follow-up periods from 1 year to a lifetime, considering a discounting rate of 3%, and with costs inflated to 2013 levels. A Markov model was constructed on the basis of the 'states' of single use, regular use, daily use and use of other illicit drugs, which were associated with 'complications' of psychosis, schizophrenia, traffic accidents, depression and amotivational syndrome. Health and cost consequences were linked to both states and complications. The programme was cost saving on the basis of evidence from the USA (ratio 1:1.1), and was cost effective (incremental cost-effectiveness ratio €22,384 per QALY) after reasonable adjustment for the Swedish context and with 20 years of follow-up. When the target group was restricted to boys who were neither studying nor working/doing work experience, the programme was cost effective after 9 years and cost saving (ratio 1:3.2) after 20 years. School-based prevention such as Project ALERT has the potential to be cost effective and to be cost saving if implemented in deprived areas. In the light of the shifting landscape regarding legalization of cannabis, it seems rational to continue the health economic analysis of prevention initiated

Time-of-Use Rates and Electricity Costs of Representative New York Dairy Farms

OpenAIRE

Boisvert, Richard N.; Bills, Nelson L.; Middagh, Mark C.; Schenkel, Mark

1992-01-01

Electric utilities throughout the Nation are experimenting with strategies to reduce total electricity consumption or to alter the timing of electrical power use by their customers. This report focuses on one such strategy, time-of-use (TaU) electric rates, and the likely effect of this pricing option on the New York dairy sector. The purpose of the study is to assess the change in farm electrical energy costs when power is sold to dairymen at higher rates for periods of peak power demand and...

Association Between Parental Barriers to Accessing a Usual Source of Care and Children's Receipt of Preventive Services.

Science.gov (United States)

Bellettiere, John; Chuang, Emmeline; Hughes, Suzanne C; Quintanilla, Isaac; Hofstetter, C Richard; Hovell, Melbourne F

Preventive health services are important for child development, and parents play a key role in facilitating access to services. This study examined how parents' reasons for not having a usual source of care were associated with their children's receipt of preventive services. We used pooled data from the 2011-2014 National Health Interview Survey (n = 34 843 participants). Parents' reasons for not having a usual source of care were framed within the Penchansky and Thomas model of access and measured through 3 dichotomous indicators: financial barriers (affordability), attitudes and beliefs about health care (acceptability), and all other nonfinancial barriers (accessibility, accommodation, and availability). We used multivariable logistic regression models to test associations between parental barriers and children's receipt of past-year well-child care visits and influenza vaccinations, controlling for other child, family, and contextual factors. In 2014, 14.3% (weighted percentage) of children had at least 1 parent without a usual source of care. Children of parents without a usual source of care because they "don't need a doctor and/or haven't had any problems" or they "don't like, trust, or believe in doctors" had 35% lower odds of receiving well-child care (adjusted odds ratio = 0.65; 95% CI, 0.56-0.74) and 23% lower odds of receiving influenza vaccination (adjusted odds ratio = 0.77; 95% CI, 0.69-0.86) than children of parents without those attitudes and beliefs about health care. Financial and other nonfinancial parental barriers were not associated with children's receipt of preventive services. Results were independent of several factors relevant to children's access to preventive health care, including whether the child had a usual source of care. Parents' attitudes and beliefs about having a usual source of care were strongly associated with their children's receipt of recommended preventive health services. Rates of receipt of child preventive

Costs and Cost Effectiveness of Three Approaches for Cervical Cancer Screening among HIV-Positive Women in Johannesburg, South Africa.

Science.gov (United States)

Lince-Deroche, Naomi; Phiri, Jane; Michelow, Pam; Smith, Jennifer S; Firnhaber, Cindy

2015-01-01

South Africa has high rates of HIV and HPV and high incidence and mortality from cervical cancer. However, cervical cancer is largely preventable when early screening and treatment are available. We estimate the costs and cost-effectiveness of conventional cytology (Pap), visual inspection with acetic acid (VIA) and HPV DNA testing for detecting cases of CIN2+ among HIV-infected women currently taking antiretroviral treatment at a public HIV clinic in Johannesburg, South Africa. Method effectiveness was derived from a validation study completed at the clinic. Costs were estimated from the provider perspective using micro-costing between June 2013-April 2014. Capital costs were annualized using a discount rate of 3%. Two different service volume scenarios were considered. Threshold analysis was used to explore the potential for reducing the cost of HPV DNA testing. VIA was least costly in both scenarios. In the higher volume scenario, the average cost per procedure was US$ 3.67 for VIA, US$ 8.17 for Pap and US$ 54.34 for HPV DNA. Colposcopic biopsies cost on average US$ 67.71 per procedure. VIA was least sensitive but most cost-effective at US$ 17.05 per true CIN2+ case detected. The cost per case detected for Pap testing was US$ 130.63 using a conventional definition for positive results and US$ 187.52 using a more conservative definition. HPV DNA testing was US$ 320.09 per case detected. Colposcopic biopsy costs largely drove the total and per case costs. A 71% reduction in HPV DNA screening costs would make it competitive with the conservative Pap definition. Women need access to services which meet their needs and address the burden of cervical dysplasia and cancer in this region. Although most cost-effective, VIA may require more frequent screening due to low sensitivity, an important consideration for an HIV-positive population with increased risk for disease progression.

Costs and Cost Effectiveness of Three Approaches for Cervical Cancer Screening among HIV-Positive Women in Johannesburg, South Africa.

Directory of Open Access Journals (Sweden)

Naomi Lince-Deroche

Full Text Available South Africa has high rates of HIV and HPV and high incidence and mortality from cervical cancer. However, cervical cancer is largely preventable when early screening and treatment are available. We estimate the costs and cost-effectiveness of conventional cytology (Pap, visual inspection with acetic acid (VIA and HPV DNA testing for detecting cases of CIN2+ among HIV-infected women currently taking antiretroviral treatment at a public HIV clinic in Johannesburg, South Africa.Method effectiveness was derived from a validation study completed at the clinic. Costs were estimated from the provider perspective using micro-costing between June 2013-April 2014. Capital costs were annualized using a discount rate of 3%. Two different service volume scenarios were considered. Threshold analysis was used to explore the potential for reducing the cost of HPV DNA testing.VIA was least costly in both scenarios. In the higher volume scenario, the average cost per procedure was US$ 3.67 for VIA, US$ 8.17 for Pap and US$ 54.34 for HPV DNA. Colposcopic biopsies cost on average US$ 67.71 per procedure. VIA was least sensitive but most cost-effective at US$ 17.05 per true CIN2+ case detected. The cost per case detected for Pap testing was US$ 130.63 using a conventional definition for positive results and US$ 187.52 using a more conservative definition. HPV DNA testing was US$ 320.09 per case detected. Colposcopic biopsy costs largely drove the total and per case costs. A 71% reduction in HPV DNA screening costs would make it competitive with the conservative Pap definition.Women need access to services which meet their needs and address the burden of cervical dysplasia and cancer in this region. Although most cost-effective, VIA may require more frequent screening due to low sensitivity, an important consideration for an HIV-positive population with increased risk for disease progression.

Single versus double embryo transfer: cost-effectiveness analysis alongside a randomized clinical trial.

Science.gov (United States)

Fiddelers, Audrey A A; van Montfoort, Aafke P A; Dirksen, Carmen D; Dumoulin, John C M; Land, Jolande A; Dunselman, Gerard A J; Janssen, J Marij; Severens, Johan L; Evers, Johannes L H

2006-08-01

Twin pregnancies after IVF are still frequent and are considered high-risk pregnancies leading to high costs. Transferring one embryo can reduce the twin pregnancy rate. We compared cost-effectiveness of one fresh cycle elective single embryo transfer (eSET) versus one fresh cycle double embryo transfer (DET) in an unselected patient population. Patients starting their first IVF cycle were randomized between eSET and DET. Societal costs per couple were determined empirically, from hormonal stimulation up to 42 weeks after embryo transfer. An incremental cost-effectiveness ratio (ICER) was calculated, representing additional costs per successful pregnancy. Successful pregnancy rates were 20.8% for eSET and 39.6% for DET. Societal costs per couple were significantly lower after eSET (7334 euro) compared with DET (10,924 euro). The ICER of DET compared with eSET was 19,096 euro, meaning that each additional successful pregnancy in the DET group will cost 19,096 euro extra. One cycle eSET was less expensive, but also less effective compared to one cycle DET. It depends on the society's willingness to pay for one extra successful pregnancy, whether one cycle DET is preferred from a cost-effectiveness point of view.

[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

21 CFR 1271.265 - Receipt, predistribution shipment, and distribution of an HCT/P.

Science.gov (United States)

2010-04-01

... DRUG ADMINISTRATION HUMAN CELLS, TISSUES, AND CELLULAR AND TISSUE-BASED PRODUCTS Current Good Tissue Practice § 1271.265 Receipt, predistribution shipment, and distribution of an HCT/P. (a) Receipt. You must... distribution of an HCT/P. 1271.265 Section 1271.265 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF...

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

Cost, cost-efficiency and cost-effectiveness of integrated family planning and HIV services.

Science.gov (United States)

Shade, Starley B; Kevany, Sebastian; Onono, Maricianah; Ochieng, George; Steinfeld, Rachel L; Grossman, Daniel; Newmann, Sara J; Blat, Cinthia; Bukusi, Elizabeth A; Cohen, Craig R

2013-10-01

To evaluate costs, cost-efficiency and cost-effectiveness of integration of family planning into HIV services. Integration of family planning services into HIV care and treatment clinics. A cluster-randomized trial. Twelve health facilities in Nyanza, Kenya were randomized to integrate family planning into HIV care and treatment; six health facilities were randomized to (nonintegrated) standard-of-care with separately delivered family planning and HIV services. We assessed costs, cost-efficiency (cost per additional use of more effective family planning), and cost-effectiveness (cost per pregnancy averted) associated with the first year of integration of family planning into HIV care. More effective family planning methods included oral and injectable contraceptives, subdermal implants, intrauterine device, and female and male sterilization. We collected cost data through interviews with study staff and review of financial records to determine costs of service integration. Integration of services was associated with an average marginal cost of $841 per site and $48 per female patient. Average overall and marginal costs of integration were associated with personnel costs [initial ($1003 vs. $872) and refresher ($498 vs. $330) training, mentoring ($1175 vs. $902) and supervision ($1694 vs. $1636)], with fewer resources required for other fixed ($18 vs. $0) and recurring expenses ($471 vs. $287). Integration was associated with a marginal cost of $65 for each additional use of more effective family planning and $1368 for each pregnancy averted. Integration of family planning and HIV services is feasible, inexpensive to implement, and cost-efficient in the Kenyan setting, and thus supports current Kenyan integration policy.

37 CFR 7.4 - Receipt of correspondence.

Science.gov (United States)

2010-07-01

... CONCERNING THE INTERNATIONAL REGISTRATION OF MARKS General Information § 7.4 Receipt of correspondence. (a... accorded the date of deposit with the United States Postal Service. (2) Responses to notices of....4 Section 7.4 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND TRADEMARK OFFICE...

Effect of migration based on strategy and cost on the evolution of cooperation

International Nuclear Information System (INIS)

Li, Yan; Ye, Hang

2015-01-01

Highlights: •Propose a migration based on strategy and cost in the Prisoner’s Dilemma Game. •The level of cooperation without mutation is higher than that with mutation. •Increased costs have no effect on the level of cooperation without mutation. •The level of cooperation decreases with the increase in cost with mutation. •An optimal density value ρ resulting in the maximum level of cooperation exists. -- Abstract: Humans consider not only their own ability but also the environment around them during the process of migration. Based on this fact, we introduce migration based on strategy and cost into the Spatial Prisoner’s Dilemma Game on a two-dimensional grid. The migration means that agents cannot move when all of the neighbors are cooperators; otherwise, agents move with a probability related to payoff and cost. The result obtained by the computer simulation shows that the moving mechanism based on strategy and cost improves the level of cooperation in a wide parameter space. This occurs because movement based on strategy effectively keeps the cooperative clusters and because movement based on cost effectively regulates the rate of movement. Both types of movement provide a favorable guarantee for the evolution of stable cooperation under the mutation rate q = 0.0. In addition, we discuss the effectiveness of the migration mechanism in the evolution of cooperation under the mutation rate q = 0.001. The result indicates that a higher level of cooperation is obtained at a lower migration cost, whereas cooperation is suppressed at a higher migration cost. Our work may provide an effective method for understanding the emergence of cooperation in our society

Receipt of preventive dental care among special-needs children enrolled in Medicaid: a crisis in need of attention.

Science.gov (United States)

Mitchell, Jean M; Gaskin, Darrell J

2008-10-01

Although not widely recognized, tooth decay is the most common childhood chronic disease among children ages five to seventeen. Despite higher rates of dental caries and greater needs, low-income minority children enrolled in Medicaid are more likely to go untreated relative to their higher income counterparts. No research has examined this issue for children with special needs. We analyzed Medicaid enrollment and claims data for special-needs children enrolled in the District of Columbia Medicaid program to evaluate receipt of recommended preventive dental care. Use of preventive dental care is abysmally low and has declined over time. Enrollment in managed care rather than fee for service improves the likelihood that special-needs children receive recommended preventive dental services, whereas residing farther from the Metro is an impediment to receipt of dental care.

A cost-effectiveness comparison between early surgery and non-surgical approach for incidental papillary thyroid microcarcinoma.

Science.gov (United States)

Lang, Brian Hung-Hin; Wong, Carlos K H

2015-09-01

The issue of whether all incidental papillary thyroid microcarcinoma (PTMC) should be managed by early surgery (ES) has been questioned and there is a growing acceptance that a non-surgical approach (NSA) might be more appropriate. We conducted a cost-effectiveness analysis comparing the two strategies in managing incidental PTMC. Our base case was a hypothetical 40-year-old female diagnosed with a unifocal intra-thyroidal 9 mm PTMC. The PTMC was considered suitable for either strategy. A Markov decision tree model was constructed to compare the estimated cost-effectiveness between ES and NSA after 20 years. Outcome probabilities, utilities and costs were derived from the literature. The threshold for cost-effectiveness was set at USD 50,000/quality-adjusted life year (QALY). A further analysis was done for patients Sensitivity and threshold analyses were used to examine model uncertainty. Each patient who adopted NSA over ES cost an extra USD 682.54 but gained an additional 0.260 QALY. NSA was cost saving (i.e. less costly and more effective) up to 16 years from diagnosis and remained cost-effective from 17 years onward. In the sensitivity analysis, NSA remained cost-effective regardless of patient age (rates of progression, year cycle and discount rate. In the threshold analysis, none of the scenarios that could have changed the conclusion appeared clinically likely. For a selected group of incidental PTMC, adopting NSA was not only cost saving in the initial 16 years but also remained cost effective thereafter. This was irrespective of patient age, complication rate or rate of PTMC progression. © 2015 European Society of Endocrinology.

7 CFR 160.204 - Fees for extra cost and hourly rate service.

Science.gov (United States)

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Fees for extra cost and hourly rate service. 160.204... STORES REGULATIONS AND STANDARDS FOR NAVAL STORES Specific Fees Payable for Services Rendered § 160.204 Fees for extra cost and hourly rate service. The fees specified in §§ 160.201 and 160.202 apply to the...

Wide Variability in Emergency Physician Admission Rates: A Target to Reduce Costs Without Compromising Quality

Directory of Open Access Journals (Sweden)

Jeffrey J. Guterman

2016-09-01

Full Text Available Introduction: Attending physician judgment is the traditional standard of care for emergency department (ED admission decisions. The extent to which variability in admission decisions affect cost and quality is not well understood. We sought to determine the impact of variability in admission decisions on cost and quality. Methods: We performed a retrospective observational study of patients presenting to a university-affiliated, urban ED from October 1, 2007, through September 30, 2008. The main outcome measures were admission rate, fiscal indicators (Medicaid-denied payment days, and quality indicators (15- and 30-day ED returns; delayed hospital admissions. We asked each Attending to estimate their inpatient admission rate and correlated their personal assessment with actual admission rates. Results: Admission rates, even after adjusting for known confounders, were highly variable (15.2%-32.0% and correlated with Medicaid denied-payment day rates (p=0.038. There was no correlation with quality outcome measures (30-day ED return or delayed hospital admission. There was no significant correlation between actual and self-described admission rate; the range of mis-estimation was 0% to 117%. Conclusion: Emergency medicine attending admission rates at this institution are highly variable, unexplained by known confounding variables, and unrelated to quality of care, as measured by 30-day ED return or delayed hospital admission. Admission optimization represents an important untapped potential for cost reduction through avoidable hospitalizations, with no apparent adverse effects on quality.

Cost minimization analysis of high-dose-rate versus low-dose-rate brachytherapy in endometrial cancer

International Nuclear Information System (INIS)

Pinilla, James

1998-01-01

Purpose: Endometrial cancer is a common, usually curable malignancy whose treatment frequently involves low-dose-rate (LDR) or high-dose-rate (HDR) brachytherapy. These treatments involve substantial resource commitments and this is increasingly important. This paper presents a cost minimization analysis of HDR versus LDR brachytherapy in the treatment of endometrial cancer. Methods and Materials: The perspective of the analysis is that of the payor, in this case the Ministry of Health. One course of LDR treatment is compared to two courses of HDR treatment. The two alternatives are considered to be comparable with respect to local control, survival, and toxicities. Labor, overhead, and capital costs are accounted for and carefully measured. A 5% inflation rate is used where applicable. A univariate sensitivity analysis is performed. Results: The HDR regime is 22% less expensive compared to the LDR regime. This is $991.66 per patient or, based on the current workload of this department (30 patients per year) over the useful lifetime of the after loader, $297,498 over 10 years in 1997 dollars. Conclusion: HDR brachytherapy minimizes costs in the treatment of endometrial cancer relative to LDR brachytherapy. These results may be used by other centers to make rational decisions regarding brachytherapy equipment replacement or acquisition

Cost-effectiveness analysis of microdose clinical trials in drug development.

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Yamane, Naoe; Igarashi, Ataru; Kusama, Makiko; Maeda, Kazuya; Ikeda, Toshihiko; Sugiyama, Yuichi

2013-01-01

Microdose (MD) clinical trials have been introduced to obtain human pharmacokinetic data early in drug development. Here we assessed the cost-effectiveness of microdose integrated drug development in a hypothetical model, as there was no such quantitative research that weighed the additional effectiveness against the additional time and/or cost. First, we calculated the cost and effectiveness (i.e., success rate) of 3 types of MD integrated drug development strategies: liquid chromatography-tandem mass spectrometry, accelerator mass spectrometry, and positron emission tomography. Then, we analyzed the cost-effectiveness of 9 hypothetical scenarios where 100 drug candidates entering into a non-clinical toxicity study were selected by different methods as the conventional scenario without MD. In the base-case, where 70 drug candidates were selected without MD and 30 selected evenly by one of the three MD methods, incremental cost-effectiveness ratio per one additional drug approved was JPY 12.7 billion (US$ 0.159 billion), whereas the average cost-effectiveness ratio of the conventional strategy was JPY 24.4 billion, which we set as a threshold. Integrating MD in the conventional drug development was cost-effective in this model. This quantitative analytical model which allows various modifications according to each company's conditions, would be helpful for guiding decisions early in clinical development.

77 FR 63804 - Federal Acquisition Regulation; Information Collection; Indirect Cost Rates

Science.gov (United States)

2012-10-17

... cost accounting information normally prepared by organizations under sound management and accounting...; Information Collection; Indirect Cost Rates AGENCY: Department of Defense (DOD), General Services... Paperwork Reduction Act, the Regulatory Secretariat will be submitting to the Office of Management and...

Cost and cost effectiveness of vaginal progesterone gel in reducing preterm birth: an economic analysis of the PREGNANT trial.

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Pizzi, Laura T; Seligman, Neil S; Baxter, Jason K; Jutkowitz, Eric; Berghella, Vincenzo

2014-05-01

Preterm birth (PTB) is a costly public health problem in the USA. The PREGNANT trial tested the efficacy of vaginal progesterone (VP) 8 % gel in reducing the likelihood of PTB among women with a short cervix. We calculated the costs and cost effectiveness of VP gel versus placebo using decision analytic models informed by PREGNANT patient-level data. PREGNANT enrolled 459 pregnant women with a cervical length of 10-20 mm and randomized them to either VP 8 % gel or placebo. We used a cost model to estimate the total cost of treatment per mother and a cost-effectiveness model to estimate the cost per PTB averted with VP gel versus placebo. Patient-level trial data informed model inputs and included PTB rates in low- and high-risk women in each study group at <28 weeks gestation, 28-31, 32-36, and ≥37 weeks. Cost assumptions were based on 2010 US healthcare services reimbursements. The cost model was validated against patient-level data. Sensitivity analyses were used to test the robustness of the cost-effectiveness model. The estimated cost per mother was $US23,079 for VP gel and $US36,436 for placebo. The cost-effectiveness model showed savings of $US24,071 per PTB averted with VP gel. VP gel realized cost savings and cost effectiveness in 79 % of simulations. Based on findings from PREGNANT, VP gel was associated with cost savings and cost effectiveness compared with placebo. Future trials designed to include cost metrics are needed to better understand the value of VP.

Comparison of response rates and cost-effectiveness for a community-based survey: postal, internet and telephone modes with generic or personalised recruitment approaches

Science.gov (United States)

2012-01-01

Background Epidemiological research often requires collection of data from a representative sample of the community or recruitment of specific groups through broad community approaches. The population coverage of traditional survey methods such as mail-outs to residential addresses, and telephone contact via public directories or random-digit-dialing is declining and survey response rates are falling. There is a need to explore new sampling frames and consider multiple response modes including those offered by changes in telecommunications and internet technology. Methods We evaluated response rates and cost-effectiveness for three modes of survey administration (postal invitation/postal survey, postal invitation/internet survey and postal invitation/telephone survey) and two styles of contact approach (personalised and generic) in a community survey of greywater use. Potential respondents were contacted only once, with no follow up of non-responders. Results The telephone survey produced the highest adjusted response rate (30.2%), followed by the personalised postal survey (10.5%), generic postal survey (7.5%) and then the internet survey (4.7% for the personalised approach and 2.2% for the generic approach). There were some differences in household characteristics and greywater use rates between respondents to different survey modes, and between respondents to personalised and generic approaches. These may be attributable to the differing levels of motivations needed for a response, and varying levels of interest in the survey topic among greywater users and non-users. The generic postal survey had the lowest costs per valid survey received (Australian $22.93), followed by the personalised postal survey ($24.75). Conclusions Our findings suggest that postal surveys currently remain the most economic option for population-based studies, with similar costs for personalised and generic approaches. Internet surveys may be effective for specialised groups where email

Cost-Effective Location Management for Mobile Agents on the Internet

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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.

A budget-impact and cost-effectiveness model for second-line treatment of major depression.

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Malone, Daniel C

2007-07-01

Depressed patients who initially fail to achieve remission when placed on a selective serotonin reuptake inhibitor (SSRI) may require a second treatment. The purpose of this study was to evaluate the effectiveness, cost, cost-effectiveness, and budget impact of second-line pharmacologic treatment for major depressive disorder (MDD). A cost-effectiveness analysis was conducted to evaluate second-line therapies (citalopram, escitalopram, fluoxetine, paroxetine, paroxetine controlled release [CR], sertraline, and venlafaxine extended release [XR]) for the treatment of depression. Effectiveness data were obtained from published clinical studies. The primary outcome was remission defined as a score of 7 or less on the Hamilton Rating Scale for Depression (HAM-D) or a score of 10 or less on the montgomery-Asberg Depression Rating Scale (MADRS) depression rating scales. The wholesale acquisition cost (WAC) for medications and medical treatment costs for depression were included. The perspective was derived from a managed care organization (MCO) with 500,000 members, a 1.9% annual incidence of depression, and treatment duration of 6 months. Assumptions included: second-line treatment is not as effective as first-line treatment, WAC price reflects MCO costs, and side effects were identical. Sensitivity analyses were conducted to determine variables that influenced the results. Second-line remission rates were 20.4% for venlafaxine XR, 16.9% for sertraline, 16.4% for escitalopram, 15.1% for generic SSRIs (weighted average), and 13.6% for paroxetine CR. Pharmacy costs ranged from $163 for generic SSRIs to $319 for venlafaxine SR. Total cost per patient achieving remission was $14,275 for venlafaxine SR, followed by $16,100 for escitalopram. The incremental cost-effectiveness ratio (ICER) for venlafaxine SR compared with generic SSRIs was $2,073 per patient achieving remission, followed by escitalopram with an ICER of $3,566. The model was most sensitive to other therapies

Improving VAT Compliance in Romania by Implementing a New Tool – Tax Lottery Receipts

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Dragos Ungureanu

2015-12-01

Full Text Available This paper aims to present and explain the newly implemented measure of organizing a Tax Lottery Receipts in Romania, in orderto combat tax evasion by raising awareness among consumers and make them responsible when purchasing any goods.The lottery proposes an approach to strengthen the fiscal voluntary conformation by stimulating financially those who promote respecting the law – asking for the fiscal receipt, and helpthe fiscal authorities this way in the fight against tax evasion, contrasting at the same time with punishing those who do not respect it – not issuing fiscal receipts.

The net effect of alternative allocation ratios on recruitment time and trial cost.

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Vozdolska, Ralitza; Sano, Mary; Aisen, Paul; Edland, Steven D

2009-04-01

Increasing the proportion of subjects allocated to the experimental treatment in controlled clinical trials is often advocated as a method of increasing recruitment rates and improving the performance of trials. The presumption is that the higher likelihood of randomization to the experimental treatment will be perceived by potential study enrollees as an added benefit of participation and will increase recruitment rates and speed the completion of trials. However, studies with alternative allocation ratios require a larger sample size to maintain statistical power, which may result in a net increase in time required to complete recruitment and a net increase in total trial cost. To describe the potential net effect of alternative allocation ratios on recruitment time and trial cost. Models of recruitment time and trial cost were developed and used to compare trials with 1:1 allocation to trials with alternative allocation ratios under a range of per subject costs, per day costs, and enrollment rates. In regard to time required to complete recruitment, alternative allocation ratios are net beneficial if the recruitment rate improves by more than about 4% for trials with a 1.5:1 allocation ratio and 12% for trials with a 2:1 allocation ratio. More substantial improvements in recruitment rate, 13 and 47% respectively for scenarios we considered, are required for alternative allocation to be net beneficial in terms of tangible monetary cost. The cost models were developed expressly for trials comparing proportions or means across treatment groups. Using alternative allocation ratio designs to improve recruitment may or may not be time and cost-effective. Using alternative allocation for this purpose should only be considered for trial contexts where there is both clear evidence that the alternative design does improve recruitment rates and the attained time or cost efficiency justifies the added study subject burden implied by a larger sample size.

How to Prepare an Indirect Cost Rate Proposal for a Non-profit Organization

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The indirect cost rate proposal is the documentation prepared by a grantee organization, in accordance with applicable federal cost principles, to substantiate its claim for the reimbursement of indirect costs.

DVT surveillance program in the ICU: analysis of cost-effectiveness.

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Ajai K Malhotra

Full Text Available BACKGROUND: Venous Thrombo-embolism (VTE--Deep venous thrombosis (DVT and/or pulmonary embolism (PE--in traumatized patients causes significant morbidity and mortality. The current study evaluates the effectiveness of DVT surveillance in reducing PE, and performs a cost-effectiveness analysis. METHODS: All traumatized patients admitted to the adult ICU underwent twice weekly DVT surveillance by bilateral lower extremity venous Duplex examination (48-month surveillance period--SP. The rates of DVT and PE were recorded and compared to the rates observed in the 36-month pre-surveillance period (PSP. All patients in both periods received mechanical and pharmacologic prophylaxis unless contraindicated. Total costs--diagnostic, therapeutic and surveillance--for both periods were recorded and the incremental cost for each Quality Adjusted Life Year (QALY gained was calculated. RESULTS: 4234 patients were eligible (PSP--1422 and SP--2812. Rate of DVT in SP (2.8% was significantly higher than in PSP (1.3% - p<0.05, and rate of PE in SP (0.7% was significantly lower than that in PSP (1.5% - p<0.05. Logistic regression demonstrated that surveillance was an independent predictor of increased DVT detection (OR: 2.53 - CI: 1.462-4.378 and decreased PE incidence (OR: 0.487 - CI: 0.262-0.904. The incremental cost was $509,091/life saved in the base case, translating to $29,102/QALY gained. A sensitivity analysis over four of the parameters used in the model indicated that the incremental cost ranged from $18,661 to $48,821/QALY gained. CONCLUSIONS: Surveillance of traumatized ICU patients increases DVT detection and reduces PE incidence. Costs in terms of QALY gained compares favorably with other interventions accepted by society.

The cost and cost-effectiveness of childhood cancer treatment in El Salvador, Central America: A report from the Childhood Cancer 2030 Network.

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Fuentes-Alabi, Soad; Bhakta, Nickhill; Vasquez, Roberto Franklin; Gupta, Sumit; Horton, Susan E

2018-01-15

Although previous studies have examined the cost of treating individual childhood cancers in low-income and middle-income countries, to the authors' knowledge none has examined the overall cost and cost-effectiveness of operating a childhood cancer treatment center. Herein, the authors examined the cost and sources of financing of a pediatric cancer unit in Hospital Nacional de Ninos Benjamin Bloom in El Salvador, and make estimates of cost-effectiveness. Administrative data regarding costs and volumes of inputs were obtained for 2016 for the pediatric cancer unit. Similar cost and volume data were obtained for shared medical services provided centrally (eg, blood bank). Costs of central nonmedical support services (eg, utilities) were obtained from hospital data and attributed by inpatient share. Administrative data also were used for sources of financing. Cost-effectiveness was estimated based on the number of new patients diagnosed annually and survival rates. The pediatric cancer unit cost $5.2 million to operate in 2016 (treating 90 outpatients per day and experiencing 1385 inpatient stays per year). Approximately three-quarters of the cost (74.7%) was attributed to 4 items: personnel (21.6%), pathological diagnosis (11.5%), pharmacy (chemotherapy, supportive care medications, and nutrition; 31.8%), and blood products (9.8%). Funding sources included government (52.5%), charitable foundations (44.2%), and a social security contribution scheme (3.4%). Based on 181 new patients per year and a 5-year survival rate of 48.5%, the cost per disability-adjusted life-year averted was $1624, which is under the threshold considered to be very cost effective. Treating childhood cancer in a specialized unit in low-income and middle-income countries can be done cost-effectively. Strong support from charitable foundations aids with affordability. Cancer 2018;124:391-7. © 2017 American Cancer Society. © 2017 American Cancer Society.

Cumulative receipt of an anti-poverty tax credit for families did not impact tobacco smoking among parents.

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Pega, Frank; Gilsanz, Paola; Kawachi, Ichiro; Wilson, Nick; Blakely, Tony

2017-04-01

The effect of anti-poverty tax credit interventions on tobacco consumption is unclear. Previous studies have estimated short-term effects, did not isolate the effects of cumulative dose of tax credits, produced conflicting results, and used methods with limited control for some time-varying confounders (e.g., those affected by prior treatment) and treatment regimen (i.e., study participants' tax credit receipt pattern over time). We estimated the longer-term, cumulative effect of New Zealand's Family Tax Credit (FTC) on tobacco consumption, using a natural experiment (administrative errors leading to exogenous variation in FTC receipt) and methods specifically for controlling confounding, reverse causation, and treatment regimen. We extracted seven waves (2002-2009) of the nationally representative Survey of Family, Income and Employment including 4404 working-age (18-65 years) parents in families. The exposure was the total numbers of years of receiving FTC. The outcomes were regular smoking and the average daily number of cigarettes usually smoked at wave 7. We estimated average treatment effects using inverse probability of treatment weighting and marginal structural modelling. Each additional year of receiving FTC affected neither the odds of regular tobacco smoking among all parents (odds ratio 1.02, 95% confidence interval 0.94-1.11), nor the number of cigarettes smoked among parents who smoked regularly (rate ratio 1.01, 95% confidence interval 0.99-1.03). We found no evidence for an association between the cumulative number of years of receiving an anti-poverty tax credit and tobacco smoking or consumption among parents. The assumptions of marginal structural modelling are quite demanding, and we therefore cannot rule out residual confounding. Nonetheless, our results suggest that tax credit programme participation will not increase tobacco consumption among poor parents, at least in this high-income country. Copyright © 2017 Elsevier Ltd. All rights

Costs of Illness Due to Cholera, Costs of Immunization and Cost-Effectiveness of an Oral Cholera Mass Vaccination Campaign in Zanzibar

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Schaetti, Christian; Weiss, Mitchell G.; Ali, Said M.; Chaignat, Claire-Lise; Khatib, Ahmed M.; Reyburn, Rita; Duintjer Tebbens, Radboud J.; Hutubessy, Raymond

2012-01-01

Background The World Health Organization (WHO) recommends oral cholera vaccines (OCVs) as a supplementary tool to conventional prevention of cholera. Dukoral, a killed whole-cell two-dose OCV, was used in a mass vaccination campaign in 2009 in Zanzibar. Public and private costs of illness (COI) due to endemic cholera and costs of the mass vaccination campaign were estimated to assess the cost-effectiveness of OCV for this particular campaign from both the health care provider and the societal perspective. Methodology/Principal Findings Public and private COI were obtained from interviews with local experts, with patients from three outbreaks and from reports and record review. Cost data for the vaccination campaign were collected based on actual expenditure and planned budget data. A static cohort of 50,000 individuals was examined, including herd protection. Primary outcome measures were incremental cost-effectiveness ratios (ICER) per death, per case and per disability-adjusted life-year (DALY) averted. One-way sensitivity and threshold analyses were conducted. The ICER was evaluated with regard to WHO criteria for cost-effectiveness. Base-case ICERs were USD 750,000 per death averted, USD 6,000 per case averted and USD 30,000 per DALY averted, without differences between the health care provider and the societal perspective. Threshold analyses using Shanchol and assuming high incidence and case-fatality rate indicated that the purchase price per course would have to be as low as USD 1.2 to render the mass vaccination campaign cost-effective from a health care provider perspective (societal perspective: USD 1.3). Conclusions/Significance Based on empirical and site-specific cost and effectiveness data from Zanzibar, the 2009 mass vaccination campaign was cost-ineffective mainly due to the relatively high OCV purchase price and a relatively low incidence. However, mass vaccination campaigns in Zanzibar to control endemic cholera may meet criteria for cost-effectiveness

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

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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.

Cost-Effectiveness Analysis of Diagnosis of Duchenne/Becker Muscular Dystrophy in Colombia.

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Atehortúa, Sara C; Lugo, Luz H; Ceballos, Mateo; Orozco, Esteban; Castro, Paula A; Arango, Juan C; Mateus, Heidi E

2018-03-09

To determine the cost-effectiveness ratio of different courses of action for the diagnosis of Duchenne or Becker muscular dystrophy in Colombia. The cost-effectiveness analysis was performed from the Colombian health system perspective. Decision trees were constructed, and different courses of action were compared considering the following tests: immunohistochemistry (IHC), Western blot (WB), multiplex polymerase chain reaction, multiplex ligation-dependent probe amplification (MLPA), and the complete sequencing of the dystrophin gene. The time horizon matched the duration of sample extraction and analysis. Transition probabilities were obtained from a systematic review. Costs were constructed with a type-case methodology using the consensus of experts and the valuation of resources from consulting laboratories and the 2001 Social Security Institute cost manual. Deterministic sensitivity and scenario analyses were performed with one or more unavailable alternatives. Costs were converted from Colombian pesos to US dollars using the 2014 exchange rate. In the base case, WB was the dominant strategy, with a cost of US $419.07 and a sensitivity of 100%. This approach remains the dominant strategy down to a 98.2% sensitivity and while costs do not exceed US $837.38. If WB was not available, IHC had the best cost-effectiveness ratio, followed by MLPA and sequencing. WB is a cost-effective alternative for the diagnosis of patients suspected of having Duchenne or Becker muscular dystrophy in the Colombian health system. The IHC test is rated as the second-best detection method. If these tests are not available, MLPA followed by sequencing would be the most cost-effective alternative. Copyright © 2018. Published by Elsevier Inc.

15 CFR 904.507 - Recovery of certain storage costs.

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2010-01-01

... fee for expenses to the United States connected with the transfer, board, handling or storage of such... States connected with the storage, care and maintenance of such property. Within a reasonable time after... the bill objects to the reasonableness of the costs assessed he or she may, within 30 days of receipt...

Frequent ice cream consumption is associated with reduced striatal response to receipt of an ice cream-based milkshake.

Science.gov (United States)

Burger, Kyle S; Stice, Eric

2012-04-01

Weight gain leads to reduced reward-region responsivity to energy-dense food receipt, and consumption of an energy-dense diet compared with an isocaloric, low-energy-density diet leads to reduced dopamine receptors. Furthermore, phasic dopamine signaling to palatable food receipt decreases after repeated intake of that food, which collectively suggests that frequent intake of an energy-dense food may reduce striatal response to receipt of that food. We tested the hypothesis that frequent ice cream consumption would be associated with reduced activation in reward-related brain regions (eg, striatum) in response to receipt of an ice cream-based milkshake and examined the influence of adipose tissue and the specificity of this relation. Healthy-weight adolescents (n = 151) underwent fMRI during receipt of a milkshake and during receipt of a tasteless solution. Percentage body fat, reported food intake, and food craving and liking were assessed. Milkshake receipt robustly activated the striatal regions, yet frequent ice cream consumption was associated with a reduced response to milkshake receipt in these reward-related brain regions. Percentage body fat, total energy intake, percentage of energy from fat and sugar, and intake of other energy-dense foods were not related to the neural response to milkshake receipt. Our results provide novel evidence that frequent consumption of ice cream, independent of body fat, is related to a reduction in reward-region responsivity in humans, paralleling the tolerance observed in drug addiction. Data also imply that intake of a particular energy-dense food results in attenuated reward-region responsivity specifically to that food, which suggests that sensory aspects of eating and reward learning may drive the specificity.

A Comparison of Response Rate, Response Time, and Costs of Mail and Electronic Surveys.

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Shannon, David M.; Bradshaw, Carol C.

2002-01-01

Compared response rates, response time, and costs of mail and electronic surveys using a sample of 377 college faculty members. Mail surveys yielded a higher response rate and a lower rate of undeliverable surveys, but response time was longer and costs were higher than for electronic surveys. (SLD)

Cost-effectiveness of hepatitis A vaccination in Indonesia

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

2014-01-01

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

Timing of prophylactic surgery in prevention of diverticulitis recurrence: a cost-effectiveness analysis.

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Richards, Robert J; Hammitt, James K

2002-09-01

Although surgery is recommended after two or more attacks of uncomplicated diverticulitis, the optimal timing for surgery in terms of cost-effectiveness is unknown. A Markov model was used to compare the costs and outcomes of performing surgery after one, two, or three uncomplicated attacks in 60-year-old hypothetical cohorts. Transition state probabilities were assigned values using published data and expert opinion. Costs were estimated from Medicare reimbursement rates. Surgery after the third attack is cost saving, yielding more years of life and quality adjusted life years at a lower cost than the other two strategies. The results were not sensitive to many of the variables tested in the model or to changes made in the discount rate (0-5%). In conclusion, performing prophylactic resection after the third attack of diverticulitis is cost saving in comparison to resection performed after the first or second attacks and remains cost-effective during sensitivity analysis.

Cost effectiveness of medical devices to diagnose pre-eclampsia in low-resource settings

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Zoë M. McLaren

Full Text Available Background: Maternal mortality remains a major health challenge facing developing countries, with pre-eclampsia accounting for up to 17% of maternal deaths. Diagnosis requires skilled health providers and devices that are appropriate for low-resource settings. This study presents the first cost-effectiveness analysis of multiple medical devices used to diagnose pre-eclampsia in low- and middle-income countries (LMICs. Methods: Blood pressure and proteinuria measurement devices, identified from compendia for LMICs, were included. We developed a decision tree framework to assess the cost-effectiveness of each device using parameter values that reflect the general standard of care based on a survey of relevant literature and expert opinion. We examined the sensitivity of our results using one-way and second-order probabilistic multivariate analyses. Results: Because the disability-adjusted life years (DALYs averted for each device were very similar, the results were influenced by the per-use cost ranking. The most cost-effective device combination was a semi-automatic blood pressure measurement device and visually read urine strip test with the lowest combined per-use cost of $0.2004 and an incremental cost effectiveness ratio of $93.6 per DALY gained relative to a baseline with no access to diagnostic devices. When access to treatment is limited, it is more cost-effective to improve access to treatment than to increase testing rates or diagnostic device sensitivity. Conclusions: Our findings were not sensitive to changes in device sensitivity, however they were sensitive to changes in the testing rate and treatment rate. Furthermore, our results suggest that simple devices are more cost-effective than complex devices. The results underscore the desirability of two design features for LMICs: ease of use and accuracy without calibration. Our findings have important implications for policy makers, health economists, health care providers and

Screening uptake rates and the clinical and cost effectiveness of screening for gestational diabetes mellitus in primary versus secondary care: study protocol for a randomised controlled trial.

LENUS (Irish Health Repository)

O Dea, Angela

2014-01-17

The risks associated with gestational diabetes mellitus (GDM) are well recognized, and there is increasing evidence to support treatment of the condition. However, clear guidance on the ideal approach to screening for GDM is lacking. Professional groups continue to debate whether selective screening (based on risk factors) or universal screening is the most appropriate approach. Additionally, there is ongoing debate about what levels of glucose abnormalities during pregnancy respond best to treatment and which maternal and neonatal outcomes benefit most from treatment. Furthermore, the implications of possible screening options on health care costs are not well established. In response to this uncertainty there have been repeated calls for well-designed, randomised trials to determine the efficacy of screening, diagnosis, and management plans for GDM. We describe a randomised controlled trial to investigate screening uptake rates and the clinical and cost effectiveness of screening in primary versus secondary care settings. The objective of this study is to assess screening uptake rates, and the clinical and cost effectiveness of screening for GDM in primary versus secondary care.

27 CFR 19.372 - Receipt of spirits, wines and alcoholic flavoring materials for processing.

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2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Receipt of spirits, wines... Spirits, Wines and Alcoholic Flavoring Materials § 19.372 Receipt of spirits, wines and alcoholic.... 5215; or (4) Alcoholic flavoring materials. (b) Spirits and wines received in bulk containers or...

77 FR 5301 - Ford Motor Company, Receipt of Petition for Decision of Inconsequential Noncompliance

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2012-02-02

...-0005; Notice 1] Ford Motor Company, Receipt of Petition for Decision of Inconsequential Noncompliance AGENCY: National Highway Traffic Safety Administration, DOT. ACTION: Receipt of petition. SUMMARY: Ford Motor Company \\1\\ (Ford) has determined that certain model year 2011 Ford E-150, E-250, E-350 and E-450...

Hearing Receipts and Closing Pending, FY 1985 - FY 2009

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Social Security Administration — A presentation for the public to view historical information about two key workload indicators ﴾hearing case receipts and hearing case closing pending﴿, we are...

Cost effectiveness of a protocol using palivizumab in preterm infants

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Yolanda Hernández-Gago

2017-03-01

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

Cost-effectiveness of escitalopram vs. citalopram in major depressive disorder.

Science.gov (United States)

Fantino, Bruno; Moore, Nicholas; Verdoux, Hélène; Auray, Jean-Paul

2007-03-01

Clinical trials have shown better efficacy of escitalopram over citalopram, and review-based economic models the cost-effectiveness of escitalopram vs. citalopram (brand and generic). No head-to-head clinical trial has, however, evaluated the cost-effectiveness of both drugs so far. The aim of this study was to assess the relative cost-effectiveness of escitalopram compared with citalopram in patients with major depressive disorder. An economic evaluation was conducted alongside a double-blind randomized clinical trial conducted by general practitioners and psychiatrists comparing fixed doses of escitalopram (20 mg/day) or citalopram (40 mg/day) over 8 weeks in ambulatory care patients with major depressive disorder (baseline Montgomery-Asberg Depression Rating Scale score > or =30). Resources use was recorded using a standardized form recording use of healthcare services and days of sick leave for the 2-month prestudy period and for the 8-week study period. Statistically significant improvements were observed in patients treated with escitalopram. Mean per-patient costs for the escitalopram group, compared with the citalopram group, were 41% lower (96 euro vs. 163 euro; Pescitalopram compared with citalopram recipients, assuming a parity price between escitalopram and citalopram. Bootstrapped distributions of the cost-effectiveness ratios also showed better effectiveness and lower costs for escitalopram compared with citalopram. Escitalopram is significantly more effective than citalopram, and is associated with lower healthcare costs. This prospective economic analysis demonstrated that escitalopram is a cost-effective first-line treatment option for major depressive disorder.

The costs and effectiveness of various decontamination procedures

International Nuclear Information System (INIS)

Robinson, C.A.; Haywood, S.M.; Brown, J.

1991-01-01

Knowledge of the cost and effectiveness of decontamination techniques is necessary to optimise the implementation of this countermeasure. These factors vary depending upon the nature of the land affected. There is a great deal of data available on the cost and efficacy of specific decontamination techniques on particular surfaces, but little information for combinations of techniques in real environments. This paper describes the preliminary stages of a project, in progress at the National Radiological Protection Board (NRPB), aimed at providing this information, for inner city, residential and rural areas. The efficacies of individual decontamination processes on specific surfaces were from the available literature. The NRPB EXPURT (EXPosure from Urban Radionuclide Transfer) compartmental model was used to determine the effectiveness of a number of representative decontamination programmes; each programme represents a combination of common decontamination techniques which may be applied to the various surfaces comprising an inner-city, residential or rural environment, ie, paving, walls, roofs and soil. The effectiveness of each programme was measured in terms of the reduction in dose, or dose rate, to an individual in that environment, taking account of the building characteristics, and the occupancy of the population in these buildings. The costs of each programme were derived, based on data available in current literature on the cost of the constituent decontamination techniques. Representative cost and effectiveness data are presented and their application is discussed

Dynamic Modeling of Cost-effectiveness of Rotavirus Vaccination, Kazakhstan

Science.gov (United States)

Flem, Elmira; Latipov, Renat; Kuatbaeva, Ajnagul; Kristiansen, Ivar Sønbø

2014-01-01

The government of Kazakhstan, a middle-income country in Central Asia, is considering the introduction of rotavirus vaccination into its national immunization program. We performed a cost-effectiveness analysis of rotavirus vaccination spanning 20 years by using a synthesis of dynamic transmission models accounting for herd protection. We found that a vaccination program with 90% coverage would prevent ≈880 rotavirus deaths and save an average of 54,784 life-years for children <5 years of age. Indirect protection accounted for 40% and 60% reduction in severe and mild rotavirus gastroenteritis, respectively. Cost per life year gained was US $18,044 from a societal perspective and US $23,892 from a health care perspective. Comparing the 2 key parameters of cost-effectiveness, mortality rates and vaccine cost at costs would be entirely offset. To further evaluate efficacy of a vaccine program, benefits of indirect protection conferred by vaccination warrant further study. PMID:24378188

Saving lives and saving money: hospital-based violence intervention is cost-effective.

Science.gov (United States)

Juillard, Catherine; Smith, Randi; Anaya, Nancy; Garcia, Arturo; Kahn, James G; Dicker, Rochelle A

2015-02-01

Victims of violence are at significant risk for injury recidivism, including fatality. We previously demonstrated that our hospital-based violence intervention program (VIP) resulted in a fourfold reduction in injury recidivism, avoiding trauma care costs of $41,000 per injury. Given limited trauma center resources, assessing cost-effectiveness of interventions is fundamental to inform use of these programs in other institutions. This study examines the cost-effectiveness of hospital-based VIP. We used a decision tree and Markov disease state modeling to analyze cost utility for a hypothetical cohort of violently injured subjects, comparing VIP versus no VIP at a trauma center. Quality-adjusted life-years (QALYs) were calculated using differences in mortality and published health state utilities. Costs of trauma care and VIP were obtained from institutional data, and risk of recidivism with and without VIP were obtained from our trial. Outcomes were QALYs gained and net costs over a 5-year horizon. Sensitivity analyses examined the impact of uncertainty in input values on results. VIP results in an estimated 25.58 QALYs and net costs (program plus trauma care) of $5,892 per patient. Without VIP, these values are 25.34 and $5,923, respectively, suggesting that VIP yields substantial health benefits (24 QALYs) and savings ($4,100) if implemented for 100 individuals. In the sensitivity analysis, net QALYs gained with VIP nearly triple when the injury recidivism rate without VIP is highest. Cost-effectiveness remained robust over a range of values; $6,000 net cost savings occur when 5-year recidivism rate without VIP is at 7%. VIP costs less than having no VIP with significant gains in QALYs especially at anticipated program scale. Across a range of plausible values at which VIP would be less cost-effective (lower injury recidivism, cost of injury, and program effectiveness), VIP still results in acceptable cost per health outcome gained. VIP is effective and cost-effective

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…

The High/Scope Perry Preschool Program: Cost-Benefit Analysis Using Data from the Age-40 Followup

Science.gov (United States)

Belfield, Clive R.; Nores, Milagros; Barnett, Steve; Schweinhart, Lawrence

2006-01-01

This paper presents an updated cost-benefit analysis of the High/Scope Perry preschool Program, using data on individuals aged 40. Children were randomly assigned to a treatment or control group. Program costs are compared against treatment impacts on educational resources, earnings, criminal activity, and welfare receipt. Net present values are…

Cost-effectiveness of the Norwegian breast cancer screening program.

Science.gov (United States)

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

2017-02-15

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

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

A systematic review of the cost and cost effectiveness of treatment for multidrug-resistant tuberculosis.

Science.gov (United States)

Fitzpatrick, Christopher; Floyd, Katherine

2012-01-01

chosen (the extent to which hospitalization or ambulatory care were relied upon) and (ii) the second-line drugs included in the treatment regimen. When extrapolated to other settings, the best estimate of the cost of treatment varied from US3401 to US195 078, depending on the region and model of care. The cost per DALY averted was lower than GDP per capita in all 14 WHO sub-regions considered, with better cost effectiveness for outpatient versus inpatient models of care. Treatment for MDR-TB can be cost effective in low- and middle-income countries. Evidence about the relative cost effectiveness of outpatient versus inpatient models of care is limited and more data are needed from Africa and Asia--especially India and China, which have the largest number of cases. Unless there is strong evidence that hospitalization is necessary to achieve high rates of adherence to treatment, patients with MDR-TB should be treated using mainly ambulatory care.

Cost-effectiveness analysis of rotavirus vaccination in Argentina.

Science.gov (United States)

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

2015-05-07

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

Cost-effectiveness analysis of different embryo transfer strategies in England.

Science.gov (United States)

Dixon, S; Faghih Nasiri, F; Ledger, W L; Lenton, E A; Duenas, A; Sutcliffe, P; Chilcott, J B

2008-05-01

The objective of this study was to assess the cost-effectiveness of different embryo transfer strategies for a single cycle when two embryos are available, and taking the NHS cost perspective. Cost-effectiveness model. Five in vitro fertilisation (IVF) centres in England between 2003/04 and 2004/05. Women with two embryos available for transfer in three age groups (Costs and adverse outcomes are estimated up to 5 years after the birth. Incremental cost per live birth was calculated for different embryo transfer strategies and for three separate age groups: less than 30, 30-35 and 36-39 years. Premature birth, neonatal intensive care unit admissions and days, cerebral palsy and incremental cost-effectiveness ratios. Single fresh embryo transfer (SET) plus frozen single embryo transfer (fzSET) is the more costly in terms of IVF costs, but the lower rates of multiple births mean that in terms of total costs, it is less costly than double embryo transfer (DET). Adverse events increase when moving from SET to SET+fzSET to DET. The probability of SET+fzSET being cost-effective decreases with age. When SET is included in the analysis, SET+fzSET no longer becomes a cost-effective option at any threshold value for all age groups studied. The analyses show that the choice of embryo transfer strategy is a function of four factors: the age of the mother, the relevance of the SET option, the value placed on a live birth and the relative importance placed on adverse outcomes. For each patient group, the choice of strategy is a trade-off between the value placed on a live birth and cost.

Replacement versus Historical Cost Profit Rates: What is the difference? When does it matter?

OpenAIRE

Basu, Deepankar

2012-01-01

This paper explains the BEA methodology for computing historical cost and replacement cost measures of the net stock of capital in the U.S. economy. It is demonstrated that there exists a threshold rate of inflation in the price of capital goods that keeps the percentage difference between the two capital stock measures constant. Hence, over periods when average inflation in the price index for capital goods is equal to the threshold value, historical cost and replacement cost profit rates wo...

Effectiveness and cost of failure mode and effects analysis methodology to reduce neurosurgical site infections.

Science.gov (United States)

Hover, Alexander R; Sistrunk, William W; Cavagnol, Robert M; Scarrow, Alan; Finley, Phillip J; Kroencke, Audrey D; Walker, Judith L

2014-01-01

Mercy Hospital Springfield is a tertiary care facility with 32 000 discharges and 15 000 inpatient surgeries in 2011. From June 2009 through January 2011, a stable inpatient elective neurosurgery infection rate of 2.15% was observed. The failure mode and effects analysis (FMEA) methodology to reduce inpatient neurosurgery infections was utilized. Following FMEA implementation, overall elective neurosurgery infection rates were reduced to 1.51% and sustained through May 2012. Compared with baseline, the post-FMEA deep-space and organ infection rate was reduced by 41% (P = .052). Overall hospital inpatient clean surgery infection rates for the same time frame did not decrease to the same extent, suggesting a specific effect of the FMEA. The study team believes that the FMEA interventions resulted in 14 fewer expected infections, $270 270 in savings, a 168-day reduction in expected length of stay, and 22 fewer readmissions. Given the serious morbidity and cost of health care-associated infections, the study team concludes that FMEA implementation was clinically cost-effective. © 2013 by the American College of Medical Quality.

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.

Simulation of the cost-effectiveness of malaria vaccines

Directory of Open Access Journals (Sweden)

Tediosi Fabrizio

2009-06-01

often a more efficient alternative to the EPI. However, the costs of increasing the coverage of mass vaccination over 50% often exceed the benefits. Conclusion The simulations indicate malaria vaccines might be efficient malaria control interventions, and that both transmission setting and vaccine delivery modality are important to their cost-effectiveness. Alternative vaccine delivery modalities to the EPI may be more efficient than the EPI. Mass vaccination is predicted to provide substantial health benefits at low additional costs, although achieving high coverage rates can lead to substantial incremental costs.

The hidden costs of installing Xpert machines in a tuberculosis high-burden country: experiences from Nigeria.

Science.gov (United States)

Abdurrahman, Saddiq Tsimiri; Emenyonu, Nnamdi; Obasanya, Olusegun Joshua; Lawson, Lovett; Dacombe, Russell; Muhammad, Muhammad; Oladimeji, Olanrewaju; Cuevas, Luis Eduardo

2014-01-01

Since the endorsement of GeneXpert MTB/RIF by the WHO, many countries have embarked on implementing this technology. We outline the cost of installing GeneXpert in district hospitals in Abuja, Nigeria. We prospectively documented costs related to the installation of GeneXpert at five sites. Costs were collected from receipts received from suppliers and normalized to USD 2012 values. Costs were often identified after initiating installation for many reasons. Installation varied widely between sites with sufficient space and power supply; sites with insufficient space or power supply and costs not directly associated with site installation. The basic cost for installation was USD 2,621.98 per machine. Sites that required additional space cost close to USD 7,000.00. Space and power requirements have a significant effect on installation costs. Countries need to carefully consider the placement of Xpert machines based on the quality and size of the available infrastructure.

Cost-effectiveness of denosumab versus zoledronic acid for preventing skeletal-related events in the Czech Republic.

Science.gov (United States)

Cristino, Joaquim; Finek, Jíndřich; Jandova, Petra; Kolek, Martin; Pásztor, Bálint; Giannopoulou, Christina; Qian, Yi; Brezina, Tomas; Lothgren, Mickael

2017-08-01

This study assessed the cost-effectiveness of the subcutaneous RANKL inhibitor, denosumab, vs the intravenous bisphosphonate, zoledronic acid, for the prevention of skeletal-related events (SREs) in patients with prostate cancer, breast cancer, and other solid tumors (OST) in the Czech Republic. A lifetime Markov model was developed to compare the effects of denosumab and zoledronic acid on costs (including drug costs and administration, patient management, SREs, and adverse events), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios from a national payer perspective. Different discount rates, time horizons, SRE rates, distributions, and nature (asymptomatic vs all SREs), and the inclusion of treatment discontinuation were considered in scenario analyses. The robustness of the model was tested using deterministic and probabilistic sensitivity analyses. Across tumor types, denosumab was associated with fewer SREs, improved QALYs, and higher total costs over a lifetime. The incremental cost per QALY gained for denosumab vs zoledronic acid was 382,673 CZK for prostate cancer, 408,450 CZK for breast cancer, and 608,133 CZK for OST. Incremental costs per SRE avoided for the same tumor type were 54,007 CZK, 51,765 CZK, and 94,426 CZK, respectively. In scenario analyses, the results remained similar to baseline, when different discount rates and time horizons were considered. At a non-official willingness-to-pay threshold of 1.2 million CZK, the probabilities of denosumab being cost-effective vs zoledronic acid were 0.64, 0.67, and 0.49 for prostate cancer, breast cancer, and OST, respectively. The SRE rates used were obtained from clinical trials; studies suggest rates may be higher in clinical practice. Additional evidence on real-world SRE rates could further improve the accuracy of the modeling. Compared with zoledronic acid, denosumab provides a cost-effective treatment option for the prevention of SREs in patients with prostate cancer

Cost-effectiveness analysis of mammography and clinical breast examination strategies

Science.gov (United States)

Ahern, Charlotte Hsieh; Shen, Yu

2009-01-01

Purpose Breast cancer screening by mammography and clinical breast exam are commonly used for early tumor detection. Previous cost-effectiveness studies considered mammography alone or did not account for all relevant costs. In this study, we assessed the cost-effectiveness of screening schedules recommended by three major cancer organizations and compared them with alternative strategies. We considered costs of screening examinations, subsequent work-up, biopsy, and treatment interventions after diagnosis. Methods We used a microsimulation model to generate women’s life histories, and assessed screening and treatment impacts on survival. Using statistical models, we accounted for age-specific incidence, preclinical disease duration, and age-specific sensitivity and specificity for each screening modality. The outcomes of interest were quality-adjusted life years (QALYs) saved and total costs with a 3% annual discount rate. Incremental cost-effectiveness ratios were used to compare strategies. Sensitivity analyses were performed by varying some of the assumptions. Results Compared to guidelines from the National Cancer Institute and the U.S. Preventive Services Task Force, alternative strategies were more efficient. Mammography and clinical breast exam in alternating years from ages 40 to 79 was a cost-effective alternative compared to the guidelines, costing $35,500 per QALY saved compared with no screening. The American Cancer Society guideline was the most effective and the most expensive, costing over $680,000 for an added QALY compared to the above alternative. Conclusion Screening strategies with lower costs and benefits comparable to those currently recommended should be considered for implementation in practice and for future guidelines. PMID:19258473

Public Budget Database - Outlays and offsetting receipts 1962-Current

Data.gov (United States)

Executive Office of the President — This file contains historical outlays and offsetting receipts for 1962 through the current budget year, as well as four years of projections. It can be used to...

78 FR 53425 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

Science.gov (United States)

2013-08-29

... method continues to be the Direct Labor Cost Base for all three DARRP component organizations. The Direct... allocation method for the development of the FY 2012 indirect cost rates. The DARRP's Indirect Cost Rates and... accounting system and allocation practices; recommend the appropriate indirect cost allocation methodology...

Frequent ice cream consumption is associated with reduced striatal response to receipt of an ice cream–based milkshake123

Science.gov (United States)

Stice, Eric

2012-01-01

Background: Weight gain leads to reduced reward-region responsivity to energy-dense food receipt, and consumption of an energy-dense diet compared with an isocaloric, low-energy-density diet leads to reduced dopamine receptors. Furthermore, phasic dopamine signaling to palatable food receipt decreases after repeated intake of that food, which collectively suggests that frequent intake of an energy-dense food may reduce striatal response to receipt of that food. Objective: We tested the hypothesis that frequent ice cream consumption would be associated with reduced activation in reward-related brain regions (eg, striatum) in response to receipt of an ice cream–based milkshake and examined the influence of adipose tissue and the specificity of this relation. Design: Healthy-weight adolescents (n = 151) underwent fMRI during receipt of a milkshake and during receipt of a tasteless solution. Percentage body fat, reported food intake, and food craving and liking were assessed. Results: Milkshake receipt robustly activated the striatal regions, yet frequent ice cream consumption was associated with a reduced response to milkshake receipt in these reward-related brain regions. Percentage body fat, total energy intake, percentage of energy from fat and sugar, and intake of other energy-dense foods were not related to the neural response to milkshake receipt. Conclusions: Our results provide novel evidence that frequent consumption of ice cream, independent of body fat, is related to a reduction in reward-region responsivity in humans, paralleling the tolerance observed in drug addiction. Data also imply that intake of a particular energy-dense food results in attenuated reward-region responsivity specifically to that food, which suggests that sensory aspects of eating and reward learning may drive the specificity. PMID:22338036

Reference costs for power generation

International Nuclear Information System (INIS)

2003-12-01

The first part of the 2003 study of reference costs for power generation has been completed. It was carried out by the General Directorate for Energy and Raw Materials (DGEMP) of the French Ministry of the Economy, Finance and Industry, with the collaboration of power-plant operators, construction firms and many other experts. A Review Committee of experts including economists (Forecasting Department, French Planning Office), qualified public figures, representatives of power-plant construction firms and operators, and non-governmental organization (NGO) experts, was consulted in the final phase. The study examines the costs of power generated by different methods (i.e. nuclear and fossil-fuel [gas-, coal-, and oil-fired] power plants) in the context of an industrial operation beginning in the year 2015. - The second part of the study relating to decentralized production methods (wind, photovoltaic, combined heat and power) is still in progress and will be presented at the beginning of next year. - 1. Study approach: The study is undertaken mainly from an investor's perspective and uses an 8% discount rate to evaluate the expenses and receipts from different years. In addition, the investment costs are considered explicitly in terms of interest during construction. - 2. Plant operating on a full-time basis (year-round): The following graph illustrates the main conclusions of the study for an effective operating period of 8000 hours. It can be seen that nuclear is more competitive than the other production methods for a year-round operation with an 8% discount rate applied to expenses. This competitiveness is even better if the costs related to greenhouse-gas (CO 2 ) emission are taken into account in estimating the MWh cost price. Integrating the costs resulting from CO 2 emissions by non-nuclear fuels (gas, coal), which will be compulsory as of 2004 with the transposition of European directives, increases the total cost per MWh of these power generation methods

[Profitability of a day hospital: analysis of activity, cost and effectiveness].

Science.gov (United States)

Hernando Ortiz, Lili; Hinojosa Mena-Bernal, Carmen; González Sarmiento, Enrique; González Guilabert, Isabel; Arana Ruiz, Jorge; Muñoz Moreno, M Fe

2012-01-01

Day hospitals are an alternative to conventional hospital care. We analyzed the functioning and profitability of the day hospital of Hospital Clínico de Valladolid, Spain, in 2009. Profitability is expressed as the provision of identical health coverage at a lower cost than that generated by conventional hospital care and with adequate quality indicators. We performed a retrospective, observational and descriptive study of the information obtained on each patient attended in the day hospital from January 1 to December 31, 2009. We studied four quality indicators: cancellation of meetings, the rate of transfusion reactions, the out-patient rate and the satisfaction index. The estimated savings for each process was calculated as the difference in the average cost of hospitalization minus the average cost of the process in the day hospital. The most frequent diseases were systemic and connective tissue diseases, accounting for 25.4% of the processes treated; of these, 17.1% corresponded to rheumatoid arthritis. Patient satisfaction was 93%. Meetings cancellations and the rate of transfusion reactions were 0%. The out-patient rate was 26%. Day hospital costs were 8.6% of conventional hospital costs, with savings of 78,390.69 euros. The day hospital is cost effective due to savings compared with conventional hospitalization and has a satisfactory quality index. Copyright © 2011 SESPAS. Published by Elsevier España, S.L. All rights reserved.

Cost-effectiveness of a Nutrition Education Curriculum Intervention in Elementary Schools.

Science.gov (United States)

Graziose, Matthew M; Koch, Pamela A; Wang, Y Claire; Lee Gray, Heewon; Contento, Isobel R

2017-09-01

To estimate the long-term cost-effectiveness of an obesity prevention nutrition education curriculum (Food, Health, & Choices) as delivered to all New York City fifth-grade public school students over 1 year. This study is a standard cost-effectiveness analysis from a societal perspective, with a 3% discount rate and a no-intervention comparator, as recommended by the US Panel on Cost-effectiveness in Health and Medicine. Costs of implementation, administration, and future obesity-related medical costs were included. Effectiveness was based on a cluster-randomized, controlled trial in 20 public schools during the 2012-2013 school year and linked to published estimates of childhood-to-adulthood body mass index trajectories using a decision analytic model. The Food, Health, & Choices intervention was estimated to cost $8,537,900 and result in 289 fewer males and 350 fewer females becoming obese (0.8% of New York City fifth-grade public school students), saving 1,599 quality-adjusted life-years (QALYs) and $8,098,600 in direct medical costs. Food, Health, & Choices is predicted to be cost-effective at $275/QALY (95% confidence interval, -$2,576/QALY to $2,084/QALY) with estimates up to $6,029/QALY in sensitivity analyses. This cost-effectiveness model suggests that a nutrition education curriculum in public schools is effective and cost-effective in reducing childhood obesity, consistent with the authors' hypothesis and previous literature. Future research should assess the feasibility and sustainability of scale-up. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

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.

Cost and cost effectiveness of long-lasting insecticide-treated bed nets - a model-based analysis

Directory of Open Access Journals (Sweden)

Pulkki-Brännström Anni-Maria

2012-04-01

Full Text Available Abstract Background The World Health Organization recommends that national malaria programmes universally distribute long-lasting insecticide-treated bed nets (LLINs. LLINs provide effective insecticide protection for at least three years while conventional nets must be retreated every 6-12 months. LLINs may also promise longer physical durability (lifespan, but at a higher unit price. No prospective data currently available is sufficient to calculate the comparative cost effectiveness of different net types. We thus constructed a model to explore the cost effectiveness of LLINs, asking how a longer lifespan affects the relative cost effectiveness of nets, and if, when and why LLINs might be preferred to conventional insecticide-treated nets. An innovation of our model is that we also considered the replenishment need i.e. loss of nets over time. Methods We modelled the choice of net over a 10-year period to facilitate the comparison of nets with different lifespan (and/or price and replenishment need over time. Our base case represents a large-scale programme which achieves high coverage and usage throughout the population by distributing either LLINs or conventional nets through existing health services, and retreats a large proportion of conventional nets regularly at low cost. We identified the determinants of bed net programme cost effectiveness and parameter values for usage rate, delivery and retreatment cost from the literature. One-way sensitivity analysis was conducted to explicitly compare the differential effect of changing parameters such as price, lifespan, usage and replenishment need. Results If conventional and long-lasting bed nets have the same physical lifespan (3 years, LLINs are more cost effective unless they are priced at more than USD 1.5 above the price of conventional nets. Because a longer lifespan brings delivery cost savings, each one year increase in lifespan can be accompanied by a USD 1 or more increase in price

A Low-Cost Time-Hopping Impulse Radio System for High Data Rate Transmission

Directory of Open Access Journals (Sweden)

Jinyun Zhang

2005-03-01

Full Text Available We present an efficient, low-cost implementation of time-hopping impulse radio that fulfills the spectral mask mandated by the FCC and is suitable for high-data-rate, short-range communications. Key features are (i all-baseband implementation that obviates the need for passband components, (ii symbol-rate (not chip rate sampling, A/D conversion, and digital signal processing, (iii fast acquisition due to novel search algorithms, and (iv spectral shaping that can be adapted to accommodate different spectrum regulations and interference environments. Computer simulations show that this system can provide 110 Mbps at 7–10 m distance, as well as higher data rates at shorter distances under FCC emissions limits. Due to the spreading concept of time-hopping impulse radio, the system can sustain multiple simultaneous users, and can suppress narrowband interference effectively.

78 FR 25443 - Federal Acquisition Regulation; Submission for OMB Review; Indirect Cost Rates

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2013-05-01

... supporting cost data are the cost accounting information normally prepared by organizations under sound management and accounting practices. The proposal and supporting data is used by the contracting official and...; Submission for OMB Review; Indirect Cost Rates AGENCY: Department of Defense (DOD), General Services...

26 CFR 1.199-4 - Costs allocable to domestic production gross receipts.

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2010-04-01

... allocation method is reasonable is based on all of the facts and circumstances including whether the taxpayer... relationship between the adjustment and the allocation base chosen; the accuracy of the method chosen as... (ii) Y uses a standard cost method to allocate all direct and indirect costs (section 471 and...

Would vaccination against nicotine be a cost-effective way to prevent smoking uptake in adolescents?

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Gartner, Coral E; Barendregt, Jan J; Wallace, Angela; Hall, Wayne D

2012-04-01

We used epidemiological modelling to assess whether nicotine vaccines would be a cost-effective way of preventing smoking uptake in adolescents. We built an epidemiological model using Australian data on age-specific smoking prevalence; smoking cessation and relapse rates; life-time sex-specific disability-adjusted life years lived for cohorts of 100,000 smokers and non-smokers; government data on the costs of delivering a vaccination programme by general practitioners; and a range of plausible and optimistic estimates of vaccine cost, efficacy and immune response rates based on clinical trial results. We first estimated the smoking uptake rates for Australians aged 12-19 years. We then used these estimates to predict the expected smoking prevalence in a birth cohort aged 12 in 2003 by age 20 under (i) current policy and (ii) different vaccination scenarios that varied in cost, initial vaccination uptake, yearly re-vaccination rates, efficacy and a favourable vaccine immune response rate. Under the most optimistic assumptions, the cost to avert a smoker at age 20 was $44,431 [95% confidence interval (CI) $40,023-49,250]. This increased to $296,019 (95% CI $252,307-$355,930) under more plausible scenarios. The vaccine programme was not cost-effective under any scenario. A preventive nicotine vaccination programme is unlikely to be cost-effective. The total cost of a universal vaccination programme would be high and its impact on population smoking prevalence negligible. For these reasons, such a programme is unlikely to be publicly funded in Australia or any other developed country. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

The Long-Term Effectiveness and Cost Effectiveness of Organized versus Opportunistic Screening for Breast Cancer in Austria.

Science.gov (United States)

Schiller-Fruehwirth, Irmgard; Jahn, Beate; Einzinger, Patrick; Zauner, Günther; Urach, Christoph; Siebert, Uwe

2017-09-01

In 2014, Austrian health authorities implemented an organized breast cancer screening program. Until then, there has been a long-standing tradition of opportunistic screening. To evaluate the cost-effectiveness of organized screening compared with opportunistic screening, as well as to identify factors influencing the clinical and economic outcomes. We developed and validated an individual-level state-transition model and assessed the health outcomes and costs of organized and opportunistic screening for 40-year-old asymptomatic women. The base-case analysis compared a scenario involving organized biennial screening with a scenario reflecting opportunistic screening practice for an average-risk woman aged 45 to 69 years. We applied an annual discount rate of 3% and estimated the incremental cost-effectiveness ratio in terms of the cost (2012 euros) per life-year gained (LYG) from a health care perspective. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty. Compared with opportunistic screening, an organized program yielded on average additional 0.0118 undiscounted life-years (i.e., 4.3 days) and cost savings of €41 per woman. In the base-case analysis, the incremental cost-effectiveness ratio of organized screening was approximately €20,000 per LYG compared with no screening. Assuming a willingness-to-pay threshold of €50,000 per LYG, there was a 70% probability that organized screening would be considered cost-effective. The attendance rate, but not the test accuracy of mammography, was an influential factor for the cost-effectiveness. The decision to adopt organized screening is likely an efficient use of limited health care resources in Austria. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

[Cost-effectiveness of addiction care].

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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.

The rate and cost of nurse turnover in Australia.

Science.gov (United States)

Roche, Michael A; Duffield, Christine M; Homer, Caroline; Buchan, James; Dimitrelis, Sofia

2015-01-01

Nurse turnover is a critical issue facing workforce planners across the globe, particularly in light of protracted and continuing workforce shortages. An ageing population coupled with the rise in complex and chronic diseases, have contributed to increased demands placed on the health system and importantly, nurses who themselves are ageing. Costs associated with nurse turnover are attracting more attention; however, existing measurements of turnover show inconsistent findings, which can be attributed to differences in study design, metrics used to calculate turnover and variations in definitions for turnover. This paper will report the rates and costs of nurse turnover across three States in Australia.

Web-Face-to-Face Mixed-Mode Design in a Longitudinal Survey: Effects on Participation Rates, Sample Composition, and Costs

Directory of Open Access Journals (Sweden)

Bianchi Annamaria

2017-06-01

Full Text Available Sequential mixed-mode designs are increasingly considered as an alternative to interviewer-administered data collection, allowing researchers to take advantage of the benefits of each mode. We assess the effects of the introduction of a sequential web-face-to-face mixed-mode design over three waves of a longitudinal survey in which members were previously interviewed face-to-face. Findings are reported from a large-scale randomised experiment carried out on the UK Household Longitudinal Study. No differences are found between the mixed-mode design and face-to-face design in terms of cumulative response rates and only minimal differences in terms of sample composition. On the other hand, potential cost savings are evident.

The cost-effectiveness, health benefits, and financial costs of new antiviral treatments for hepatitis C virus.

Science.gov (United States)

Rein, David B; Wittenborn, John S; Smith, Bryce D; Liffmann, Danielle K; Ward, John W

2015-07-15

New hepatitis C virus (HCV) treatments deliver higher cure rates with fewer contraindications, increasing demand for treatment and healthcare costs. The cost-effectiveness of new treatments is unknown. We conducted a microsimulation of guideline testing followed by alternative treatment regimens for HCV among the US population aged 20 and older to estimate cases identified, treated, sustained viral response, deaths, medical costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) of different treatment options expressed as discounted lifetime costs and benefits from the healthcare perspective. Compared to treatment with pegylated interferon and ribavirin (PR), and a protease inhibitor for HCV genotype (G) 1 and PR alone for G2/3, treatment with PR and Sofosbuvir (PRS) for G1/4 and treatment with Sofosbuvir and ribavirin (SR) for G2/3 increased QALYs by 555 226, reduced deaths by 80 682, and increased costs by $26.2 billion at an ICER of $47 304 per QALY gained. As compared to PRS/SR, treating with an all oral regimen of Sofosbuvir and Simeprevir (SS) for G1/4 and SR for G2/3, increased QALYs by 1 110 451 and reduced deaths by an additional 164 540 at an incremental cost of $80.1 billion and an ICER of $72 169. In sensitivity analysis, where treatment with SS effectiveness was set to the list price of Viekira Pak and then Harvoni, treatment cost $24 921 and $25 405 per QALY gained as compared to PRS/SR. New treatments are cost-effectiveness per person treated, but pent-up demand for treatment may create challenges for financing. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

The Interpersonal Sunk-Cost Effect.

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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.

Cost-effectiveness modeling of colorectal cancer: Computed tomography colonography vs colonoscopy or fecal occult blood tests

International Nuclear Information System (INIS)

Lucidarme, Olivier; Cadi, Mehdi; Berger, Genevieve; Taieb, Julien; Poynard, Thierry; Grenier, Philippe; Beresniak, Ariel

2012-01-01

Objectives: To assess the cost-effectiveness of three colorectal-cancer (CRC) screening strategies in France: fecal-occult-blood tests (FOBT), computed-tomography-colonography (CTC) and optical-colonoscopy (OC). Methods: Ten-year simulation modeling was used to assess a virtual asymptomatic, average-risk population 50–74 years old. Negative OC was repeated 10 years later, and OC positive for advanced or non-advanced adenoma 3 or 5 years later, respectively. FOBT was repeated biennially. Negative CTC was repeated 5 years later. Positive CTC and FOBT led to triennial OC. Total cost and CRC rate after 10 years for each screening strategy and 0–100% adherence rates with 10% increments were computed. Transition probabilities were programmed using distribution ranges to account for uncertainty parameters. Direct medical costs were estimated using the French national health insurance prices. Probabilistic sensitivity analyses used 5000 Monte Carlo simulations generating model outcomes and standard deviations. Results: For a given adherence rate, CTC screening was always the most effective but not the most cost-effective. FOBT was the least effective but most cost-effective strategy. OC was of intermediate efficacy and the least cost-effective strategy. Without screening, treatment of 123 CRC per 10,000 individuals would cost €3,444,000. For 60% adherence, the respective costs of preventing and treating, respectively 49 and 74 FOBT-detected, 73 and 50 CTC-detected and 63 and 60 OC-detected CRC would be €2,810,000, €6,450,000 and €9,340,000. Conclusion: Simulation modeling helped to identify what would be the most effective (CTC) and cost-effective screening (FOBT) strategy in the setting of mass CRC screening in France.

Health economic studies: an introduction to cost-benefit, cost-effectiveness, and cost-utility analyses.

Science.gov (United States)

Angevine, Peter D; Berven, Sigurd

2014-10-15

Narrative overview. To provide clinicians with a basic understanding of economic studies, including cost-benefit, cost-effectiveness, and cost-utility analyses. As decisions regarding public health policy, insurance reimbursement, and patient care incorporate factors other than traditional outcomes such as satisfaction or symptom resolution, health economic studies are increasingly prominent in the literature. This trend will likely continue, and it is therefore important for clinicians to have a fundamental understanding of the common types of economic studies and be able to read them critically. In this brief article, the basic concepts of economic studies and the differences between cost-benefit, cost-effectiveness, and cost-utility studies are discussed. An overview of the field of health economic analysis is presented. Cost-benefit, cost-effectiveness, and cost-utility studies all integrate cost and outcome data into a decision analysis model. These different types of studies are distinguished mainly by the way in which outcomes are valued. Obtaining accurate cost data is often difficult and can limit the generalizability of a study. With a basic understanding of health economic analysis, clinicians can be informed consumers of these important studies.

42 CFR 412.62 - Federal rates for inpatient operating costs for fiscal year 1984.

Science.gov (United States)

2010-10-01

... determines national adjusted DRG prospective payment rates for operating costs, for each inpatient hospital... DRG prospective payment rates for inpatient operating costs for such discharges in each region, for... classifications. (1) For purposes of paragraph (e) of this section, the following definitions apply: (i) The term...

42 CFR 457.1015 - Cost-effectiveness.

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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...

76 FR 60721 - Deduction for Qualified Film and Television Production Costs

Science.gov (United States)

2011-09-30

... which the costs are paid (for an owner who uses the cash receipts and disbursements method of accounting) or incurred (for an owner who uses an accrual method of accounting). The deduction under section 181... Bernard P. Harvey, Office of Associate Chief Counsel (Income Tax and Accounting). However, other personnel...

Nuclear power's effects on electric rate making

International Nuclear Information System (INIS)

Smith, D.S.; Lancaster, A.A.

1978-01-01

Government and the electric utility industry are re-evaluating nuclear power's contribution to the total U.S. energy supplies. This article addresses how the recently increased nuclear plant construction and operation costs are translated into the prices that consumers pay for electricity. The electric rates that consumers pay must reflect the costs of producing electricity, as well as the costs of transmission, distribution, metering, and billing. The use of nuclear power for electric production is anticipated to grow rapidly so as to meet a larger portion of our country's electricity needs through the end of the century; so nuclear power costs are expected to be an even larger portion of the total electricity price. There are certain rate-making issues that are actively being discussed in public forums and before state and Federal regulatory bodies. These issues are not unique to nuclear power, but take on added significance when nuclear power is used by utilities to produce electricity because of the technology required and because of the type, timing, and magnitude of the costs involved. These are: (1) inclusion of construction work in progress in the rate base; (2) fuel adjustment clauses and treatment of nuclear fuel cycle costs; (3) treatment of certain taxes under the rate-making method called normalization or deferral accounting (sometimes referred to as ''phantom taxes''); and (4) rate treatment for particular nuclear expense items reflecting costs of delays, plant cancellations, and operational slowdowns

Discount rates, equity weights and the social cost of carbon

International Nuclear Information System (INIS)

Hope, Chris

2008-01-01

Equity weighting has been proposed as a way of allowing welfare equivalents to be included in the social cost of carbon since a dollar to a poor person is worth more than a dollar to a rich one. Here we use the PAGE2002 integrated assessment model to show that the social cost of carbon is higher without equity weights (an elasticity of marginal utility with respect to income of 0) than with them. This might seem counter-intuitive, but it comes about because of the logical link between equity weights and discount rates; as the elasticity goes from 0 to - 0.5 to - 1.0, the social rate of time preference rises, and the drop in present values that results far outweighs the small increase in impacts that equity weights bring. (author)

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)

The Impact of Accounting Methods on Cost Reduction Rates in Defense Aerospace Weapons System Programs

Science.gov (United States)

1988-12-01

and adhered to in U.S. industry, allow some flexibility in accounting. Under GAAP , accounting areas such as depreciation , inventory, investment tax... depreciation , inventory and investment tax credit) in predicting cost reduction rates are studied. Of the three accounting variables, only inventory...RATES .. ................. ........... 5 1. Depreciation ........ ............... 6 2. Capitalizing or Expensing of Costs . . .. 6 3. Material Costs

Racial differences in receipt of adjuvant hormonal therapy among Medicaid enrollees in South Carolina diagnosed with breast cancer

Science.gov (United States)

Felder, Tisha M.; Do, D. Phuong; Lu, Z. Kevin; Lal, Lincy S.; Heiney, Sue P.; Bennett, Charles L.

2016-01-01

Purpose Several factors contribute to the pervasive Black-White disparity in breast cancer mortality in the U.S., such as tumor biology, access to care and treatments received including adjuvant hormonal therapy (AHT), which significantly improves survival for hormone-receptor positive breast cancers (HR+). We analyzed South Carolina Central Cancer Registry-Medicaid linked data to determine if, in an equal access health care system, racial differences in the receipt of AHT exist. Methods We evaluated 494 study-eligible, Black (n=255) and White women (n=269) who were under 65 years old and diagnosed with stages I–III, HR+ breast cancers between 2004 and 2007. Bivariate and multivariate analyses were conducted to assess receipt of ≥ 1 AHT prescriptions at any point in time following (ever-use) or within 12 months of (early-use) breast cancer diagnosis. Results Seventy-two percent of the participants were ever-users (70% Black, 74% White) and 68% were early-users (65% Black, 71% White) of AHT. Neither ever-use (adjusted OR (AOR)=0.75, 95% CI: 0.48–1.17) nor early-use (AOR=0.70, 95% CI: 0.46–1.06) of AHT differed by race. However, receipt of other breast cancer-specific treatments was independently associated with ever-use and early-use of AHT [ever-use: receipt of surgery (AOR= 2.15, 95% CI: 1.35–3.44); chemotherapy (AOR=1.97, 95% CI: 1.22–3.20); radiation (AOR=2.33, 95% CI: 1.50–3.63); early-use: receipt of surgery (AOR=2.03, 95% CI: 1.30–3.17); chemotherapy (AOR=1.90, 95% CI: 1.20–3.03); radiation (AOR=1.73, 95% CI: 1.14–2.63)]. Conclusions No racial variations in use of AHT among women with HR+ breast cancers insured by Medicaid in South Carolina were identified, but overall rates of AHT use by these women is low. Strategies to improve overall use of AHT should include targeting breast cancer patients who do not receive adjuvant chemotherapy and/or radiation. PMID:27120468

Cost-effectiveness of quadrivalent human papillomavirus vaccination in adolescent girls

Directory of Open Access Journals (Sweden)

A. V. Rudakova

2016-01-01

Full Text Available The human papillomavirus (HPV infection is one of the major risk factor of development of genital warts, a cervical dysplasia, a cervical cancer, and also some other oncologic diseases. The usage of quadrivalent HPV vaccine in girls reduces the corresponding case rate and the mortality significantly.The objective of this study is to analyze the cost-effectiveness of quadrivalent HPV vaccination cases of 12-yearold girls in Russian Federation.Materials and methods. A Markov model is used on the basis of epidemiological data in Russian Federation. The cost-effectiveness was estimated from societal perspective. We assumed that the effect of vaccination remains throughout all life. The analysis is performed for survival of 12-year-old girls. We considered only effect in the vaccinated population. Costs for therapy of the diseases associated with HPV infection corresponded to compulsory health insurance rates across St. Petersburg for 2016. Costs and life expectancy have been discounted for 3,5% a year.Results. Quadrivalent HPV vaccination of 12-year-old girls in Russian Federation will allow to prevent counting on 10000 the vaccinated persons 293 cases of genital warts, 15 cases of pre invasive cervical cancer, 81 cases of invasive cervical cancer, 6 cases of vulvar cancer, 2 cases of vaginal cancer, 2 cases of anal cancer, 1 case of oropharyngeal cancer. In general, 49 cases of death caused by HPV infection on 10000 vaccinated girls would be prevented. The vaccination will provide cost reduction, caused by HPV-associated diseases, for 68% (58,38 million rubles on 10000 vaccinated, and 96% of the predicted prevented costs will be caused by decrease in incidence of cervical cancer. The quadrivalent HPV vaccination is associated with an incremental cost-effectiveness ratio (ICER of 172 000 rubles per quality adjusted life-year (QALY and 411 300 rubles per death caused by HPV-associated diseases.Conclusions. Quadrivalent

Cost-effectiveness of lobectomy versus genetic testing (Afirma®) for indeterminate thyroid nodules: Considering the costs of surveillance.

Science.gov (United States)

Balentine, Courtney J; Vanness, David J; Schneider, David F

2018-01-01

We evaluated whether diagnostic thyroidectomy for indeterminate thyroid nodules would be more cost-effective than genetic testing after including the costs of long-term surveillance. We used a Markov decision model to estimate the cost-effectiveness of thyroid lobectomy versus genetic testing (Afirma®) for evaluation of indeterminate (Bethesda 3-4) thyroid nodules. The base case was a 40-year-old woman with a 1-cm indeterminate nodule. Probabilities and estimates of utilities were obtained from the literature. Cost estimates were based on Medicare reimbursements with a 3% discount rate for costs and quality-adjusted life-years. During a 5-year period after the diagnosis of indeterminate thyroid nodules, lobectomy was less costly and more effective than Afirma® (lobectomy: $6,100; 4.50 quality-adjusted life- years vs Afirma®: $9,400; 4.47 quality-adjusted life-years). Only in 253 of 10,000 simulations (2.5%) did Afirma® show a net benefit at a cost-effectiveness threshold of $100,000 per quality- adjusted life-years. There was only a 0.3% probability of Afirma® being cost saving and a 14.9% probability of improving quality-adjusted life-years. Our base case estimate suggests that diagnostic lobectomy dominates genetic testing as a strategy for ruling out malignancy of indeterminate thyroid nodules. These results, however, were highly sensitive to estimates of utilities after lobectomy and living under surveillance after Afirma®. Published by Elsevier Inc.

Costs and cost-effectiveness of pediatric inguinal hernia repair in Uganda.

Science.gov (United States)

Eeson, Gareth; Birabwa-Male, Doreen; Pennington, Mark; Blair, Geoffrey K

2015-02-01

Surgically treatable diseases contribute approximately 11% of disability-adjusted life years (DALYs) worldwide yet they remain a neglected public health priority in low- and middle-income countries (LMICs). Pediatric inguinal hernia is the most common congenital abnormality in newborns and a major cause of morbidity and mortality yet elective repair remains largely unavailable in LMICs. This study is aimed to determine the costs and cost-effectiveness of pediatric inguinal hernia repair (PIHR) in a low-resource setting. Medical costs of consecutive elective PIHRs were recorded prospectively at two centers in Uganda. Decision modeling was used to compare two different treatment scenarios (adoption of PIHR and non-adoption) from a provider perspective. A Markov model was constructed to estimate health outcomes under each scenario. The robustness of the cost-effectiveness results in the base case analysis was tested in one-way and probabilistic sensitivity analysis. The primary outcome of interest was cost per DALY averted by the intervention. Sixty-nine PIHRs were performed in 65 children (mean age 3.6 years). Mean cost per procedure was $86.68 US (95% CI 83.1-90.2 USD) and averted an average of 5.7 DALYs each. Incremental cost-effectiveness ratio was $12.41 per DALY averted. The probability of cost-effectiveness was 95% at a cost-effectiveness threshold of $35 per averted DALY. Results were robust to sensitivity analysis under all considered scenarios. Elective PIHR is highly cost-effective for the treatment and prevention of complications of hernia disease even in low-resource settings. PIHR should be prioritized in LMICs alongside other cost-effective interventions.

A cost-benefit/cost-effectiveness analysis of an unsanctioned supervised smoking facility in the Downtown Eastside of Vancouver, Canada.

Science.gov (United States)

Jozaghi, Ehsan

2014-11-13

Smoking crack involves the risk of transmitting diseases such as HIV and hepatitis C (HCV). The current study determines whether the formerly unsanctioned supervised smoking facility (SSF)-operated by the grassroot organization, Vancouver Area Network of Drug Users (VANDU) for the last few years-costs less than the costs incurred for health-care services as a direct consequence of not having such a program in Vancouver, Canada. The data pertaining to the attendance at the SSF was gathered in 2012-2013 by VANDU. By relying on this data, a mathematical model was employed to estimate the number of HCV infections prevented by the former facility in Vancouver's Downtown Eastside (DTES). The DTES SSF's benefit-cost ratio was conservatively estimated at 12.1:1 due to its low operating cost. The study used 70% and 90% initial pipe-sharing rates for sensitivity analysis. At 80% sharing rate, the marginal HCV cases prevented were determined to be 55 cases. Moreover, at 80% sharing rate, the marginal cost-effectiveness ratio ranges from $1,705 to $97,203. The results from both the baseline and sensitivity analysis demonstrated that the establishment of the SSF by VANDU on average had annually saved CAD$1.8 million dollars in taxpayer's money. Funding SSFs in Vancouver is an efficient and effective use of financial resources in the public health domain; therefore, Vancouver Coastal Health should actively participate in their establishment in order to reduce HCV and other blood-borne infections such as HIV within the non-injecting drug users.

Discounting in the evaluation of the cost-effectiveness of a vaccination programme: A critical review.

Science.gov (United States)

Jit, Mark; Mibei, Walter

2015-07-31

Discounting future costs and health benefits usually has a large effect on results of cost-effectiveness evaluations of vaccination because of delays between the initial expenditure in the programme and the health benefits from averting disease. Most guidelines currently recommend discounting both costs and health effects at a positive, constant, common rate back to a common point in time. A review of 84 published economic evaluations of vaccines found that most of them apply these recommendations. However, both technical and normative arguments have been presented for discounting health at a different rate to consumption (differential discounting), discounting at a rate that changes over time (non-constant discounting), discounting intra-generational and inter-generational effects at a different rate (two-stage discounting), and discounting the health gains from an intervention to a different discount year from the time of intervention (delayed discounting). These considerations are particularly acute for vaccines, because their effects can occur in a different generation from the one paying for them, and because the time of vaccination, of infection aversion, and of disease aversion usually differ. Using differential, two-stage or delayed discounting in model-based cost-effectiveness evaluations of vaccination raises technical challenges, but mechanisms have been proposed to overcome them. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Cost-effective hybrid RF/FSO backhaul solution for next generation wireless systems

KAUST Repository

Dahrouj, Hayssam

2015-10-28

The rapid pace of demand for mobile data services and the limited supply of capacity in the current wireless access networks infrastructure are leading network operators to increase the density of base station deployments to improve network performance. This densification, made possible by small-cell deployment, also brings a novel set of challenges, specifically related to the cost of ownership, in which backhaul is of primary concern. This article proposes a cost-effective hybrid RF/free-space optical (FSO) solution to combine the advantages of RF backhauls (low cost, NLOS applications) and FSO backhauls (high-rate, low latency). To first illustrate the cost advantages of the RF backhaul solution, the first part of this article presents a business case of NLOS wireless RF backhaul, which has a low cost of ownership as compared to other backhaul candidates. RF backhaul, however, is limited by latency problems. On the other side, an FSO solution, which offers better latency and higher data rate than RF backhauls, remains sensitive to weather and nature conditions (e.g., rain, fog). To combine RF and FSO advantages, the second part of this article proposes a lowcost hybrid RF/FSO solution, wherein base stations are connected to each other using either optical fiber or hybrid RF/FSO links. This part addresses the problem of minimizing the cost of backhaul planning under reliability, connectivity, and data rate constraints, and proposes choosing the appropriate cost-effective backhaul connection between BSs (i.e., either OF or hybrid RF/FSO) using graph theory techniques.

THE EFFECT OF EXCHANGE RATE ON THE CONSTRUCTION PROJECTS AND PROTECTION METHODS

Directory of Open Access Journals (Sweden)

Handan AKSUYEK,

2017-02-01

Full Text Available As with all sectors, recent extreme changes occurred in the exchange rates have substantially affected the construction operations. While the rise in foreign exchange rates leads to harmful effects in the negative direction at the operations having foreign exchange – based debt or it provides also advantageous effect in the positive direction at the construction companies having foreign exchange – indexed investments. In this context, this sudden change in foreign exchange rates which cannot be predicted beforehand and emerges as a result of speculative events. As with all operations carrying out foreign exchange – based tasks, these fluctuations in the foreign exchange rate head first among the factors which affect the achievement or failure of the cost or profit targets previously determined by the construction companies as well. Therefore, the companies whose costs and profits consist of different units of currency in their construction agreements should apply to the hedging methods in order to be protected against the exchange rate. As for the main tools of protection method are the derivative products such as forward, futures, swap and optional contracts. In this study, the effect of exchange rate fluctuations on the completion costs of construction projects is scrutinized. Moreover, the tools which may be employed by the construction companies in order to get rid of exchange rate which adversely influence the building companies in both directions have been comparatively evaluated.

Construction Performance Optimization toward Green Building Premium Cost Based on Greenship Rating Tools Assessment with Value Engineering Method

Science.gov (United States)

Latief, Yusuf; Berawi, Mohammed Ali; Basten, Van; Riswanto; Budiman, Rachmat

2017-07-01

Green building concept becomes important in current building life cycle to mitigate environment issues. The purpose of this paper is to optimize building construction performance towards green building premium cost, achieving green building rating tools with optimizing life cycle cost. Therefore, this study helps building stakeholder determining building fixture to achieve green building certification target. Empirically the paper collects data of green building in the Indonesian construction industry such as green building fixture, initial cost, operational and maintenance cost, and certification score achievement. After that, using value engineering method optimized green building fixture based on building function and cost aspects. Findings indicate that construction performance optimization affected green building achievement with increasing energy and water efficiency factors and life cycle cost effectively especially chosen green building fixture.

Cost-effectiveness analysis of prophylactic cervical cancer vaccination in Japanese women.

Science.gov (United States)

Konno, Ryo; Sasagawa, Toshiyuki; Fukuda, Takashi; Van Kriekinge, Georges; Demarteau, Nadia

2010-04-01

The incidence of cervical cancer (CC) is high in Japan and is further increasing among women younger than 30 years. This burden could be reduced by the implementation of a CC vaccine, but its cost-effectiveness is unknown. We quantified the clinical impact and assessed the cost-effectiveness of adding CC vaccination at age 12 to the current screening in place in Japan with a lifetime Markov model adapted to the Japanese setting. Transition probabilities and utility values were obtained from public databases. Direct costs for treatment and screening were estimated using Japanese medical fees. Annual costs and benefits were discounted at 3%. Sensitivity analyses were conducted on the age at vaccination, the vaccine characteristics, the discount rates, the proportion of human papillomavirus types 16/18 in cancer, and the screening coverage. Vaccinating a 12-year-old cohort was predicted to reduce CC incidence and deaths from CC by 73%. These clinical effects were associated with an incremental cost-effectiveness ratio of yen1.8 million per quality-adjusted life year gained. The incremental cost-effectiveness ratio of vaccinating all 10- to 45-year-old women was yen2.8 million per quality-adjusted life year, still below the threshold value. The implementation of a CC vaccination in Japan could reduce the CC burden in a very cost-effective manner for women up to 45 years.

75 FR 51958 - California Association of Marriage and Family Therapists; Notice of Receipt of Petition for...

Science.gov (United States)

2010-08-24

... NUCLEAR REGULATORY COMMISSION 10 CFR Part 26 [Docket No. PRM-26-4; NRC-2010-0269] California Association of Marriage and Family Therapists; Notice of Receipt of Petition for Rulemaking AGENCY: Nuclear Regulatory Commission. ACTION: Petition for rulemaking; notice of receipt. SUMMARY: The Nuclear Regulatory...

Modeling of live-birth rates and cost-effectiveness of oocyte cryopreservation for cancer patients prior to high- and low-risk gonadotoxic chemotherapy.

Science.gov (United States)

Lyttle Schumacher, B; Grover, N; Mesen, T; Steiner, A; Mersereau, J

2017-10-01

What is the live-birth rate (LBR) and cost-effectiveness of fertility preservation with oocyte cryopreservation (FP-OC) compared to expectant management in cancer patients age 25-40 based on estimated gonadotoxicity of treatments 5 years after cancer diagnosis? Oocyte cryopreservation prior to cancer treatment is more costly, yet more effective (producing more live births), than not undergoing oocyte cryopreservation but it is most beneficial for patients undergoing high-risk chemotherapy (HRC). The decision to undergo FP prior to treatment is multifactorial and can be costly and delay treatment. Not all treatments carry the same gonadotoxicity and patients may choose to undergo FP-OC based on the probability of premature ovarian insufficiency, predicted outcomes and cost. A comprehensive model that incorporates age at diagnosis and toxicity of treatment to help guide patients in the decision to undergo FP-OC does not yet exist. This study used a Decision Analysis Model to estimate effectiveness and cost of FP for cancer patients. Age-based estimates of LBR and cost per live birth were calculated for ages 25-40 years based on gonadotoxicity of treatment. A decision analysis model was constructed using Treeage Pro 2015 with case base probabilities derived from national registries, practice guidelines and medical records from a national network of infertility practices (IntegraMed). Compared to no FP-OC, FP-OC improved LBRs for women of all ages undergoing either low-risk chemotherapy (LRC) or HRC; however, it was most cost effective for women undergoing LRC at older ages or HRC at younger ages. Although FP-OC results in higher LBRs, it was always more costly. Using donor oocyte IVF can be a successful alternative to autologous FP-OC. Decision tree results reflect probabilities of certain events and are compiled from multiple reputable sources but are not directly derived from a recruited cohort of patients. Outcomes are based on United States estimates and should be

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

Directory of Open Access Journals (Sweden)

White Michael T

2011-11-01

Full Text Available Abstract Background The control and elimination of malaria requires expanded coverage of and access to effective malaria control interventions such as insecticide-treated nets (ITNs, indoor residual spraying (IRS, intermittent preventive treatment (IPT, diagnostic testing and appropriate treatment. Decisions on how to scale up the coverage of these interventions need to be based on evidence of programme effectiveness, equity and cost-effectiveness. Methods A systematic review of the published literature on the costs and cost-effectiveness of malaria interventions was undertaken. All costs and cost-effectiveness ratios were inflated to 2009 USD to allow comparison of the costs and benefits of several different interventions through various delivery channels, across different geographical regions and from varying costing perspectives. Results Fifty-five studies of the costs and forty three studies of the cost-effectiveness of malaria interventions were identified, 78% of which were undertaken in sub-Saharan Africa, 18% in Asia and 4% in South America. The median financial cost of protecting one person for one year was $2.20 (range $0.88-$9.54 for ITNs, $6.70 (range $2.22-$12.85 for IRS, $0.60 (range $0.48-$1.08 for IPT in infants, $4.03 (range $1.25-$11.80 for IPT in children, and $2.06 (range $0.47-$3.36 for IPT in pregnant women. The median financial cost of diagnosing a case of malaria was $4.32 (range $0.34-$9.34. The median financial cost of treating an episode of uncomplicated malaria was $5.84 (range $2.36-$23.65 and the median financial cost of treating an episode of severe malaria was $30.26 (range $15.64-$137.87. Economies of scale were observed in the implementation of ITNs, IRS and IPT, with lower unit costs reported in studies with larger numbers of beneficiaries. From a provider perspective, the median incremental cost effectiveness ratio per disability adjusted life year averted was $27 (range $8.15-$110 for ITNs, $143 (range $135

26 CFR 1.924(a)-1T - Temporary regulations; definition of foreign trading gross receipts.

Science.gov (United States)

2010-04-01

... trading gross receipts. 1.924(a)-1T Section 1.924(a)-1T Internal Revenue INTERNAL REVENUE SERVICE... United States § 1.924(a)-1T Temporary regulations; definition of foreign trading gross receipts. (a) In general. The term “foreign trading gross receipts” means any of the five amounts described in paragraphs...

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

CALiPER Report 21.3. Cost Effectiveness of Linear (T8) LED Lamps

Energy Technology Data Exchange (ETDEWEB)

None

2014-05-01

Meeting performance expectations is important for driving adoption of linear LED lamps, but cost-effectiveness may be an overriding factor in many cases. Linear LED lamps cost more initially than fluorescent lamps, but energy and maintenance savings may mean that the life-cycle cost is lower. This report details a series of life-cycle cost simulations that compared a two-lamp troffer using LED lamps (38 W total power draw) or fluorescent lamps (51 W total power draw) over a 10-year study period. Variables included LED system cost ($40, $80, or $120), annual operating hours (2,000 hours or 4,000 hours), LED installation time (15 minutes or 30 minutes), and melded electricity rate ($0.06/kWh, $0.12/kWh, $0.18/kWh, or $0.24/kWh). A full factorial of simulations allows users to interpolate between these values to aid in making rough estimates of economic feasibility for their own projects. In general, while their initial cost premium remains high, linear LED lamps are more likely to be cost-effective when electric utility rates are higher than average and hours of operation are long, and if their installation time is shorter.

CALiPER Report 21.3: Cost-Effectiveness of Linear (T8) LED Lamps

Energy Technology Data Exchange (ETDEWEB)

Miller, Naomi J.; Perrin, Tess E.; Royer, Michael P.

2014-05-27

Meeting performance expectations is important for driving adoption of linear LED lamps, but cost-effectiveness may be an overriding factor in many cases. Linear LED lamps cost more initially than fluorescent lamps, but energy and maintenance savings may mean that the life-cycle cost is lower. This report details a series of life-cycle cost simulations that compared a two-lamp troffer using LED lamps (38 W total power draw) or fluorescent lamps (51 W total power draw) over a 10-year study period. Variables included LED system cost ($40, $80, or $120), annual operating hours (2,000 hours or 4,000 hours), LED installation time (15 minutes or 30 minutes), and melded electricity rate ($0.06/kWh, $0.12/kWh, $0.18/kWh, or $0.24/kWh). A full factorial of simulations allows users to interpolate between these values to aid in making rough estimates of economic feasibility for their own projects. In general, while their initial cost premium remains high, linear LED lamps are more likely to be cost-effective when electric utility rates are higher than average and hours of operation are long, and if their installation time is shorter.

Tradeable CO2 emission permits for cost-effective control of global warming

International Nuclear Information System (INIS)

Kosobud, R.F.; South, D.W.; Daly, T.A.; Quinn, K.G.

1991-01-01

Many current global warming mitigation policy proposals call for large, near-term reductions in CO 2 emissions, thereby entailing high initial carbon emission tax rates or permit prices. This paper claims that these high initial tax rates or permit prices are not cost-effective in achieving the desired degree of climate change control. A cost-effective permit system is proposed and described that, under certain assumptions, would allow markets to optimally lead permit prices along a gradually increasing trajectory over tie. This price path presents the Hotelling result and would ease the abrupt, inefficient, and costly adjustments imposed on the fossil fuel and other industries in current proposals. This finding is demonstrated using the Argonne Model, a linear programming energy- environmental-economic model that allows for intertemporal optimization of consumer energy well-being. 12 refs., 3 figs., 1 tab

Benefit, risks and cost-effectiveness of screening for abdominal aortic aneurysm

International Nuclear Information System (INIS)

Schmidt, T.; Muehlberger, N.; Siebert, U.; Chemelli-Steingruber, I.E.; Chemelli, Andreas; Strasak, A.; Kofler, B.

2010-01-01

Purpose: abdominal aortic aneurysms (AAA) cause a considerable number of deaths. A ruptured AAA is associated with a mortality rate of 80%. The purpose of this study was to summarize the current evidence from published health economic models for the long-term effectiveness and cost-effectiveness of screening programs for AAA. Materials and methods: medical, economic and health technology assessment (HTA) databases were systematically searched for cost-effectiveness models up to October 2007. Only models with a lifetime time horizon of evaluating AAA screening in men over 65 years were included in the review. Study data were extracted, standardized and summarized in evidence tables and cost-effectiveness plots. Results: we reviewed 8 cost-effectiveness models published between 1993 and 2007 comparing AAA screening and lack of screening in men over 60. One model yielded a loss of life-years at additional costs. The remaining seven models yielded gains in life expectancy ranging from 0.02 to 0.28LYs. Gains in quality-adjusted life expectancy reported by six of the seven models ranged from 0.015 to 0.059 QALYs. Incremental costs ranged from 96 to 721 Euros. Incremental cost-effectiveness ratios (ICER) ranged from 1443 to 13299 Euros per LY or QALY gained. Conclusion: based on our analysis, the introduction of a screening program to identify AAA will probably gain additional life years and quality of life at acceptable extra costs. The target population for a screening program should be men 65 years and older. (orig.)

Cost-effectiveness analysis of thermotherapy versus pentavalent antimonials for the treatment of cutaneous leishmaniasis.

Science.gov (United States)

Cardona-Arias, Jaiberth Antonio; López-Carvajal, Liliana; Tamayo Plata, Mery Patricia; Vélez, Iván Darío

2017-05-01

The treatment of cutaneous leishmaniasis is toxic, has contraindications, and a high cost. The objective of this study was to estimate the cost-effectiveness of thermotherapy versus pentavalent antimonials for the treatment of cutaneous leishmaniasis. Effectiveness was the proportion of healing and safety with the adverse effects; these parameters were estimated from a controlled clinical trial and a meta-analysis. A standard costing was conducted. Average and incremental cost-effectiveness ratios were estimated. The uncertainty regarding effectiveness, safety, and costs was determined through sensitivity analyses. The total costs were $66,807 with Glucantime and $14,079 with thermotherapy. The therapeutic effectiveness rates were 64.2% for thermotherapy and 85.1% for Glucantime. The average cost-effectiveness ratios ranged between $721 and $1275 for Glucantime and between $187 and $390 for thermotherapy. Based on the meta-analysis, thermotherapy may be a dominant strategy. The excellent cost-effectiveness ratio of thermotherapy shows the relevance of its inclusion in guidelines for the treatment. © 2017 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

49 CFR 1302.43 - Applicable rates on shipments in transit when statute becomes effective.

Science.gov (United States)

2010-10-01

... AND SERVICE TERMS EXPORT AND IMPORT SHIPMENTS; RAILROADS Charges for Rail Transportation When Water... receipted for by common carriers subject to the provisions of section 6 of the Interstate Commerce Act... receipted for by common carriers subject to the provisions of section 6 of the Interstate Commerce Act (49 U...

Cost-Effectiveness/Cost-Benefit Analysis of Newborn Screening for Severe Combined Immune Deficiency in Washington State.

Science.gov (United States)

Ding, Yao; Thompson, John D; Kobrynski, Lisa; Ojodu, Jelili; Zarbalian, Guisou; Grosse, Scott D

2016-05-01

To evaluate the expected cost-effectiveness and net benefit of the recent implementation of newborn screening (NBS) for severe combined immunodeficiency (SCID) in Washington State. We constructed a decision analysis model to estimate the costs and benefits of NBS in an annual birth cohort of 86 600 infants based on projections of avoided infant deaths. Point estimates and ranges for input variables, including the birth prevalence of SCID, proportion detected asymptomatically without screening through family history, screening test characteristics, survival rates, and costs of screening, diagnosis, and treatment were derived from published estimates, expert opinion, and the Washington NBS program. We estimated treatment costs stratified by age of identification and SCID type (with or without adenosine deaminase deficiency). Economic benefit was estimated using values of $4.2 and $9.0 million per death averted. We performed sensitivity analyses to evaluate the influence of key variables on the incremental cost-effectiveness ratio (ICER) of net direct cost per life-year saved. Our model predicts an additional 1.19 newborn infants with SCID detected preclinically through screening, in addition to those who would have been detected early through family history, and 0.40 deaths averted annually. Our base-case model suggests an ICER of $35 311 per life-year saved, and a benefit-cost ratio of either 5.31 or 2.71. Sensitivity analyses found ICER values <$100 000 and positive net benefit for plausible assumptions on all variables. Our model suggests that NBS for SCID in Washington is likely to be cost-effective and to show positive net economic benefit. Published by Elsevier Inc.

Cost-effectiveness of benign Wirsung duct strictures treatment in chronic pancreatitis.

Science.gov (United States)

Łaski, Dariusz; Hać, Stanisław; Marek, Iwona; Kobiela, Jarosław; Kostro, Justyna; Adrych, Krystian; Śledziński, Zbigniew

2018-03-01

Chronic pancreatitis (CP) is an important problem for modern medicine, the healthcare system (Poland - NFZ) and the national insurance system (Poland - ZUS). The chronic nature of the disease, the lack of targeted treatment and the low mortality rate lead to an accumulation of patients who demand expensive treatment, both conservative and invasive. Rising costs in health care are forcing the need for a more cost-effective method of treatment. The primary aim of this study was to perform a retrospective calculation of costs in both surgical and endoscopic treatment, hospital stay, healthcare, and public insurance of patients suffering from chronic pancreatitis. Parallel quality of life analysis was performed. It was possible to develop a cost-effective therapeutic algorithm for patients with an uncomplicated stricture of Wirsung's duct within the Polish health care system. In Poland, the hospital costs of endoscopic treatment of patients with chronic pancreatitis were higher than those of the surgical treatment group despite both resulting in a similar life quality. From a cost-effectiveness perspective, it was shown that surgical intervention is a more cost-effective therapy than endotherapy. Furthermore, patients with benign stricture of the main pancreatic duct in chronic pancreatitis should not be treated with endotherapy for longer than 12 months.

11 CFR 300.31 - Receipt of Levin funds.

Science.gov (United States)

2010-01-01

... Levin funds. (a) General rule. Levin funds expended or disbursed by any State, district, or local...) Donation amount limitation—(1) General rule. A State, district, or local committee of a political party... 11 Federal Elections 1 2010-01-01 2010-01-01 false Receipt of Levin funds. 300.31 Section 300.31...

Understanding The Asean-5 Tourism Sector Based On Australia Outbound Tourism

Directory of Open Access Journals (Sweden)

Petrus Jerry Pardomuan

2018-03-01

Full Text Available Many studies have been conducted with the aim at investigating the relationship between the tourism performance and macroeconomic variables. However, only few studies investigated the regional tourism performance based on a specific origin country. This study investigated the relationship between ASEAN-5 international tourism receipts as the dependent variable and macroeconomic variables as the independent variables namely the exchange rates to Australian Dollar, Australia GDP per capita, international tourism expenditure, and transportation costs. The method used to investigate this study is panel data regression model to determine the influence among the explanatory variables to the dependent variable. The results denote that the exchange rates, GDP per capita, and the transportation cost are significant to the tourism receipts. Meanwhile, the international tourism expenditure variable shows an insignificant result to the tourism receipts.

11 CFR 103.3 - Deposit of receipts and disbursements (2 U.S.C. 432(h)(1)).

Science.gov (United States)

2010-01-01

... receipts by a political committee shall be deposited in account(s) established pursuant to 11 CFR 103.2... the treasurer memorializing an oral communication explaining why the contribution is legal. If the... on new evidence not available to the political committee at the time of receipt and deposit, the...

A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Ottawa, Canada.

Science.gov (United States)

Jozaghi, Ehsan; Reid, Andrew A; Andresen, Martin A; Juneau, Alexandre

2014-08-04

Supervised injection facilities (SIFs) are venues where people who inject drugs (PWID) have access to a clean and medically supervised environment in which they can safely inject their own illicit drugs. There is currently only one legal SIF in North America: Insite in Vancouver, British Columbia, Canada. The responses and feedback generated by the evaluations of Insite in Vancouver have been overwhelmingly positive. This study assesses whether the above mentioned facility in the Downtown Eastside of Vancouver needs to be expanded to other locations, more specifically that of Canada's capital city, Ottawa. The current study is aimed at contributing to the existing literature on health policy by conducting cost-benefit and cost-effective analyses for the opening of SIFs in Ottawa, Ontario. In particular, the costs of operating numerous SIFs in Ottawa was compared to the savings incurred; this was done after accounting for the prevention of new HIV and Hepatitis C (HCV) infections. To ensure accuracy, two distinct mathematical models and a sensitivity analysis were employed. The sensitivity analyses conducted with the models reveals the potential for SIFs in Ottawa to be a fiscally responsible harm reduction strategy for the prevention of HCV cases--when considered independently. With a baseline sharing rate of 19%, the cumulative annual cost model supported the establishment of two SIFs and the marginal annual cost model supported the establishment of a single SIF. More often, the prevention of HIV or HCV alone were not sufficient to justify the establishment cost-effectiveness; rather, only when both HIV and HCV are considered does sufficient economic support became apparent. Funded supervised injection facilities in Ottawa appear to be an efficient and effective use of financial resources in the public health domain.

Screening for chronic kidney disease in Canadian indigenous peoples is cost-effective.

Science.gov (United States)

Ferguson, Thomas W; Tangri, Navdeep; Tan, Zhi; James, Matthew T; Lavallee, Barry D A; Chartrand, Caroline D; McLeod, Lorraine L; Dart, Allison B; Rigatto, Claudio; Komenda, Paul V J

2017-07-01

Canadian indigenous (First Nations) have rates of kidney failure that are 2- to 4-fold higher than the non-indigenous general Canadian population. As such, a strategy of targeted screening and treatment for CKD may be cost-effective in this population. Our objective was to assess the cost utility of screening and subsequent treatment for CKD in rural Canadian indigenous adults by both estimated glomerular filtration rate and the urine albumin-to-creatinine ratio. A decision analytic Markov model was constructed comparing the screening and treatment strategy to usual care. Primary outcomes were presented as incremental cost-effectiveness ratios (ICERs) presented as a cost per quality-adjusted life-year (QALY). Screening for CKD was associated with an ICER of $23,700/QALY in comparison to usual care. Restricting the model to screening in communities accessed only by air travel (CKD prevalence 34.4%), this ratio fell to $7,790/QALY. In road accessible communities (CKD prevalence 17.6%) the ICER was $52,480/QALY. The model was robust to changes in influential variables when tested in univariate sensitivity analyses. Probabilistic sensitivity analysis found 72% of simulations to be cost-effective at a $50,000/QALY threshold and 93% of simulations to be cost-effective at a $100,000/QALY threshold. Thus, targeted screening and treatment for CKD using point-of-care testing equipment in rural Canadian indigenous populations is cost-effective, particularly in remote air access-only communities with the highest risk of CKD and kidney failure. Evaluation of targeted screening initiatives with cluster randomized controlled trials and integration of screening into routine clinical visits in communities with the highest risk is recommended. Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Structural Intervention With School Nurses Increases Receipt of Sexual Health Care Among Male High School Students.

Science.gov (United States)

Dittus, Patricia J; Harper, Christopher R; Becasen, Jeffrey S; Donatello, Robin A; Ethier, Kathleen A

2018-01-01

Adolescent males are less likely to receive health care and have lower levels of sexual and reproductive health (SRH) knowledge than adolescent females. The purpose of this study was to determine if a school-based structural intervention focused on school nurses increases receipt of condoms and SRH information among male students. Interventions to improve student access to sexual and reproductive health care were implemented in six urban high schools with a matched set of comparison schools. Interventions included working with school nurses to improve access to sexual and reproductive health care, including the provision of condoms and information about pregnancy and sexually transmitted disease prevention and services. Intervention effects were assessed through five cross-sectional yearly surveys, and analyses include data from 13,740 male students. Nurses in intervention schools changed their interactions with male students who visited them for services, such that, among those who reported they went to the school nurse for any reason in the previous year, those in intervention schools reported significant increases in receipt of sexual health services over the course of the study compared with students in comparison schools. Further, these results translated into population-level effects. Among all male students surveyed, those in intervention schools were more likely than those in comparison schools to report increases in receipt of sexual health services from school nurses. With a minimal investment of resources, school nurses can become important sources of SRH information and condoms for male high school students. Published by Elsevier Inc.

Cost and cost-effectiveness of conventional and liquid-based ...

African Journals Online (AJOL)

Methods. The unit of effectiveness was defined as the number of cervical intraepithelial neoplasm (CIN) II or higher lesions detected. Costs were assessed retrospectively for the financial year (2010/11) from a laboratory service provider perspective. A cost-effectiveness analysis was performed by combining secondary data ...

Public Budget Database - Budget Authority and offsetting receipts 1976-Current

Data.gov (United States)

Executive Office of the President — This file contains historical budget authority and offsetting receipts for 1976 through the current budget year, as well as four years of projections. It can be used...

[Cost-effectiveness of Synchronous vs. Asynchronous Telepsychiatry in Prison Inmates With Depression].

Science.gov (United States)

Barrera-Valencia, Camilo; Benito-Devia, Alexis Vladimir; Vélez-Álvarez, Consuelo; Figueroa-Barrera, Mario; Franco-Idárraga, Sandra Milena

Telepsychiatry is defined as the use of information and communication technology (ICT) in providing remote psychiatric services. Telepsychiatry is applied using two types of communication: synchronous (real time) and asynchronous (store and forward). To determine the cost-effectiveness of a synchronous and an asynchronous telepsychiatric model in prison inmate patients with symptoms of depression. A cost-effectiveness study was performed on a population consisting of 157 patients from the Establecimiento Penitenciario y Carcelario de Mediana Seguridad de Manizales, Colombia. The sample was determined by applying Zung self-administered surveys for depression (1965) and the Hamilton Depression Rating Scale (HDRS), the latter being the tool used for the comparison. Initial Hamilton score, arrival time, duration of system downtime, and clinical effectiveness variables had normal distributions (P>.05). There were significant differences (P<.001) between care costs for the different models, showing that the mean cost of the asynchronous model is less than synchronous model, and making the asynchronous model more cost-effective. The asynchronous model is the most cost-effective model of telepsychiatry care for patients with depression admitted to a detention centre, according to the results of clinical effectiveness, cost measurement, and patient satisfaction. Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Mid-term cost-effectiveness analysis of open and endovascular repair for ruptured abdominal aortic aneurysm.

Science.gov (United States)

Rollins, K E; Shak, J; Ambler, G K; Tang, T Y; Hayes, P D; Boyle, J R

2014-02-01

Emergency endovascular repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) may have lower operative mortality rates than open surgical repair. Concerns remain that the early survival benefit after EVAR for rAAA may be offset by late reinterventions. The aim of this study was to compare reintervention rates and cost-effectiveness of EVAR and open repair for rAAA. A retrospective analysis was undertaken of patients with rAAA undergoing EVAR or open repair over 6 years. A health economic model developed for the cost-effectiveness of elective EVAR was used in the emergency setting. Sixty-two patients (mean age 77·9 years) underwent EVAR and 85 (mean age 75·9 years) had open repair of rAAA. Median follow-up was 42 and 39 months respectively. There was no significant difference in 30-day mortality rates after EVAR and open repair (18 and 26 per cent respectively; P = 0·243). Reintervention rates were also similar (32 and 31 per cent; P = 0·701). The mean cost per patient was €26,725 for EVAR and €30,297 for open repair, and the cost per life-year gained was €7906 and €9933 respectively (P = 0·561). Open repair had greater initial costs: longer procedural times (217 versus 178·5 min; P < 0·001) and intensive care stay (5·0 versus 1·0 days; P = 0·015). Conversely, EVAR had greater reintervention (€156,939 versus €35,335; P = 0·001) and surveillance (P < 0·001) costs. There was no significant difference in reintervention rates after EVAR or open repair for rAAA. EVAR was as cost-effective at mid-term follow-up. The increased procedural costs of open repair are not outweighed by greater surveillance and reintervention costs after EVAR. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Cost-effective backhaul design using hybrid radio/free-space optical technology

KAUST Repository

Douik, Ahmed S.

2015-06-08

The deluge of date rate in today\\'s networks poses a cost burden on the backhaul network design. Developing cost efficient backhaul solutions becomes an interesting, yet challenging, problem. Traditional technologies for backhaul networks include either radio-frequency backhauls (RF) or optical fibres (OF). While RF is a cost-effective solution as compared to OF, it supports lower data rate requirements. Another promising backhaul solution that may combine both a high data rate and a relatively low cost is the free-space optics (FSO). FSO, however, is sensitive to nature conditions (e.g., rain, fog, line-ofsight, etc.). A more reliable alternative is, therefore, to combine RF and FSO solutions through a hybrid structure called hybrid RF/FSO. Consider a backhaul network, where the base-stations (BS) can be connected to each other either via OF or hybrid RF/FSO backhaul links. The paper addresses the problem of minimizing the cost of backhaul planning under connectivity and data rates constraints, so as to choose the appropriate costeffective backhaul type between BSs (i.e., either OF or hybrid RF/FSO). The paper solves the problem using graph theory techniques by introducing the corresponding planning graph. It shows that under a specified realistic assumption about the cost of OF and hybrid RF/FSO links, the problem is equivalent to a maximum weight clique problem, which can be solved with moderate complexity. Simulation results show that our proposed solution shows a close-to-optimal performance, especially for practical prices of the hybrid RF/FSO.

Cost-effective backhaul design using hybrid radio/free-space optical technology

KAUST Repository

Douik, Ahmed S.; Dahrouj, Hayssam; Al-Naffouri, Tareq Y.; Alouini, Mohamed-Slim

2015-01-01

The deluge of date rate in today's networks poses a cost burden on the backhaul network design. Developing cost efficient backhaul solutions becomes an interesting, yet challenging, problem. Traditional technologies for backhaul networks include either radio-frequency backhauls (RF) or optical fibres (OF). While RF is a cost-effective solution as compared to OF, it supports lower data rate requirements. Another promising backhaul solution that may combine both a high data rate and a relatively low cost is the free-space optics (FSO). FSO, however, is sensitive to nature conditions (e.g., rain, fog, line-ofsight, etc.). A more reliable alternative is, therefore, to combine RF and FSO solutions through a hybrid structure called hybrid RF/FSO. Consider a backhaul network, where the base-stations (BS) can be connected to each other either via OF or hybrid RF/FSO backhaul links. The paper addresses the problem of minimizing the cost of backhaul planning under connectivity and data rates constraints, so as to choose the appropriate costeffective backhaul type between BSs (i.e., either OF or hybrid RF/FSO). The paper solves the problem using graph theory techniques by introducing the corresponding planning graph. It shows that under a specified realistic assumption about the cost of OF and hybrid RF/FSO links, the problem is equivalent to a maximum weight clique problem, which can be solved with moderate complexity. Simulation results show that our proposed solution shows a close-to-optimal performance, especially for practical prices of the hybrid RF/FSO.

Receipt and Inspection of Chemical - Biological (CB) Materiel

Science.gov (United States)

2017-08-31

TOP provides guidance on how to plan and conduct receipt inspection. The TOP provides specific procedures and data collection sheets . 15. SUBJECT...Unclassified Unclassified Unclassified 19b. TELEPHONE NUMBER (include area code ) Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std. Z39-18...10 APPENDIX A. DATA COLLECTION SHEET ............................................ A-1 B. ABBREVIATIONS

11 CFR 104.8 - Uniform reporting of receipts.

Science.gov (United States)

2010-01-01

... the candidate shall report the receipt of any bank loan obtained by the candidate or loan of money... follows: (1) The amount of the loan that is used in connection with the candidate's campaign shall be... certain loans used for a candidate's routine living expenses. [45 FR 15108, Mar. 7, 1980, as amended at 52...

Cost-effectiveness analysis of secukinumab for the treatment of active psoriatic arthritis: a Canadian perspective.

Science.gov (United States)

Goeree, Ron; Chiva-Razavi, Sima; Gunda, Praveen; Graham, Christopher N; Miles, LaStella; Nikoglou, Efthalia; Jugl, Steffen M; Gladman, Dafna D

2018-02-01

The study evaluates the cost-effectiveness of secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin (IL)-17A, vs currently licensed biologic treatments in patients with active psoriatic arthritis (PsA) from a Canadian healthcare system perspective. A decision analytic semi-Markov model evaluated the cost-effectiveness of secukinumab 150 mg and 300 mg compared to subcutaneous biologics adalimumab, certolizumab pegol, etanercept, golimumab, and ustekinumab, and intravenous biologics infliximab and infliximab biosimilar in biologic-naive and biologic-experienced patients over a lifetime horizon. The response to treatments was evaluated after 12 weeks by PsA Response Criteria (PsARC) response rates. Non-responders or patients discontinuing initial-line of biologic treatment were allowed to switch to subsequent-line biologics. Model input parameters (Psoriasis Area Severity Index [PASI], Health Assessment Questionnaire [HAQ], withdrawal rates, costs, and resource use) were collected from clinical trials, published literature, and other Canadian sources. Benefits were expressed as quality-adjusted life years (QALYs). An annual discount rate of 5% was applied to costs and benefits. The robustness of the study findings were evaluated via sensitivity analyses. Biologic-naive patients treated with secukinumab achieved the highest number of QALYs (8.54) at the lowest cost (CAD 925,387) over a lifetime horizon vs all comparators. Secukinumab dominated all treatments, except for infliximab and its biosimilar, which achieved minimally more QALYs (8.58). However, infliximab and its biosimilar incurred more costs than secukinumab (infliximab: CAD 1,015,437; infliximab biosimilar: CAD 941,004), resulting in higher cost-effectiveness estimates relative to secukinumab. In the biologic-experienced population, secukinumab dominated all treatments as it generated more QALYs (8.89) at lower costs (CAD 954,692). Deterministic sensitivity analyses

Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis

OpenAIRE

Baggaley, R. F.; Irvine, M. A.; Leber, W.; Cambiano, V.; Figueroa, J.; McMullen, H.; Anderson, J.; Santos, A. C.; Terris-Prestholt, F.; Miners, A.; Hollingsworth, T. D.; Griffiths, C. J.

2017-01-01

BACKGROUND: Early HIV diagnosis reduces morbidity, mortality, the probability of onward transmission, and their associated costs, but might increase cost because of earlier initiation of antiretroviral treatment (ART). We investigated this trade-off by estimating the cost-effectiveness of HIV screening in primary care. METHODS: We modelled the effect of the four-times higher diagnosis rate observed in the intervention arm of the RHIVA2 randomised controlled trial done in Hackney, London (UK),...

Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis

OpenAIRE

Baggaley, Rebecca F; Irvine, Michael A; Leber, Werner; Cambiano, Valentina; Figueroa, Jose; McMullen, Heather; Anderson, Jane; Santos, Andreia C; Terris-Prestholt, Fern; Miners, Alec; Hollingsworth, T Déirdre; Griffiths, Chris J

2017-01-01

Summary Background Early HIV diagnosis reduces morbidity, mortality, the probability of onward transmission, and their associated costs, but might increase cost because of earlier initiation of antiretroviral treatment (ART). We investigated this trade-off by estimating the cost-effectiveness of HIV screening in primary care. Methods We modelled the effect of the four-times higher diagnosis rate observed in the intervention arm of the RHIVA2 randomised controlled trial done in Hackney, London...

Health care utilization, costs, and readmission rates associated with hyponatremia.

Science.gov (United States)

Deitelzweig, Steven; Amin, Alpesh; Christian, Rudell; Friend, Keith; Lin, Jay; Lowe, Timothy J

2013-02-01

Hyponatremia is associated with higher morbidity and mortality rates among hospitalized patients. Our study evaluated health care utilization and associated costs of patients hospitalized with a primary diagnosis of hyponatremia. Hospitalized patients with a primary discharge diagnosis of hyponatremia (aged ≥ 18 years) were identified from the Premier Perspective™ database (January 1, 2007-March 31, 2010) and matched to non-hyponatremic (non-HN) patients using a combination of exact patient characteristic matching and propensity score matching. Univariate and multivariate statistics were used to compare hospital resource usage, costs, and 30-day readmission rates between cohorts. Hospital length of stay (LOS) (± standard deviation) (3.78 ± 3.19 vs 3.54 ± 3.26 days; P ratio, 1.89, confidence limits, 1.72, 2.07; P ratio, 4.76; confidence limits, 4.31, 5.26; P profitability due to the increased likelihood of 30-day readmission.

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

The costs and cost-effectiveness of an integrated sepsis treatment protocol.

Science.gov (United States)

Talmor, Daniel; Greenberg, Dan; Howell, Michael D; Lisbon, Alan; Novack, Victor; Shapiro, Nathan

2008-04-01

Sepsis is associated with high mortality and treatment costs. International guidelines recommend the implementation of integrated sepsis protocols; however, the true cost and cost-effectiveness of these are unknown. To assess the cost-effectiveness of an integrated sepsis protocol, as compared with conventional care. Prospective cohort study of consecutive patients presenting with septic shock and enrolled in the institution's integrated sepsis protocol. Clinical and economic outcomes were compared with a historical control cohort. Beth Israel Deaconess Medical Center. Overall, 79 patients presenting to the emergency department with septic shock in the treatment cohort and 51 patients in the control group. An integrated sepsis treatment protocol incorporating empirical antibiotics, early goal-directed therapy, intensive insulin therapy, lung-protective ventilation, and consideration for drotrecogin alfa and steroid therapy. In-hospital treatment costs were collected using the hospital's detailed accounting system. The cost-effectiveness analysis was performed from the perspective of the healthcare system using a lifetime horizon. The primary end point for the cost-effectiveness analysis was the incremental cost per quality-adjusted life year gained. Mortality in the treatment group was 20.3% vs. 29.4% in the control group (p = .23). Implementing an integrated sepsis protocol resulted in a mean increase in cost of approximately $8,800 per patient, largely driven by increased intensive care unit length of stay. Life expectancy and quality-adjusted life years were higher in the treatment group; 0.78 and 0.54, respectively. The protocol was associated with an incremental cost of $11,274 per life-year saved and a cost of $16,309 per quality-adjusted life year gained. In patients with septic shock, an integrated sepsis protocol, although not cost-saving, appears to be cost-effective and compares very favorably to other commonly delivered acute care interventions.

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.

Cost effectiveness of MR imaging in the evaluation of focal lesions in the liver

International Nuclear Information System (INIS)

Cahill, P.T.; Goldberg, S.; Millerin, J.; Whalen, J.P.; Markisz, J.A.

1986-01-01

The authors evaluated the advantages of MR imaging over conventional imaging techniques with respect to clinical sensitivity, risk to patients, and cost-effectiveness. Patients were separated into four groups: cancer patients, those with incidental findings of liver lesions, those with questionable CT findings, and those with known hepatic hemangiomas that should be followed up. The determination of cost-effectiveness of MR imaging depended on the ability of CT to accurately distinguish between hemangiomas and metastases, as well as the cost of each examination. MR imaging at $400 per series was always cost-effective for the first three groups of patients. With a questionable rate of only 20%, MR imaging became cost-effective at an examination cost of $600. CT was cost-effective for the fourth group of patients in all instances. This analysis supports the use of MR imaging in the diagnosis of solitary liver lesions and for clinical evaluation of patients with cancer

48 CFR 315.606-1 - Receipt and initial review.

Science.gov (United States)

2010-10-01

... CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Unsolicited Proposals 315.606-1 Receipt and initial review. (d) OPDIVs shall not refuse consideration of an unsolicited proposal because an organization initially submitted it as a grant application. However, OPDIVs shall not award contracts based on...

A Longitudinal Study and Color Rating System of Acquisition Cost Growth

Science.gov (United States)

2017-03-23

cost growth analysis. Ways in which this research can be carried forward include: • Collect more SAR data to further populate our research database... Growth Cory N. D’Amico Follow this and additional works at: https://scholar.afit.edu/etd Part of the Finance and Financial Management Commons This...and Color Rating System of Acquisition Cost Growth " (2017). Theses and Dissertations. 781. https://scholar.afit.edu/etd/781 A Longitudinal

Costs and cost-effectiveness of 9-valent human papillomavirus (HPV) vaccination in two East African countries.

Science.gov (United States)

Kiatpongsan, Sorapop; Kim, Jane J

2014-01-01

Current prophylactic vaccines against human papillomavirus (HPV) target two of the most oncogenic types, HPV-16 and -18, which contribute to roughly 70% of cervical cancers worldwide. Second-generation HPV vaccines include a 9-valent vaccine, which targets five additional oncogenic HPV types (i.e., 31, 33, 45, 52, and 58) that contribute to another 15-30% of cervical cancer cases. The objective of this study was to determine a range of vaccine costs for which the 9-valent vaccine would be cost-effective in comparison to the current vaccines in two less developed countries (i.e., Kenya and Uganda). The analysis was performed using a natural history disease simulation model of HPV and cervical cancer. The mathematical model simulates individual women from an early age and tracks health events and resource use as they transition through clinically-relevant health states over their lifetime. Epidemiological data on HPV prevalence and cancer incidence were used to adapt the model to Kenya and Uganda. Health benefit, or effectiveness, from HPV vaccination was measured in terms of life expectancy, and costs were measured in international dollars (I$). The incremental cost of the 9-valent vaccine included the added cost of the vaccine counterbalanced by costs averted from additional cancer cases prevented. All future costs and health benefits were discounted at an annual rate of 3% in the base case analysis. We conducted sensitivity analyses to investigate how infection with multiple HPV types, unidentifiable HPV types in cancer cases, and cross-protection against non-vaccine types could affect the potential cost range of the 9-valent vaccine. In the base case analysis in Kenya, we found that vaccination with the 9-valent vaccine was very cost-effective (i.e., had an incremental cost-effectiveness ratio below per-capita GDP), compared to the current vaccines provided the added cost of the 9-valent vaccine did not exceed I$9.7 per vaccinated girl. To be considered very cost-effective

Cost-effectiveness of cervical-cancer screening in five developing countries.

Science.gov (United States)

Goldie, Sue J; Gaffikin, Lynne; Goldhaber-Fiebert, Jeremy D; Gordillo-Tobar, Amparo; Levin, Carol; Mahé, Cédric; Wright, Thomas C

2005-11-17

Cervical-cancer screening strategies that involve the use of conventional cytology and require multiple visits have been impractical in developing countries. We used computer-based models to assess the cost-effectiveness of a variety of cervical-cancer screening strategies in India, Kenya, Peru, South Africa, and Thailand. Primary data were combined with data from the literature to estimate age-specific incidence and mortality rates for cancer and the effectiveness of screening for and treatment of precancerous lesions. We assessed the direct medical, time, and program-related costs of strategies that differed according to screening test, targeted age and frequency, and number of clinic visits required. Single-visit strategies involved the assumption that screening and treatment could be provided in the same day. Outcomes included the lifetime risk of cancer, years of life saved, lifetime costs, and cost-effectiveness ratios (cost per year of life saved). The most cost-effective strategies were those that required the fewest visits, resulting in improved follow-up testing and treatment. Screening women once in their lifetime, at the age of 35 years, with a one-visit or two-visit screening strategy involving visual inspection of the cervix with acetic acid or DNA testing for human papillomavirus (HPV) in cervical cell samples, reduced the lifetime risk of cancer by approximately 25 to 36 percent, and cost less than 500 dollars per year of life saved. Relative cancer risk declined by an additional 40 percent with two screenings (at 35 and 40 years of age), resulting in a cost per year of life saved that was less than each country's per capita gross domestic product--a very cost-effective result, according to the Commission on Macroeconomics and Health. Cervical-cancer screening strategies incorporating visual inspection of the cervix with acetic acid or DNA testing for HPV in one or two clinical visits are cost-effective alternatives to conventional three

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.

22 CFR 136.4 - Restrictions on dispositions of personal property.

Science.gov (United States)

2010-04-01

... this section including any interest earned by the employee or family member on such profits, shall be... currencies, proceeds received and costs incurred in a foreign currency shall be valued in United States dollars at the time of receipt or payment at the rate of exchange that was in effect for reverse...

Production rates and costs of cable yarding wood residue from clearcut units

Science.gov (United States)

Chris B. LeDoux

1984-01-01

Wood residue is a little used source of fiber, chips, and fuel because harvest costs are largely unknown. This study calculates incremental production rates and costs for yarding and loading logging residue in clearcut old-growth Douglas-fir/western hemlock forests. Harvest operations were observed for two timber sales in western Oregon. Three different cable yarding...

The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico.

Directory of Open Access Journals (Sweden)

Delphine Hu

Full Text Available BACKGROUND: In Mexico, the lifetime risk of dying from maternal causes is 1 in 370 compared to 1 in 2,500 in the U.S. Although national efforts have been made to improve maternal services in the last decade, it is unclear if Millennium Development Goal 5--to reduce maternal mortality by three-quarters by 2015--will be met. METHODOLOGY/PRINCIPAL FINDINGS: We developed an empirically calibrated model that simulates the natural history of pregnancy and pregnancy-related complications in a cohort of 15-year-old women followed over their lifetime. After synthesizing national and sub-national trends in maternal mortality, the model was calibrated to current intervention-specific coverage levels and validated by comparing model-projected life expectancy, total fertility rate, crude birth rate and maternal mortality ratio with Mexico-specific data. Using both published and primary data, we assessed the comparative health and economic outcomes of alternative strategies to reduce maternal morbidity and mortality. A dual approach that increased coverage of family planning by 15%, and assured access to safe abortion for all women desiring elective termination of pregnancy, reduced mortality by 43% and was cost saving compared to current practice. The most effective strategy added a third component, enhanced access to comprehensive emergency obstetric care for at least 90% of women requiring referral. At a national level, this strategy reduced mortality by 75%, cost less than current practice, and had an incremental cost-effectiveness ratio of $300 per DALY relative to the next best strategy. Analyses conducted at the state level yielded similar results. CONCLUSIONS/SIGNIFICANCE: Increasing the provision of family planning and assuring access to safe abortion are feasible, complementary and cost-effective strategies that would provide the greatest benefit within a short-time frame. Incremental improvements in access to high-quality intrapartum and emergency

Bevacizumab for Metastatic Colorectal Cancer: A Global Cost-Effectiveness Analysis.

Science.gov (United States)

Goldstein, Daniel A; Chen, Qiushi; Ayer, Turgay; Chan, Kelvin K W; Virik, Kiran; Hammerman, Ariel; Brenner, Baruch; Flowers, Christopher R; Hall, Peter S

2017-06-01

In the U.S., the addition of bevacizumab to first-line chemotherapy in metastatic colorectal cancer (mCRC) has been demonstrated to provide 0.10 quality-adjusted life years (QALYs) at an incremental cost-effectiveness ratio (ICER) of $571,000/QALY. Due to variability in pricing, value for money may be different in other countries. Our objective was to establish the cost-effectiveness of bevacizumab in mCRC in the U.S., U.K., Canada, Australia, and Israel. We performed the analysis using a previously established Markov model for mCRC. Input data for efficacy, adverse events, and quality of life were considered to be generalizable and therefore identical for all countries. We used country-specific prices for medications, administration, and other health service costs. All costs were converted from local currency to U.S. dollars at the exchange rates in March 2016. We conducted one-way and probabilistic sensitivity analyses (PSA) to assess the model robustness across parameter uncertainties. Base case results demonstrated that the highest ICER was in the U.S. ($571,000/QALY) and the lowest was in Australia ($277,000/QALY). In Canada, the U.K., and Israel, ICERs ranged between $351,000 and $358,000 per QALY. PSA demonstrated 0% likelihood of bevacizumab being cost-effective in any country at a willingness to pay threshold of $150,000 per QALY. The addition of bevacizumab to first-line chemotherapy for mCRC consistently fails to be cost-effective in all five countries. There are large differences in cost-effectiveness between countries. This study provides a framework for analyzing the value of a cancer drug from the perspectives of multiple international payers. The cost-effectiveness of bevacizumab varies significantly between multiple countries. By conventional thresholds, bevacizumab is not cost-effective in metastatic colon cancer in the U.S., the U.K., Australia, Canada, and Israel. © AlphaMed Press 2017.

A low-cost, high-resolution, video-rate imaging optical radar

Energy Technology Data Exchange (ETDEWEB)

Sackos, J.T.; Nellums, R.O.; Lebien, S.M.; Diegert, C.F. [Sandia National Labs., Albuquerque, NM (United States); Grantham, J.W.; Monson, T. [Air Force Research Lab., Eglin AFB, FL (United States)

1998-04-01

Sandia National Laboratories has developed a unique type of portable low-cost range imaging optical radar (laser radar or LADAR). This innovative sensor is comprised of an active floodlight scene illuminator and an image intensified CCD camera receiver. It is a solid-state device (no moving parts) that offers significant size, performance, reliability, and simplicity advantages over other types of 3-D imaging sensors. This unique flash LADAR is based on low cost, commercially available hardware, and is well suited for many government and commercial uses. This paper presents an update of Sandia`s development of the Scannerless Range Imager technology and applications, and discusses the progress that has been made in evolving the sensor into a compact, low, cost, high-resolution, video rate Laser Dynamic Range Imager.

Cost-effectiveness analysis of HPV vaccination: comparing the general population with socially vulnerable individuals.

Science.gov (United States)

Han, Kyu-Tae; Kim, Sun Jung; Lee, Seo Yoon; Park, Eun-Cheol

2014-01-01

After the WHO recommended HPV vaccination of the general population in 2009, government support of HPV vaccination programs was increased in many countries. However, this policy was not implemented in Korea due to perceived low cost-effectiveness. Thus, the aim of this study was to analyze the cost-utility of HPV vaccination programs targeted to high risk populations as compared to vaccination programs for the general population. Each study population was set to 100,000 people in a simulation study to determine the incremental cost-utility ratio (ICUR), then standard prevalence rates, cost, vaccination rates, vaccine efficacy, and the Quality-Adjusted Life-Years (QALYs) were applied to the analysis. In addition, sensitivity analysis was performed by assuming discounted vaccination cost. In the socially vulnerable population, QALYs gained through HPV vaccination were higher than that of the general population (General population: 1,019, Socially vulnerable population: 5,582). The results of ICUR showed that the cost of HPV vaccination was higher for the general population than the socially vulnerable population. (General population: 52,279,255 KRW, Socially vulnerable population: 9,547,347 KRW). Compared with 24 million KRW/QALYs as the social threshold, vaccination of the general population was not cost-effective. In contrast, vaccination of the socially vulnerable population was strongly cost-effective. The results suggest the importance and necessity of government support of HPV vaccination programs targeted to socially vulnerable populations because a targeted approach is much more cost-effective. The implementation of government support for such vaccination programs is a critical strategy for decreasing the burden of HPV infection in Korea.

Estimating long-term clinical effectiveness and cost-effectiveness of HPV 16/18 vaccine in China.

Science.gov (United States)

Zhang, Qian; Liu, Yi-Jun; Hu, Shang-Ying; Zhao, Fang-Hui

2016-11-04

Human papillomavirus (HPV) 16 and 18 are the two most common HPV oncogenic types that can be prevented by vaccination. This study aimed at assessing the cost-effectiveness of 3 doses of the bivalent HPV vaccine in rural and urban settings in China. A Markov model was adapted to reflect the lifetime of a modelled 100,000 12-year-old girls cohort in rural and urban settings in China. Input parameters were obtained from published literature, official reports and a two-round expert review panel. Clinical and economic outcomes of vaccination at age 12 with screening was compared to screening only. In the base case analysis, a 3 % discount rate, the vaccine cost of 247 CNY (US$ 39, PAHO vaccine cost in 2013), two rounds of screening in a life time and 70 % coverage for both screening and vaccination were used. One-way, two-way and probabilistic sensitivity analyses were performed. We used different thresholds of cost-effectiveness to reflect the diversity of economic development in China. Vaccination in addition to screening could prevent 60 % more cervical cancer cases and deaths than screening only. The incremental cost effectiveness ratio varied largely when changing cost of vaccination and discount in one way analysis. Vaccination was very cost-effective when the vaccine cost ranged 87-630 CNY (US$ 13.8-100) in rural and 87-750 CNY (US$ 13.8-119) in urban; and remained cost-effective when the vaccine cost ranged 630-1,700 CNY (US$ 100-270) in rural and 750-1,900 CNY (US$ 119-302) in urban in two way analysis. Probabilistic sensitivity analyses showed that model results were robust. In both rural and urban, the vaccination cost and discounting are important factors determining the cost-effectiveness of HPV vaccination; policy makers in China should take these into account when making a decision on the introduction of HPV vaccine. In areas with a high burden of cervical cancer and limited screening activities, HPV vaccination should be prioritized. However, the vaccine

Cost-effective framework for basic surgical skills training.

Science.gov (United States)

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

2013-06-01

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

DETERMINATION OF BISPHENOL A IN THERMAL PAPER RECEIPTS

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Mustafa Serkan YALÇIN

2016-08-01

Full Text Available Bisphenol A (BPA is a chemical substance which is produced in great quantities globally and of which serious negative effects on endocrine system are suspected. It’s a commonly used color developer in thermal paper. BPA used for this purpose is in free, unbound form and one of the potential sources for BPA exposure of humans. In this study, 12 thermal paper receipt samples were collected from various workplaces selected randomly and analyzed. BPA was determined in all samples. Average value of high BPA concentrations obtained from 10 samples was found as 13.83 mg BPA/g paper. At the same time, low values being 0.40 mg BPA/g paper and 0.11 mg BPA/g paper respectively were found in two samples as compared to others.

7 CFR 1033.30 - Reports of receipts and utilization.

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2010-01-01

... handler shall report monthly so that the market administrator's office receives the report on or before... with respect to the receipts and utilization of skim milk, butterfat, milk protein, other nonfat solids, and somatic cell information as the market administrator may prescribe. (b) Each handler operating a...

7 CFR 1032.30 - Reports of receipts and utilization.

Science.gov (United States)

2010-01-01

... handler shall report monthly so that the market administrator's office receives the report on or before... with respect to the receipts and utilization of skim milk, butterfat, milk protein, other nonfat solids, and somatic cell information, as the market administrator may prescribe. (b) Each handler operating a...

7 CFR 1124.30 - Reports of receipts and utilization.

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2010-01-01

... handler shall report monthly so that the market administrator's office receives the report on or before... other information with respect to the receipts and utilization of skim milk, butterfat, milk protein, and other nonfat solids, as the market administrator may prescribe. (b) Each handler operating a...

7 CFR 1126.30 - Reports of receipts and utilization.

Science.gov (United States)

2010-01-01

... handler shall report monthly so that the market administrator's office receives the report on or before... paragraph; and (4) Such other information with respect to the receipts and utilization of skim milk, butterfat, milk protein, other nonfat solids, and somatic cell information, as the market administrator may...

Heart rate profiles and energy cost of locomotion during cross-country skiing races.

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Mognoni, P; Rossi, G; Gastaldelli, F; Canclini, A; Cotelli, F

2001-07-01

The purpose of this study was to compare heart rate responses and speed in two cross-country skiing races, which were run by seven male and seven female subjects by using classic and free style. Heart rates and skiing velocities were analyzed over flat, uphill and downhill sections, which were run from one to three times. Heart rates were higher in uphill sections than in flat sections; a steady-state heart rate was never reached in the downhill section. When the same uphill section was repeated, the heart rate tended to increase but the speed to decrease. Oxygen uptake (VO2) was calculated from heart rate:VO2 ratio, measured during uphill walking with the aid of poles. The mean (SD) energy cost of locomotion (i.e., the ratio between net VO2 and speed) was 162.1 (9.4) ml.km(-1).kg(-1) and 147.7 (7.1) ml.km(-1).kg(-1) when male subjects ran the flat section after first downhill by using classic and free style, respectively. Females had lower values for VO2 and speed, but similar energy costs. In general, the variability of the energy cost of locomotion in skiers of a similar competitive level is of the same order as that found in uphill walking on a treadmill.

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

Science.gov (United States)

Tan, Jonathan M; Macario, Alex; Carvalho, Brendan; Druzin, Maurice L; El-Sayed, Yasser Y

2010-01-21

External cephalic version (ECV) is recommended by the American College of Obstetricians and Gynecologists to convert a breech fetus to vertex position and reduce the need for cesarean delivery. The goal of this study was to determine the incremental cost-effectiveness ratio, from society's perspective, of ECV compared to scheduled cesarean for term breech presentation. A computer-based decision model (TreeAge Pro 2008, Tree Age Software, Inc.) was developed for a hypothetical base case parturient presenting with a term singleton breech fetus with no contraindications for vaginal delivery. The model incorporated actual hospital costs (e.g., $8,023 for cesarean and $5,581 for vaginal delivery), utilities to quantify health-related quality of life, and probabilities based on analysis of published literature of successful ECV trial, spontaneous reversion, mode of delivery, and need for unanticipated emergency cesarean delivery. The primary endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted year of life gained. A threshold of $50,000 per quality-adjusted life-years (QALY) was used to determine cost-effectiveness. The incremental cost-effectiveness of ECV, assuming a baseline 58% success rate, equaled $7,900/QALY. If the estimated probability of successful ECV is less than 32%, then ECV costs more to society and has poorer QALYs for the patient. However, as the probability of successful ECV was between 32% and 63%, ECV cost more than cesarean delivery but with greater associated QALY such that the cost-effectiveness ratio was less than $50,000/QALY. If the probability of successful ECV was greater than 63%, the computer modeling indicated that a trial of ECV is less costly and with better QALYs than a scheduled cesarean. The cost-effectiveness of a trial of ECV is most sensitive to its probability of success, and not to the probabilities of a cesarean after ECV, spontaneous reversion to breech, successful second ECV trial, or adverse

Cost-effectiveness of external cephalic version for term breech presentation

Directory of Open Access Journals (Sweden)

Carvalho Brendan

2010-01-01

Full Text Available Abstract Background External cephalic version (ECV is recommended by the American College of Obstetricians and Gynecologists to convert a breech fetus to vertex position and reduce the need for cesarean delivery. The goal of this study was to determine the incremental cost-effectiveness ratio, from society's perspective, of ECV compared to scheduled cesarean for term breech presentation. Methods A computer-based decision model (TreeAge Pro 2008, Tree Age Software, Inc. was developed for a hypothetical base case parturient presenting with a term singleton breech fetus with no contraindications for vaginal delivery. The model incorporated actual hospital costs (e.g., $8,023 for cesarean and $5,581 for vaginal delivery, utilities to quantify health-related quality of life, and probabilities based on analysis of published literature of successful ECV trial, spontaneous reversion, mode of delivery, and need for unanticipated emergency cesarean delivery. The primary endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted year of life gained. A threshold of $50,000 per quality-adjusted life-years (QALY was used to determine cost-effectiveness. Results The incremental cost-effectiveness of ECV, assuming a baseline 58% success rate, equaled $7,900/QALY. If the estimated probability of successful ECV is less than 32%, then ECV costs more to society and has poorer QALYs for the patient. However, as the probability of successful ECV was between 32% and 63%, ECV cost more than cesarean delivery but with greater associated QALY such that the cost-effectiveness ratio was less than $50,000/QALY. If the probability of successful ECV was greater than 63%, the computer modeling indicated that a trial of ECV is less costly and with better QALYs than a scheduled cesarean. The cost-effectiveness of a trial of ECV is most sensitive to its probability of success, and not to the probabilities of a cesarean after ECV, spontaneous reversion

Cost-effectiveness analysis of treatment strategies for initial Clostridium difficile infection.

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Varier, R U; Biltaji, E; Smith, K J; Roberts, M S; Jensen, M K; LaFleur, J; Nelson, R E

2014-12-01

Clostridium difficile infection (CDI) is costly. Current guidelines recommend metronidazole as first-line therapy and vancomycin as an alternative. Recurrence is common. Faecal microbiota transplantation (FMT) is an effective therapy for recurrent CDI (RCDI). This study explores the cost-effectiveness of FMT, vancomycin and metronidazole for initial CDI. We constructed a decision-analytic computer simulation using inputs from published literature to compare FMT with a 10-14-day course of oral metronidazole or vancomycin for initial CDI. Parameters included cure rates (baseline value (range)) for metronidazole (80% (65-85%)), vancomycin (90% (88-92%)) and FMT(91% (83-100%)). Direct costs of metronidazole, vancomycin and FMT, adjusted to 2011 dollars, were $57 ($43-72), $1347 ($1195-1499) and $1086 ($815-1358), respectively. Our effectiveness measure was quality-adjusted life years (QALYs). One-way and probabilistic sensitivity analyses were conducted from the third-party payer perspective. Analysis using baseline values showed that FMT($1669, 0.242 QALYs) dominated (i.e. was less costly and more effective) vancomycin ($1890, 0.241 QALYs). FMT was more costly and more effective than metronidazole ($1167, 0.238 QALYs), yielding an incremental cost-effectiveness ratio (ICER) of $124 964/QALY. One-way sensitivity analyses showed that metronidazole dominated both strategies if its probability of cure were >90%; FMT dominated if it cost costly. FMT and vancomycin are more effective. However, FMT is less likely to be economically favourable, and vancomycin is unlikely to be favourable as first-line therapy when compared with FMT. © 2014 The Authors Clinical Microbiology and Infection © 2014 European Society of Clinical Microbiology and Infectious Diseases.

21 CFR 203.60 - Request and receipt forms, reports, and records.

Science.gov (United States)

2010-04-01

... SERVICES (CONTINUED) DRUGS: GENERAL PRESCRIPTION DRUG MARKETING Request and Receipt Forms, Reports, and...; (2) Preserved in accessible and retrievable fashion; and (3) Available to permit copying for purposes...

School Breakfast Receipt and Obesity among American Fifth- and Eighth-Graders.

Science.gov (United States)

Sudharsanan, Nikkil; Romano, Sebastian; Cunningham, Solveig A

2016-04-01

School breakfast consumption can improve children's nutrition, but the implications of breakfast at school for children's weight remains unclear. The aim of this study was to determine whether receiving breakfast at school is related to changes in children's weight between the fifth and eighth grades, and whether the relationship between school breakfasts and obesity varies for children of different socioeconomic backgrounds. This was a longitudinal study of children observed in the fifth and eighth grades. Data are from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-99, a nationally representative prospective cohort of children in the United States. The analytic sample consisted of 6,495 children interviewed in the fifth and eighth grades. Standard thresholds from the Centers for Disease Control and Prevention were used to classify children as not obese or obese based on direct-measured height and weight. Difference-in-difference propensity score matching and fixed-effect logistic regression models were used to estimate the relationship between receipt of school breakfast and change in obesity between the fifth and eighth grades, adjusting for child, household, and school characteristics. School breakfast receipt was not associated with a change in obesity status between the fifth and eighth grades for children overall (odds ratio=1.31; P=0.129). In the propensity score model, receiving school breakfasts more than doubled the odds of becoming obese (odds ratio=2.31; P=0.0108) for children from families below the federal poverty line compared with children of similar socioeconomic backgrounds who did not regularly receive school breakfasts. School breakfast receipt was not independently related to obesity for most children. Receiving school breakfasts in the fifth grade may be associated with weight gain between the fifth and eighth grades for children from families below the federal poverty line compared with children of similar socioeconomic

Cost-effectiveness of increasing access to mammography through mobile mammography for older women.

Science.gov (United States)

Naeim, Arash; Keeler, Emmett; Bassett, Lawrence W; Parikh, Jay; Bastani, Roshan; Reuben, David B

2009-02-01

To compare the costs of mobile and stationary mammography and examine the incremental cost-effectiveness of using mobile mammography to increase screening rates. A cost-effectiveness analysis was performed using effectiveness data from a randomized clinical trial and modeling of costs associated with the mobile mammography intervention. The trial involved 60 community-based meal sites, senior centers, and clubs. Four hundred ninety-nine individuals were enrolled in the study, of whom 463 had outcome data available for analysis. Costs were calculated for stationary and mobile mammography, as well as costs due to differences in technology and film versus digital. Incremental cost-effectiveness (cost per additional screen) was modeled, and sensitivity analysis was performed by altering efficiency (throughput) and effectiveness based on subgroup data from the randomized trial. The estimated annual costs were $435,162 for a stationary unit, $539,052 for a mobile film unit, and $456, 392 for a mobile digital unit. Assuming mobile units are less efficient (50% annual volume), the cost per screen was $41 for a stationary unit, $86 for a mobile film unit, and $102 for a mobile digital unit. The incremental cost per additional screen were $207 for a mobile film unit and $264 for a mobile digital unit over a stationary unit. Although mobile mammography is a more effective way to screen older women, the absolute cost per screen of mobile units is higher, whereas the reimbursement is no different. Financial barriers may impede the widespread use of this approach.

Cost-effectiveness analysis of fidaxomicin versus vancomycin in Clostridium difficile infection.

Science.gov (United States)

Nathwani, Dilip; Cornely, Oliver A; Van Engen, Anke K; Odufowora-Sita, Olatunji; Retsa, Peny; Odeyemi, Isaac A O

2014-11-01

Fidaxomicin was non-inferior to vancomycin with respect to clinical cure rates in the treatment of Clostridium difficile infections (CDIs) in two Phase III trials, but was associated with significantly fewer recurrences than vancomycin. This economic analysis investigated the cost-effectiveness of fidaxomicin compared with vancomycin in patients with severe CDI and in patients with their first CDI recurrence. A 1 year time horizon Markov model with seven health states was developed from the perspective of Scottish public healthcare providers. Model inputs for effectiveness, resource use, direct costs and utilities were obtained from published sources and a Scottish expert panel. The main model outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY), for fidaxomicin versus vancomycin; ICERs were interpreted using willingness-to-pay thresholds of £20,000/QALY and £30,000/QALY. One-way and probabilistic sensitivity analyses were performed. Total costs were similar with fidaxomicin and vancomycin in patients with severe CDI (£14,515 and £14,344, respectively) and in patients with a first recurrence (£16,535 and £16,926, respectively). Improvements in clinical outcomes with fidaxomicin resulted in small QALY gains versus vancomycin (severe CDI, +0.010; patients with first recurrence, +0.019). Fidaxomicin was cost-effective in severe CDI (ICER £16,529/QALY) and dominant (i.e. more effective and less costly) in patients with a first recurrence. The probability that fidaxomicin was cost-effective at a willingness-to-pay threshold of £30,000/QALY was 60% for severe CDI and 68% in a first recurrence. Fidaxomicin is cost-effective in patients with severe CDI and in patients with a first CDI recurrence versus vancomycin. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.

Cost-effectiveness of cetuximab and panitumumab for chemotherapy-refractory metastatic colorectal cancer.

Science.gov (United States)

Carvalho, Adriana Camargo; Leal, Frederico; Sasse, Andre Deeke

2017-01-01

Cetuximab and panitumumab are monoclonal antibodies targeting the epidermal growth factor receptor. Both drugs are active against RAS wild type metastatic colorectal cancer after chemotherapy failure, with similar efficacy and toxicity profiles. However, their cost and limited survival benefits may compromise incorporation in the Brazilian public healthcare system, the Unified Heath System (Sistema Único de Saúde) (SUS). A cost-effectiveness analysis was conducted using a Markov model from the Brazilian Public health perspective and a lifetime horizon in patients with RAS -wt mCRC. Transition probabilities and mortality rates were extracted from randomized studies. Treatment costs were obtained from price tables regulated by the Brazilian Health Ministry. The World Health Organization recommendation of three times GDP per capita was used to define the cost-effectiveness threshold. The use of cetuximab or panitumumab for chemotherapy-refractory mCRC patients resulted in 0.22 additional life-years relative to BSC, with incremental cost-effectiveness ratios (ICERs) of $58,240 and $52,772 per LY, respectively. That exceeds the pre-specified threshold for cost-effectiveness. Acquisition of biological agents was the major driver of increased costs. Our economic evaluation demonstrates that both cetuximab and panitumumab are not a cost-effective approach in RAS-wt mCRC patients. Discussion about drug price should be prioritized to enable incorporation of these monoclonal antibodies in the SUS.

Statin cost effectiveness in primary prevention: A systematic review of the recent cost-effectiveness literature in the United States

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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.

Impact and cost-effectiveness of rotavirus vaccination in Bangladesh.

Science.gov (United States)

Pecenka, Clint; Parashar, Umesh; Tate, Jacqueline E; Khan, Jahangir A M; Groman, Devin; Chacko, Stephen; Shamsuzzaman, Md; Clark, Andrew; Atherly, Deborah

2017-07-13

Diarrheal disease is a leading cause of child mortality globally, and rotavirus is responsible for more than a third of those deaths. Despite substantial decreases, the number of rotavirus deaths in children under five was 215,000 per year in 2013. Of these deaths, approximately 41% occurred in Asia and 3% of those in Bangladesh. While Bangladesh has yet to introduce rotavirus vaccination, the country applied for Gavi support and plans to introduce it in 2018. This analysis evaluates the impact and cost-effectiveness of rotavirus vaccination in Bangladesh and provides estimates of the costs of the vaccination program to help inform decision-makers and international partners. This analysis used Pan American Health Organization's TRIVAC model (version 2.0) to examine nationwide introduction of two-dose rotavirus vaccination in 2017, compared to no vaccination. Three mortality scenarios (low, high, and midpoint) were assessed. Benefits and costs were examined from the societal perspective over ten successive birth cohorts with a 3% discount rate. Model inputs were locally acquired and complemented by internationally validated estimates. Over ten years, rotavirus vaccination would prevent 4000 deaths, nearly 500,000 hospitalizations and 3 million outpatient visits in the base scenario. With a Gavi subsidy, cost/disability adjusted life year (DALY) ratios ranged from $58/DALY to $142/DALY averted. Without a Gavi subsidy and a vaccine price of $2.19 per dose, cost/DALY ratios ranged from $615/DALY to $1514/DALY averted. The discounted cost per DALY averted was less than the GDP per capita for nearly all scenarios considered, indicating that a routine rotavirus vaccination program is highly likely to be cost-effective. Even in a low mortality setting with no Gavi subsidy, rotavirus vaccination would be cost-effective. These estimates exclude the herd immunity benefits of vaccination, so represent a conservative estimate of the cost-effectiveness of rotavirus vaccination

Patient reminder and recall interventions to improve immunization rates.

Science.gov (United States)

Jacobson Vann, Julie C; Jacobson, Robert M; Coyne-Beasley, Tamera; Asafu-Adjei, Josephine K; Szilagyi, Peter G

2018-01-18

Immunization rates for children and adults are rising, but coverage levels have not reached optimal goals. As a result, vaccine-preventable diseases still occur. In an era of increasing complexity of immunization schedules, rising expectations about the performance of primary care, and large demands on primary care providers, it is important to understand and promote interventions that work in primary care settings to increase immunization coverage. One common theme across immunization programs in many nations involves the challenge of implementing a population-based approach and identifying all eligible recipients, for example the children who should receive the measles vaccine. However, this issue is gradually being addressed through the availability of immunization registries and electronic health records. A second common theme is identifying the best strategies to promote high vaccination rates. Three types of strategies have been studied: (1) patient-oriented interventions, such as patient reminder or recall, (2) provider interventions, and (3) system interventions, such as school laws. One of the most prominent intervention strategies, and perhaps best studied, involves patient reminder or recall systems. This is an update of a previously published review. To evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations. We searched CENTRAL, MEDLINE, Embase and CINAHL to January 2017. We also searched grey literature and trial registers to January 2017. We included randomized trials, controlled before and after studies, and interrupted time series evaluating immunization-focused patient reminder or recall interventions in children, adolescents, and adults who receive immunizations in any setting. We included no-intervention control groups, standard practice activities that did not include immunization patient reminder or recall, media-based activities aimed at promoting immunizations

Fast mode decision based on human noticeable luminance difference and rate distortion cost for H.264/AVC

Science.gov (United States)

Li, Mian-Shiuan; Chen, Mei-Juan; Tai, Kuang-Han; Sue, Kuen-Liang

2013-12-01

This article proposes a fast mode decision algorithm based on the correlation of the just-noticeable-difference (JND) and the rate distortion cost (RD cost) to reduce the computational complexity of H.264/AVC. First, the relationship between the average RD cost and the number of JND pixels is established by Gaussian distributions. Thus, the RD cost of the Inter 16 × 16 mode is compared with the predicted thresholds from these models for fast mode selection. In addition, we use the image content, the residual data, and JND visual model for horizontal/vertical detection, and then utilize the result to predict the partition in a macroblock. From the experimental results, a greater time saving can be achieved while the proposed algorithm also maintains performance and quality effectively.

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

Science.gov (United States)

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

2017-03-01

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

Capital adjustment cost and bias in income based dynamic panel models with fixed effects

OpenAIRE

Yoseph Yilma Getachew; Keshab Bhattarai; Parantap Basu

2012-01-01

The fixed effects (FE) estimator of "conditional convergence" in income based dynamic panel models could be biased downward when capital adjustment cost is present. Such a capital adjustment cost means a rising marginal cost of investment which could slow down the convergence. The standard FE regression fails to take into account of this capital adjustment cost and thus it could overestimate the rate of convergence. Using a Ramsey model with long-run adjustment cost of capital, we characteriz...

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.

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...

Marital Biography, Social Security Receipt, and Poverty

OpenAIRE

Lin, I-Fen; Brown, Susan L.; Hammersmith, Anna M.

2017-01-01

Increasingly, older adults are unmarried, which could mean a larger share is at risk of economic disadvantage. Using data from the 2010 Health and Retirement Study, we chart the diverse range of marital biographies, capturing marital sequences and timing, of adults who are age eligible for Social Security and examine three indicators of economic well-being: Social Security receipt, Social Security benefit levels, and poverty status. Partnereds are disproportionately likely to receive Social S...

Systematic review of studies on cost-effectiveness of cystic fibrosis carrier testing

Directory of Open Access Journals (Sweden)

Ernesto Andrade-Cerquera

2016-10-01

Full Text Available Introduction: Cystic fibrosis is considered the most common autosomal disease with multisystem complications in non-Hispanic white population. Objective: To review the available evidence on cost-effectiveness of the cystic fibrosis carrier testing compared to no intervention. Materials and methods: The databases of MEDLINE, Embase, NHS, EBM Reviews - Cochrane Database of Systematic Reviews, LILACS, Health Technology Assessment, Genetests.org, Genetsickkids.org and Web of Science were used to conduct a systematic review of the cost-effectiveness of performing the genetic test in cystic fibrosis patients. Cost-effectiveness studies were included without language or date of publication restrictions. Results: Only 13 studies were relevant for full review. Prenatal, preconception and mixed screening strategies were found. Health perspective was the most used; the discount rate applied was heterogeneous between 3.5% and 5%; the main analysis unit was the cost per detected carrier couple, followed by cost per averted birth with cystic fibrosis. It was evident that the most cost-effective strategy was preconception screening associated with prenatal test. Conclusions: A marked heterogeneity in the methodology was found, which led to incomparable results and to conclude that there are different approaches to this genetic test.

Cost-effectiveness analysis of trastuzumab in the adjuvant setting for treatment of HER2-positive breast cancer.

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Garrison, Louis P; Lubeck, Deborah; Lalla, Deepa; Paton, Virginia; Dueck, Amylou; Perez, Edith A

2007-08-01

Adding trastuzumab to adjuvant chemotherapy provides significant clinical benefit in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. A cost-effectiveness analysis was performed to assess clinical and economic implications of adding trastuzumab to adjuvant chemotherapy, based upon joint analysis of NSABP B-31 and NCCTG N9831 trials. A Markov model with 4 health states was used to estimate the cost utility for a 50-year-old woman on the basis of trial results through 4 years and estimates of long-term recurrence and death based on a meta-analysis of trials. From 6 years onward, rates of recurrence and death were assumed to be the same in both trastuzumab and chemotherapy-only arms. Incremental costs were estimated for diagnostic and treatment-related costs. Analyses were from payer and societal perspectives, and these analyses were projected to lifetime and 20-year horizons. Over a lifetime, the projected cost of trastuzumab per quality-adjusted life year (QALY; discount rate 3%) gained was 26,417 dollars (range 9,104 dollars-69,340 dollars under multiway sensitivity analysis). Discounted incremental lifetime cost was 44,923 dollars, and projected life expectancy was 3 years longer for patients who received trastuzumab (19.4 years vs 16.4 years). During a 20-year horizon, the projected cost of adding trastuzumab to chemotherapy was 34,201 dollars per QALY gained. Key cost-effectiveness drivers were discount rate, trastuzumab price, and probability of metastasis. The cost-effectiveness result was robust to sensitivity analysis. Trastuzumab for adjuvant treatment of early stage breast cancer was projected to be cost effective over a lifetime horizon, achieving a cost-effectiveness ratio below that of many widely accepted oncology treatments. (c) 2007 American Cancer Society.

Is scorpion antivenom cost-effective as marketed in the United States?

Science.gov (United States)

Armstrong, Edward P; Bakall, Maja; Skrepnek, Grant H; Boyer, Leslie V

2013-12-15

The purpose of this study was to analyze the cost-effectiveness of scorpion antivenom compared to no antivenom, in the United States, using a decision analysis framework. A decision analytic model was created to assess patient course with and without antivenom. Costs were determined from the perspective of a health care payer. Cost data used in the model were extracted from Arizona Medicaid. The probability of clinical events occurring with and without antivenom was obtained from the published literature, medical claims obtained from Arizona Medicaid, and results of recent clinical trials. Patients that became so ill that mechanical ventilator support was necessary were considered treatment failures. A Monte Carlo simulation was run 1000 times and sampled simultaneously across all variable distributions in the model. The mean success rate was 99.87% (95% CI 99.64%-99.98%) with scorpion antivenom and 94.31% (95% CI 91.10%-96.61%) without scorpion antivenom. The mean cost using scorpion antivenom was $10,708 (95% CI $10,556 - $11,010) and the mean cost without scorpion antivenom was $3178 (95% CI $1627 - $5184). Since the 95% CIs do not overlap for either the success or cost, use of the scorpion antivenom was significantly more effective and significantly more expensive than no antivenom. Cost-effectiveness analysis found that the scorpion antivenom was not cost-effective at its current price as marketed in the United States. The scorpion antivenom marketed in the United States is extremely effective, but too costly to justify its use in most clinical situations. Formulary committees should restrict the use of this antivenom to only the most severe scorpion envenomations. Copyright © 2013 Elsevier Ltd. All rights reserved.

Cost-effectiveness analysis of smoking-cessation counseling training for physicians and pharmacists.

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Cantor, Scott B; Deshmukh, Ashish A; Luca, Nancy Stancic; Nogueras-González, Graciela M; Rajan, Tanya; Prokhorov, Alexander V

2015-06-01

Although smoking-cessation interventions typically focus directly on patients, this paper conducts an economic evaluation of a novel smoking-cessation intervention focused on training physicians and/or pharmacists to use counseling techniques that would decrease smoking rates at a reasonable cost. To evaluate the cost-effectiveness of interventions that train physicians and/or pharmacists to counsel their patients on smoking-cessation techniques. Using decision-analytic modeling, we compared four strategies for smoking-cessation counseling education: training only physicians, training only pharmacists, training both physicians and pharmacists (synergy strategy), and training neither physicians nor pharmacists (i.e., no specialized training, which is the usual practice). Short-term outcomes were based on results from a clinical trial conducted in 16 communities across the Houston area; long-term outcomes were calculated from epidemiological data. Short-term outcomes were measured using the cost per quit, and long-term outcomes were measured using the cost per quality-adjusted life-year (QALY). Cost data were taken from institutional sources; both costs and QALYs were discounted at 3%. Training both physicians and pharmacists added 0.09 QALY for 45-year-old men. However, for 45-year-old women, the discounted quality-adjusted life expectancy only increased by 0.01 QALY when comparing the synergy strategy to no intervention. The incremental cost-effectiveness ratio (ICER) of the synergy strategy with respect to the non-intervention strategy was US$868/QALY for 45-year-old men and US$8953/QALY for 45-year-old women. The results were highly sensitive to the quit rates and community size. Synergistic educational training for physicians and pharmacists could be a cost-effective method for smoking cessation in the community. Published by Elsevier Ltd.

12 CFR Appendix K to Part 226 - Total Annual Loan Cost Rate Computations for Reverse Mortgage Transactions

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2010-01-01

... Appendix K to Part 226—Total Annual Loan Cost Rate Computations for Reverse Mortgage Transactions (a... loan cost rate for various transactions, as well as instructions, explanations, and examples for.... (2) Term of the transaction. For purposes of total annual loan cost disclosures, the term of a...

Measuring Effective Tax Rates for Oil and Gas in Canada

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Jack M. Mintz

2010-03-01

Full Text Available The purpose of this report is to provide cost of capital formulae for assessing the effects of taxation on the incentive to invest in oil and gas industries in Canada. The analysis is based on the assumption that businesses invest in capital until the after-tax rate of return on capital is equal to the tax-adjusted cost of capital. The cost of capital in absence of taxation is the inflation-adjusted cost of finance. The after-tax rate of return on capital is the annualized profit earned on a project net of the taxes paid by the businesses. For this purpose, we include corporate income, sales and other capital-related taxes as applied to oil and gas investments. For oil and gas taxation, it is necessary to account for royalties in a special way. Royalties are payment made by businesses for the right to extract oil and gas from land owned by the property holder. The land is owned by the province so the royalties are a rental payment for the benefit received from extracting the product from provincial lands. Thus, provincial royalty payments are a cost to oil and gas companies for using public property. However, since the provincial government is responsible for the royalty regime and could use taxes like the corporate income tax to extract revenue, one might think of royalties as part of the overall fiscal regime to raise revenue. In principle, one should subtract the rental benefit received from oil and gas businesses from taxes and royalty payments to assess the overall fiscal impact. This is impossible to do without measuring some explicit rental rate for use of provincial property. Further, royalty payments may distort economic decisions unlike a payment based on the economic rents earned on oil and gas projects. Instead, for comparability across jurisdictions, one might calculate the aggregate tax and royalty effective tax rates (such as between Alberta and Texas.

Cost-Effective Fuel Treatment Planning

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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

Cost-effectiveness of diagnostic-therapeutic strategies for paediatric visceral leishmaniasis in Morocco.

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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.

Cost-effectiveness optimization of a solar hot water heater with integrated storage system

International Nuclear Information System (INIS)

Kamaruzzaman Sopian; Syahri, M.; Shahrir, A.; Mohd Yusof Othman; Baharuddin Yatim

2006-01-01

Solar processes are generally characterized by high first cost and low operating costs. Therefore, the basic economic problem is one of comparing an initial known investment with estimated future operating cost. This paper present the cost-benefit ratio of solar collector with integrated storage system. Evaluation of the annual cost (AC) and the annual energy gain (AEG) of the collector are performed and the ratio of AC/AEG or the cost benefit ratio is presented for difference combination of mass flow rate, solar collector length and channel depth. Using these cost-effectiveness curves, the user can select optimum design features, which correspond to minimum AC/AEG

27 CFR 24.226 - Receipt or transfer of spirits.

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2010-04-01

... BUREAU, DEPARTMENT OF THE TREASURY LIQUORS WINE Spirits § 24.226 Receipt or transfer of spirits. When spirits are received at the bonded wine premises, the proprietor shall determine that the spirits are the... transferred to a distilled spirits plant or to bonded wine premises, the proprietor shall use the transfer...

26 CFR 1.199-3 - Domestic production gross receipts.

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2010-04-01

... receipts for the taxable year that are recognized under the taxpayer's methods of accounting used for... consumer electronics stores. S requires that its customers purchase a minimum of 100 television sets per... accounting for its production activities under section 263A, and wishes to change its method of accounting to...

7 CFR 1001.30 - Reports of receipts and utilization.

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2010-01-01

... receipts and utilization of skim milk, butterfat, milk protein, and other nonfat solids as the market... handler shall report monthly so that the Market Administrator's office receives the report on or before... skim milk in route disposition in the marketing area. (c) Each handler described in § 1000.9(c) shall...

27 CFR 22.113 - Receipt of tax-free alcohol.

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2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Receipt of tax-free alcohol. 22.113 Section 22.113 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS DISTRIBUTION AND USE OF TAX-FREE ALCOHOL Withdrawal and...

The social costs of alcohol misuse in Estonia.

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Saar, Indrek

2009-01-01

The aim of this study was to estimate the social costs of alcohol misuse in Estonia in 2006. Using a prevalence-based cost-of-illness approach, both direct and indirect costs were considered, including tangible costs associated with health care, criminal justice, rescue services, damage to property, premature mortality, incarceration, incapability of working due to illnesses, and lower labor productivity. The results show that alcohol misuse cost Estonia more than EUR 200 million in 2006. The costs involved are estimated to represent 1.6% of the gross domestic product (GDP), which is relatively high in comparison with many other countries. In addition, the state receives less receipts from the alcohol excise tax than the costs that it incurs as a consequence of alcohol misuse, which points to the existence of economic inefficiency with respect to the alcohol market. The results of this study suggest that there is definitely a need for further cost-benefit analysis to reach a conclusion regarding the possible utility of government intervention. Copyright 2008 S. Karger AG, Basel.

Surgeon Influence on Variation in Receipt of Contralateral Prophylactic Mastectomy for Women With Breast Cancer.

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Katz, Steven J; Hawley, Sarah T; Hamilton, Ann S; Ward, Kevin C; Morrow, Monica; Jagsi, Reshma; Hofer, Timothy P

2018-01-01

Rates of contralateral prophylactic mastectomy (CPM) have markedly increased but we know little about the influence of surgeons on variability of the procedure in the community. To quantify the influence of the attending surgeon on rates of CPM and clinician attitudes that explained it. In this population-based survey study, we identified 7810 women with stages 0 to II breast cancer treated in 2013 to 2015 through the Surveillance, Epidemiology, and End Results registries of Georgia and Los Angeles County. Surveys were sent approximately 2 months after surgery. Surveys were also sent to 488 attending surgeons identified by the patients. We conducted multilevel analyses to examine the impact of surgeon influence on variations in patient receipt of CPM using information from patient and surgeon surveys merged to Surveillance, Epidemiology, and End Results data. A total of 5080 women responded to the survey (70% response rate), and 377 surgeons responded (77% response rate). The mean (SD) age of responding women was 61.9 (11) years; 28% had an increased risk of second primary cancer, and 16% received CPM. Half of surgeons (52%) practiced for more than 20 years and 30% treated more than 50 new patients with breast cancer annually. Attending surgeon explained a large amount (20%) of the variation in CPM, controlling for patient factors. The odds of a patient receiving CPM increased almost 3-fold (odds ratio, 2.8; 95% CI, 2.1-3.4) if she saw a surgeon with a practice approach 1 SD above a surgeon with the mean CPM rate (independent of age, diagnosis date, BRCA status, and risk of second primary). One-quarter (25%) of the surgeon influence was explained by attending attitudes about initial recommendations for surgery and responses to patient requests for CPM. The estimated rate of CPM was 34% for surgeons who least favored initial breast conservation and were least reluctant to perform CPM vs 4% for surgeons who most favored initial breast conservation and were most

Cost-effective strategies for mitigating a future influenza pandemic with H1N1 2009 characteristics.

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Nilimesh Halder

Full Text Available BACKGROUND: We performed an analysis of the cost-effectiveness of pandemic intervention strategies using a detailed, individual-based simulation model of a community in Australia together with health outcome data of infected individuals gathered during 2009-2010. The aim was to examine the cost-effectiveness of a range of interventions to determine the most cost-effective strategies suitable for a future pandemic with H1N1 2009 characteristics. METHODOLOGY/PRINCIPAL FINDINGS: Using transmissibility, age-stratified attack rates and health outcomes determined from H1N1 2009 data, we determined that the most cost-effective strategies involved treatment and household prophylaxis using antiviral drugs combined with limited duration school closure, with costs ranging from $632 to $777 per case prevented. When school closure was used as a sole intervention we found the use of limited duration school closure to be significantly more cost-effective compared to continuous school closure, a result with applicability to countries with limited access to antiviral drugs. Other social distancing strategies, such as reduced workplace attendance, were found to be costly due to productivity losses. CONCLUSION: The mild severity (low hospitalisation and case fatality rates and low transmissibility of H1N1 2009 meant that health treatment costs were dominated by the higher productivity losses arising from workplace absence due to illness and childcare requirements following school closure. Further analysis for higher transmissibility but with the same, mild severity had no effect on the overall findings.

Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis.

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Baggaley, Rebecca F; Irvine, Michael A; Leber, Werner; Cambiano, Valentina; Figueroa, Jose; McMullen, Heather; Anderson, Jane; Santos, Andreia C; Terris-Prestholt, Fern; Miners, Alec; Hollingsworth, T Déirdre; Griffiths, Chris J

2017-10-01

Early HIV diagnosis reduces morbidity, mortality, the probability of onward transmission, and their associated costs, but might increase cost because of earlier initiation of antiretroviral treatment (ART). We investigated this trade-off by estimating the cost-effectiveness of HIV screening in primary care. We modelled the effect of the four-times higher diagnosis rate observed in the intervention arm of the RHIVA2 randomised controlled trial done in Hackney, London (UK), a borough with high HIV prevalence (≥0·2% adult prevalence). We constructed a dynamic, compartmental model representing incidence of infection and the effect of screening for HIV in general practices in Hackney. We assessed cost-effectiveness of the RHIVA2 trial by fitting model diagnosis rates to the trial data, parameterising with epidemiological and behavioural data from the literature when required, using trial testing costs and projecting future costs of treatment. Over a 40 year time horizon, incremental cost-effectiveness ratios were £22 201 (95% credible interval 12 662-132 452) per quality-adjusted life-year (QALY) gained, £372 207 (268 162-1 903 385) per death averted, and £628 874 (434 902-4 740 724) per HIV transmission averted. Under this model scenario, with UK cost data, RHIVA2 would reach the upper National Institute for Health and Care Excellence cost-effectiveness threshold (about £30 000 per QALY gained) after 33 years. Scenarios using cost data from Canada (which indicate prolonged and even higher health-care costs for patients diagnosed late) suggest this threshold could be reached in as little as 13 years. Screening for HIV in primary care has important public health benefits as well as clinical benefits. We predict it to be cost-effective in the UK in the medium term. However, this intervention might be cost-effective far sooner, and even cost-saving, in settings where long-term health-care costs of late-diagnosed patients in high

Cost-effective analysis of unilateral vestibular weakness investigation.

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Gandolfi, Michele M; Reilly, Erin K; Galatioto, Jessica; Judson, Randy B; Kim, Ana H

2015-02-01

To evaluate the cost-effectiveness of obtaining a magnetic resonance imaging (MRI) in patients with abnormal electronystagmography (ENG) or videonystagmography (VNG) results. Retrospective chart review. Academic specialty center. Patients presenting with vertigo between January 1, 2010, and August 30, 2013. Patients who fit the following abnormal criteria were included in the study: unilateral caloric weakness (≥20%), abnormal ocular motor testing, and nystagmus on positional testing. Patients with abnormal findings who then underwent MRI with gadolinium were evaluated. Of the 1,996 charts reviewed, there were 1,358 patients who met the inclusion criteria. The average age of these patients was 62 years (12-94 yr). The male:female ratio was approximately 1:2. Of the 1,358 patients, 253 received an MRI with the following pathologies: four vestibular schwannomas, three subcortical/periventricular white matter changes suspicious for demyelinating disease, four acute cerebellar/posterior circulation infarct, two vertebral artery narrowing, one pseudomeningocele of internal auditory canal, and two white matter changes indicative of migraines. The positive detection rate on MRI was 5.5% based on MRI findings of treatable pathologies causing vertigo. Average cost of an MRI is $1,200, thereby making the average cost of identifying a patient with a positive MRI finding $15,180. In our study, those patients with a positive MRI had a constellation of symptoms and findings (asymmetric sensorineural hearing loss, tinnitus, vertigo, and abnormal ENG/VNG). Cost-effectiveness can be improved by ordering an MRI only when clinical examination and VNG point toward a central pathology. Clinical examination and appropriate testing should be factored when considering the cost-effectiveness of obtaining an MRI in patients with abnormal ENG/VNG findings.

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

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Jukes Matthew CH

2008-09-01

Full Text Available Abstract Background Awareness of the potential impact of malaria among school-age children has stimulated investigation into malaria interventions that can be delivered through schools. However, little evidence is available on the costs and cost-effectiveness of intervention options. This paper evaluates the costs and cost-effectiveness of intermittent preventive treatment (IPT as delivered by teachers in schools in western Kenya. Methods Information on actual drug and non-drug associated costs were collected from expenditure and salary records, government budgets and interviews with key district and national officials. Effectiveness data were derived from a cluster-randomised-controlled trial of IPT where a single dose of sulphadoxine-pyrimethamine and three daily doses of amodiaquine were provided three times in year (once termly. Both financial and economic costs were estimated from a provider perspective, and effectiveness was estimated in terms of anaemia cases averted. A sensitivity analysis was conducted to assess the impact of key assumptions on estimated cost-effectiveness. Results The delivery of IPT by teachers was estimated to cost US$ 1.88 per child treated per year, with drug and teacher training costs constituting the largest cost components. Set-up costs accounted for 13.2% of overall costs (equivalent to US$ 0.25 per child whilst recurrent costs accounted for 86.8% (US$ 1.63 per child per year. The estimated cost per anaemia case averted was US$ 29.84 and the cost per case of Plasmodium falciparum parasitaemia averted was US$ 5.36, respectively. The cost per case of anaemia averted ranged between US$ 24.60 and 40.32 when the prices of antimalarial drugs and delivery costs were varied. Cost-effectiveness was most influenced by effectiveness of IPT and the background prevalence of anaemia. In settings where 30% and 50% of schoolchildren were anaemic, cost-effectiveness ratios were US$ 12.53 and 7.52, respectively. Conclusion This

Efficacy, outcomes, and cost-effectiveness of desensitization using IVIG and rituximab.

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Vo, Ashley A; Petrozzino, Jeffrey; Yeung, Kai; Sinha, Aditi; Kahwaji, Joseph; Peng, Alice; Villicana, Rafael; Mackowiak, John; Jordan, Stanley C

2013-03-27

Transplantation rates are very low for the broadly sensitized patient (panel reactive antibody [PRA]>80%; HS). Here, we examine the efficacy, outcomes, and cost-effectiveness of desensitization using high-dose intravenous immunoglobulin (IVIG) and rituximab to improve transplantation rates in HS patients. From July 2006 to December 2011, 207 HS (56 living donors/151 deceased donors) patients (donor-specific antibody positive, PRA>80%) were desensitized using IVIG and rituximab. After desensitization, responsive patients proceeded to transplantation with an acceptable crossmatch. Cost and outcomes of desensitization were compared with dialysis. Of the 207 treated patients, 146 (71%) were transplanted. At 48 months, patient and graft survival by Kaplan-Meier were 95% and 87.5%, respectively. The total 3-year cost for patients treated in the desensitization arm was $219,914 per patient compared with $238,667 per patient treated in the dialysis arm. Thus, each patient treated with desensitization is estimated to save the U.S. healthcare system $18,753 in 2011 USD. Overall, estimated patient survival at the end of 3 years was 96.6% for patients in the desensitization arm of the model (based on Cedars-Sinai survival rate) compared with 79.0% for an age, end-stage renal disease etiology, and PRA matched group of patients remaining on dialysis during the study period. We conclude that desensitization with IVIG+rituximab is clinically and cost-effective, with both financial savings and an estimated 17.6% greater probability of 3-year survival associated with desensitization versus dialysis alone. However, the benefits of desensitization and transplantation are limited by organ availability and allocation policies.