WorldWideScience

Sample records for cost-effective sustainable society

  1. Dutch environmental policy up for revision. Towards a cost-effective, sustainable society. Part 1

    International Nuclear Information System (INIS)

    Van Dorp, H.W.; Schmitz, H.

    2009-01-01

    In a series of two articles an important energy formula is used to discuss current Dutch environmental policy and calculations are made based on 7.2 million dwellings. Normally, everyone who has an opinion on energy and carbon dioxide emissions should know this formula and be able to apply it. The second article discusses climate policy and provides a comparison of the social cost at new housing level for both policy lines. More specifically, the investment effectiveness of carbon dioxide in the soil near Barendrecht and Geleen is discussed as well as the annual investments in the 220 and 380 kV high tension grid. Moreover, some recommendations and necessary policy adjustments to strengthen the competitive edge of the SMB compared to large energy companies and to realize an affordable and sustainable society are provided [nl

  2. Netherlands climate policy to be revised. Towards a cost-effective, sustainable society

    International Nuclear Information System (INIS)

    Van Dorp, H.W.; Schmitz, H.

    2009-01-01

    This is the second article in a series of two. The first article addresses current Dutch energy policy by means of an important energy formula and calculations were made based on 7.2 million Dutch dwellings. This article addresses climate policy with a comparison of the social cost on the level of new housing construction of both policy lines. More specifically, the investment effect of carbon dioxide storage in the soil in Barendrecht and Geleen, both Netherlands, is discussed as well as the annual investment in the 220 and 380 kV high voltage grid. Some recommendations and necessary policy adjustments are suggested that will strengthen the competitive edge of the SMBs compared to large energy companies and will help realize a truly affordable sustainable society [nl

  3. Levee Setbacks: An Innovative, Cost Effective, and Sustainable Solution for Improved Flood Risk management

    Science.gov (United States)

    2017-06-30

    ER D C/ EL S R- 17 -3 Levee Setbacks: An Innovative , Cost-Effective, and Sustainable Solution for Improved Flood Risk Management En vi...EL SR-17-3 June 2017 Levee Setbacks: An Innovative , Cost-Effective, and Sustainable Solution for Improved Flood Risk Management David L. Smith...alternative view point is necessary. ERDC/EL SR-17-3 4 Levee setbacks are a relatively recent innovation in Corps flood risk management practice

  4. Can the Clean Development Mechanism attain both cost-effectiveness and sustainable development objectives?

    International Nuclear Information System (INIS)

    Kolshus, Hans H; Vevatne, Jonas; Torvanger, Asbjoern; Aunan, Kristin

    2001-06-01

    The Clean Development Mechanism (CDM), as defined in the Kyoto Protocol, has two objectives: to promote sustainable development in host developing countries, and to improve global cost-effectiveness by assisting developed countries in meeting their Kyoto targets. The aim of this paper is to explore the background of the CDM and discuss to what extent its current design allows it to achieve its dual objective. The first part of the paper is a literature review that includes descriptions of the flexibility mechanisms under the Kyoto Protocol; the CDM's market potential, and the issues of cost-effectiveness and sustainable development. In the second part of the paper, we discuss to what extent there is a conflict between cost-effectiveness and sustain ability, and whether the two objectives of the CDM can be achieved simultaneously. We develop a set of indicators to evaluate non-carbon benefits of CDM projects on the environment, development, and. equity, and show how these indicators can be used in practice by looking at case studies of CDM project candidates in the energy sector from Brazil and China. We demonstrate that for some CDM projects there is a trade-off between cost-effectiveness, in terms of a low quota price, and a high score on sustain ability indicators. We have reason to believe that the size of the CDM market in some studies is over-estimated since transaction costs and the challenge of promoting sustainable development are not fully accounted for. Also, we find that the proposed set of indicators can be a necessary tool to assure that sustain ability impacts of CDM projects are taken into consideration. (author)

  5. Can the Clean Development Mechanism attain both cost-effectiveness and sustainable development objectives?

    Energy Technology Data Exchange (ETDEWEB)

    Kolshus, Hans H; Vevatne, Jonas; Torvanger, Asbjoern; Aunan, Kristin

    2001-06-01

    The Clean Development Mechanism (CDM), as defined in the Kyoto Protocol, has two objectives: to promote sustainable development in host developing countries, and to improve global cost-effectiveness by assisting developed countries in meeting their Kyoto targets. The aim of this paper is to explore the background of the CDM and discuss to what extent its current design allows it to achieve its dual objective. The first part of the paper is a literature review that includes descriptions of the flexibility mechanisms under the Kyoto Protocol; the CDM's market potential, and the issues of cost-effectiveness and sustainable development. In the second part of the paper, we discuss to what extent there is a conflict between cost-effectiveness and sustain ability, and whether the two objectives of the CDM can be achieved simultaneously. We develop a set of indicators to evaluate non-carbon benefits of CDM projects on the environment, development, and. equity, and show how these indicators can be used in practice by looking at case studies of CDM project candidates in the energy sector from Brazil and China. We demonstrate that for some CDM projects there is a trade-off between cost-effectiveness, in terms of a low quota price, and a high score on sustain ability indicators. We have reason to believe that the size of the CDM market in some studies is over-estimated since transaction costs and the challenge of promoting sustainable development are not fully accounted for. Also, we find that the proposed set of indicators can be a necessary tool to assure that sustain ability impacts of CDM projects are taken into consideration. (author)

  6. The Knowledge Society: A Sustainability Paradigm

    Directory of Open Access Journals (Sweden)

    Naim Hamdija Afgan

    2010-10-01

    Full Text Available This paper defines the knowledge society as a human structured organisation based on contemporary developed knowledge and representing new quality of life support systems. It implies the need for a full understanding of distribution of knowledge, access to information and the capability to transfer information into a knowledge. The understanding of knowledge is the central challenge when defining a knowledge society. From our present perception of knowledge society, it is of interest to emphasize the role of the knowledge society in future development of human society. The life support systems are essential pillars of human society development. In this respect knowledge society represents a new paradigm for future development and it is strongly correlated to sustainable development. For this reason the sustainability paradigm of knowledge society is a potential frame for human society development leading to social cohesion, economic competitiveness and stability, use of resources and economic development, safeguarding biodiversity and the ecosystem.In order to verify the mutual relation between knowledge society and sustainability, we have to introduce the difference between these two terms. The knowledge society is based on the agglomeration of eco-knowledge, env-knowledge and soc-knowledge, it may be evaluated as the complex knowledge of quality of life support systems. We have to introduce metrics which will allow us to present knowledge as the paradigm of the number of indicators for verifying progress made.Sustainability metrics are designed to consolidate measures of economic, environmental and social performance of any system. It can be understood as a pattern for evaluation of the available knowledge about systems and their performance. In particular the decision-making process for the selection of the system under consideration must be based on the available knowledge. The link between knowledge and sustainability makes it possible for

  7. The sustainability of our society

    International Nuclear Information System (INIS)

    Sommer, T.

    1997-01-01

    German society is in a crisis characterized by five criteria: the German unification process, globalization, social achievements, a crisis of meaning and of leadership. Five problems must be solved if the crisis is to be overcome: A new attitude to work and to technology must be found. After reunification, there is need for thorough renewal. The democratic system must give answers to the essential questions of social life and life in a community. A new leading elite with imagination, initiative, and responsibility for the 21st century must be found. What is needed, in a way, is the ethical equivalent of war and defeat. The present crisis should be the cause, and the reason, for seizing and opportunity it includes. (orig.) [de

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

    Science.gov (United States)

    2012-01-01

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

  9. Innovation Habitat: Sustainable possibilities for the society

    Directory of Open Access Journals (Sweden)

    Andreia de Bem Machado

    2015-12-01

    Full Text Available Contemporary society is moving in the core of a reality in which sustainability needs to be thought out and inserted through practices carried out in different dimensions of society, such as organizations, public and private institutions. This paper aims to identify the contribution of innovation habitats (IH for sustainability in society. The methodology used was systematic review of scientific literature in one online database. As a result, it was identified: 47 scientific papers publicated since 2000, but more frequently in the last year, 2014, with 10 publications, without providing a reference author in the area. There was also a high number of papers about management and social sciences. It was noticed a short number of publications, empirical and theoretical, about practices to promote sustainable actions in the society, so this indicates the need of research on this kind of practices, with innovation environment as the driver.

  10. Towards a Global Sustainable Information Society (GSIS?

    Directory of Open Access Journals (Sweden)

    Christian Fuchs

    2008-07-01

    Full Text Available The development, diffusion, and adoption of new ICTs doesn’t automatically result in ecological sustainability, it poses both new opportunities and risks. Embedded into the antagonism between capital and economy it seems like the logical of profitability frequently offsets ecological awareness and hence has negative effects on the realization of positive potentials of ICTs on the environment. Environmental problems are social problems, not technological problems, they are neither caused by science or technology as such, nor can they be solved by science or technology as such. The discourse on sustainable development shows a shift from the view of nature as an enemy that must be controlled to a view that considers nature as an important pre-condition of human existence that must be treated carefully. In the discourse on sustainability there has been a shift from a focus on ecological issues towards the inclusion of broader societal issues. It has now become very common to identify an ecological, an economic, a social, and an institutional dimension of sustainability. One can distinguish four types of sustainability concepts based on where in the nature-society-relationship they locate sustainability: ecological reductionism, social projectionism, dualism, man-nature-dialectic. Both nature and society are self-organizing systems in the sense that they permanently produce themselves. Ecological sustainability means that humans appropriate nature in a way that allows ecological diversity, i.e. the autopoiesis of nature can develop in such a way that nature flourishes, reproduces its subsystems, differentiates itself and produces new qualities, i.e. new ecological life forms and subsystems. Societal sustainability can broadly be defined as a good life for all. A sustainable society encompasses ecological diversity, technological usability, economic wealth, political participation, and cultural wisdom. Ecological sustainability is based on social

  11. Sustainable Society Formed by Unselfish Agents

    Science.gov (United States)

    Kikuchi, Toshiko

    It has been pointed out that if the social configuration of the three relations (market, communal and obligatory relations) is not balanced, a market based society as a total system fails. Using multi-agent simulations, this paper shows that a sustainable society is formed when all three relations are integrated and function respectively. When agent trades are based on the market mechanism (i.e., agents act in their own interest and thus only market relations exist), weak agents who cannot perform transactions die. If a compulsory tax is imposed to enable all weak agents to survive (i.e., obligatory relations exist), then the fiscal deficit increases. On the other hand, if agents who have excess income undertake the unselfish action of distributing their surplus to the weak agents (i.e., communal relations exist), then trade volume increases. It is shown that the existence of unselfish agents is necessary for the realization of a sustainable society. However, the survival of all agents is difficult in a communal society. In an artificial society, for all agents survive and fiscal balance to be maintained, all three social relations need to be fully integrated. These results show that adjusting the balance of the three social relations well lead to the realization of a sustainable society.

  12. Can renewable energy sources sustain affluent society?

    International Nuclear Information System (INIS)

    Trainer, F.E.

    1995-01-01

    Figures commonly quoted on costs of generating energy from renewable sources can give the impression that it will be possible to switch to renewables as the foundation for the continuation of industrial societies with high material living standards. Although renewable energy must be the sole source in a sustainable society, major difficulties become evident when conversions, storage and supply for high latitudes are considered. It is concluded that renewable energy sources will not be able to sustain present rich world levels of energy use and that a sustainable world order must be based on acceptance of much lower per capita levels of energy use, much lower living standards and a zero growth economy. (Author)

  13. Modular laboratories--cost-effective and sustainable infrastructure for resource-limited settings.

    Science.gov (United States)

    Bridges, Daniel J; Colborn, James; Chan, Adeline S T; Winters, Anna M; Dengala, Dereje; Fornadel, Christen M; Kosloff, Barry

    2014-12-01

    High-quality laboratory space to support basic science, clinical research projects, or health services is often severely lacking in the developing world. Moreover, the construction of suitable facilities using traditional methods is time-consuming, expensive, and challenging to implement. Three real world examples showing how shipping containers can be converted into modern laboratories are highlighted. These include use as an insectary, a molecular laboratory, and a BSL-3 containment laboratory. These modular conversions have a number of advantages over brick and mortar construction and provide a cost-effective and timely solution to offer high-quality, user-friendly laboratory space applicable within the developing world. © The American Society of Tropical Medicine and Hygiene.

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

    Science.gov (United States)

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

    2004-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-07-01

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

  16. Coal technology in a sustainable society

    International Nuclear Information System (INIS)

    Anon

    2000-01-01

    Coal is a major world energy resource. For many countries it is the primary fuel in electricity generation. As world energy demand increases so also will the demand for coal. Steel and aluminium-essential elements in the fabric of modern society -also rely heavily on coal. This article points out that the Australian coal industry is responding to the challenges facing coal by investigating a sustainable development strategy and examining the full life cycle outcomes of coal as fuel and reductant. The challenge is to deliver much more efficient ways of extracting energy from coal. The most effective strategies are seen to be: ash displacement credits, synergies with renewables and integration with other industries

  17. Maintaining the competitiveness of the American fisheries society journals: an assessment based on influence and cost-effectiveness

    Science.gov (United States)

    Hewitt, David A.; Link, Jason S.; Steinich, Dave R.; Wahl, David H.; Mather, Martha E.

    2009-01-01

    Recent changes in the landscape of scientific publishing prompted the Publications Overview Committee of the American Fisheries Society (AFS) to review the Society's portfolio of scientific journals. We evaluated journals based on metrics in two categories: (1) citation-based measures of the influence of a journal on the scientific literature, and (2) measures of the cost-effectiveness of a journal (citation rate adjusted for subscription cost). Over the long-term, we found that ecology journals had far stronger citation-based influence than fisheries and aquatic sciences journals, and that journals publishing primarily basic research had stronger influence than journals publishing applied research (including four AFS journals and Fisheries magazine). In evaluating the current status of fisheries and aquatic sciences journals, we found that metrics of influence and cost-effectiveness provided considerably different portrayals of journals relative to their peers. In terms of citation-based influence, we found that the AFS journal Transactions of the American Fisheries Society (TAFS) and Fisheries magazine were competitive with highly regarded peer fisheries journals, but that North American Journal of Aquaculture (NAJA) and Journal of Aquatic Animal Health (JAAH) were less influential than their peers. The citation-based influence of North American Journal of Fisheries Management (NAJFM) was intermediate between TAFS/Fisheries and NAJA/JAAH. For journals like NAJFM and NAJA, we expect that much of the scientific influence on policy and management is not captured by citations in the primary literature, and alternative methods of evaluation may be needed. All of the AFS journals ranked highly with regard to cost-effectiveness because their subscription costs are low, and these rankings are in accordance with membership needs and the strategic mission of AFS to provide broad and timely dissemination of scientific information. We conclude by suggesting

  18. Solar Irradiance Measurements Using Smart Devices: A Cost-Effective Technique for Estimation of Solar Irradiance for Sustainable Energy Systems

    Directory of Open Access Journals (Sweden)

    Hussein Al-Taani

    2018-02-01

    Full Text Available Solar irradiance measurement is a key component in estimating solar irradiation, which is necessary and essential to design sustainable energy systems such as photovoltaic (PV systems. The measurement is typically done with sophisticated devices designed for this purpose. In this paper we propose a smartphone-aided setup to estimate the solar irradiance in a certain location. The setup is accessible, easy to use and cost-effective. The method we propose does not have the accuracy of an irradiance meter of high precision but has the advantage of being readily accessible on any smartphone. It could serve as a quick tool to estimate irradiance measurements in the preliminary stages of PV systems design. Furthermore, it could act as a cost-effective educational tool in sustainable energy courses where understanding solar radiation variations is an important aspect.

  19. Creating Sustainable Societies: Developing Emerging Professionals through Transforming Current Mindsets

    Science.gov (United States)

    Griswold, Wendy

    2017-01-01

    Future professionals will bear the brunt of creating sustainable societies. Equipping them for the task is the challenge of current educators. Educational experiences facilitating the development of sustainable habits of mind are needed. This research reports on the experiences of developing scientists and engineers engaged in a sustainable energy…

  20. Waste management in a sustainable society

    International Nuclear Information System (INIS)

    Ascari, Sergio; Milan, Univ. ''Bocconi''

    1997-01-01

    This paper summarises the environmental economics debate about sustainable management of solid wastes. Sustainable levels of solid waste generation, recycling and disposal cannot be set by general criteria, but priorities are better defined locally. Preferable solutions are mostly determined by market forces once economic instruments are introduced in order to compel agents to incorporate environmental costs and benefits into their decisions. Greater care should be devoted to dangerous wastes, where schemes may be devised to subsidize not only recovery and recycling but environmentally safe disposal as well; these may be financed by raw materials levies

  1. Applying Andragogical Concepts in Creating a Sustainable Lifelong Learning Society

    Science.gov (United States)

    Charungkaittikul, Suwithida; Henschke, John A.

    2017-01-01

    Today, the world is changing, re-establishing the role of education to have a developed society. This article aims to explore the practical application of Andragogy as a key element for creating a sustainable lifelong learning society, to propose strategies for developing a lifelong learning society using andragogical concepts, to enhance…

  2. International Partnerships for Sustainable Societies | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    ... we face opportunities and challenges with multiple social, economic, environmental, ... These collaborations are producing high-quality research to inform academic, public, and policy debates in ways that can help create just, inclusive, and sustainable social and economic development. ... Careers · Contact Us · Site map.

  3. Modular Laboratories—Cost-Effective and Sustainable Infrastructure for Resource-Limited Settings

    Science.gov (United States)

    Bridges, Daniel J.; Colborn, James; Chan, Adeline S. T.; Winters, Anna M.; Dengala, Dereje; Fornadel, Christen M.; Kosloff, Barry

    2014-01-01

    High-quality laboratory space to support basic science, clinical research projects, or health services is often severely lacking in the developing world. Moreover, the construction of suitable facilities using traditional methods is time-consuming, expensive, and challenging to implement. Three real world examples showing how shipping containers can be converted into modern laboratories are highlighted. These include use as an insectary, a molecular laboratory, and a BSL-3 containment laboratory. These modular conversions have a number of advantages over brick and mortar construction and provide a cost-effective and timely solution to offer high-quality, user-friendly laboratory space applicable within the developing world. PMID:25223943

  4. Occupational ethis sustainable a global society

    Directory of Open Access Journals (Sweden)

    Nilton Cesar Flores

    2015-09-01

    Full Text Available The thematic working environment reproduces the complexities of the risks in a globalized world. In imbricar the interrelationship of this globalization movement of the economy and productive restructuring that triggers a series of social consequences. While globalization and the emergence of new technologies benefited the man, however, they gave up the cost of a degree of disregard and neglect the integrity of those involved in the process. Thus arises the need for new approaches to law. To this end, the study overcomes the theory of shallow ecology and of the understanding of the theory of deep ecology without it looses its essence, proposing an analysis focused on the human element within the web of life, indicating a new guiding principle: sustainable occupational ethics.

  5. Tax modifications: sustainable energy and society

    International Nuclear Information System (INIS)

    Thorp, J.P.

    2000-01-01

    The application of taxes is said to be a valuable means of solving environmental problems; provision of the right incentives will invariably achieve the goal. The policy requirements for addressing the environmental problems are (i) to understand and accept a vision of a sustainable future; (ii) to understand the nature of the challenge; (iii) decide a course of action for the desired future and (iv) the will to implement the actions. The subject is discussed under the sub-headings of (a) The Government Approach; (b) The Climate Change Levy; (c) The Future (short, medium and long term); (d) Recommendations and (e) Renewable Technologies. The potential for carbon savings through a market led transition to a low carbon economy is 'extensive'. The Government must have regulation, taxation or legislation to shape the market to lead to a socially desirable outcome

  6. Sustainability in Multi-Religious Societies: An Islamic Perspective

    Science.gov (United States)

    Grine, Fadila; Bensaid, Benaouda; Nor, Mohd Roslan Mohd; Ladjal, Tarek

    2013-01-01

    The question of sustainability in multi-religious societies underscores interrelating theological, moral and cultural issues affecting the very process of social co-existence, cohesion and development. This article discusses Islam's understanding of the question of sustainability in multi-religious contexts while highlighting the contribution of…

  7. Lives saved from malaria prevention in Africa--evidence to sustain cost-effective gains

    Directory of Open Access Journals (Sweden)

    Korenromp Eline L

    2012-03-01

    Full Text Available Abstract Lives saved have become a standard metric to express health benefits across interventions and diseases. Recent estimates of malaria-attributable under-five deaths prevented using the Lives Saved tool (LiST, extrapolating effectiveness estimates from community-randomized trials of scale-up of insecticide-treated nets (ITNs in the 1990s, confirm the substantial impact and good cost-effectiveness that ITNs have achieved in high-endemic sub-Saharan Africa. An even higher cost-effectiveness would likely have been found if the modelling had included the additional indirect mortality impact of ITNs on preventing deaths from other common child illnesses, to which malaria contributes as a risk factor. As conventional ITNs are being replaced by long-lasting insecticidal nets and scale-up is expanded to target universal coverage for full, all-age populations at risk, enhanced transmission reduction may--above certain thresholds--enhance the mortality impact beyond that observed in the trials of the 1990s. On the other hand, lives saved by ITNs might fall if improved malaria case management with artemisinin-based combination therapy averts the deaths that ITNs would otherwise prevent. Validation and updating of LiST's simple assumption of a universal, fixed coverage-to-mortality-reduction ratio will require enhanced national programme and impact monitoring and evaluation. Key indicators for time trend analysis include malaria-related mortality from population-based surveys and vital registration, vector control and treatment coverage from surveys, and parasitologically-confirmed malaria cases and deaths recorded in health facilities. Indispensable is triangulation with dynamic transmission models, fitted to long-term trend data on vector, parasite and human populations over successive phases of malaria control and elimination. Sound, locally optimized budget allocation including on monitoring and evaluation priorities will benefit much if policy

  8. Energy, society and environment. Technology for a sustainable future

    International Nuclear Information System (INIS)

    Elliott, D.

    1997-04-01

    Energy, Society and Environment examines energy and energy use, and the interactions between technology, society and the environment. The book is clearly structured to examine; Key environmental issues, and the harmful impacts of energy use; New technological solutions to environmental problems; Implementation of possible solutions, and Implications for society in developing a sustainable approach to energy use. Social processes and strategic solutions to problems are located within a clear, technological context with topical case studies. (UK)

  9. From the Big Bang to sustainable societies.

    Science.gov (United States)

    Eriksson, K E; Robèrt, K H

    1991-01-01

    A series of events in the history of cosmos has created the prerequisites for life on Earth. With respect to matter, the earth is a closed system. However, it receives light from the sun and emits infrared radiation into space. The difference in thermodynamic potential between these two flows has provided the physical conditions for self-organization. The transformation of lifeless matter into modern life forms, with their high degree of order and complexity, has occurred in the context of the earth's natural cycles, including the water cycle and the biochemical cycles between plants and animals. Primary production units, the cells of green plants, can use the thermodynamic potential of the energy balance in a very direct way, i.e. in photosynthesis. Plant cells are unique in their ability to synthesize more structure than is broken down elsewhere in the biosphere. The perpetuation of this process requires the recycling of wastes. However, modern industrial societies are obsessed with the supply side, ignoring the principle of matter's conservation and neglecting to plan for the entire material flow. As a result there has been an accumulation of both visible and invisible garbage (pollution), which disturbs the biosphere and reduces stocks of natural resources. Furthermore, due to complexity and delay mechanisms, we usually cannot predict time parameters for the resulting socio-economic consequences or the development of disease. To continue along this path of folly is not compatible with the maintenance of wealth, nor with the health of humans or the biosphere. Rather than address the millions of environmental problems one at a time, we need to approach them at the systemic level. It is essential to convert to human life-styles and forms of societal organization that are based on cyclic processes compatible with the earth's natural cycles. The challenge to the developed countries is not only to decrease their own emissions of pollutants but to develop the cyclic

  10. Strategies for achieving a sustainable, clean and cost-effective biomass resource

    International Nuclear Information System (INIS)

    Turnbull, J.

    1993-01-01

    Biomass produced in an economically and environmentally sustainable manner, could realistically be used to supply 50,000 MW (5 Quads) of electric capacity by the year 2010 and probably twice that amount by the year 2030. During the past year, the Electric Power Research Institute (EPRI) and the U.S. Department of Energy (DOE) have each been independently evaluating the potential for biomass to become a major renewable energy resource over the next four decades, able to offset some of the U.S. dependency on imported fossil fuels while also offering important environmental and economic benefits. This paper presents EPRI's conclusions, which are more conservative than those of DOE, and outlines possible strategies by which EPRI can advance acceptance of biomass as a preferred renewable resource

  11. Sustainable Sanitation—A Cost-Effective Tool to Improve Plant Yields and the Environment

    Directory of Open Access Journals (Sweden)

    Päivi Karinen

    2010-01-01

    Full Text Available Human urine and faeces are products formed every day in every human society. The volume and fertilisation value of urine is higher than that of faeces. This paper reviews data that urine has been used successfully as a fertiliser for cereals and some vegetables. According to the literature, urine fertilised plants may have produced higher, similar or slightly lower yields than mineral fertilized plants but they invariably resulted in higher yields than non-fertilised plants. There have been no microbiological risks associated with any products. The taste and chemical quality of the products are similar to plants treated with mineral fertilisers. Separating toilets, where urine and faeces are separated already in the toilet, could be beneficial not only in poor but also in the industrialized countries. A separating toilet could be installed also in old buildings and it could allow individuals to live in coastal areas, mountainous or other sensitive environments. In poor areas, urine fertilisation could increase food production also in home plots and reduce hunger. It could also combat water contamination and help to reduce diseases caused by enteric micro-organisms. If urine were to be viewed as a resource rather than a waste product, more families could be encouraged to install low-cost toilets which would especially improve the wellbeing of women.

  12. Beyond cost-effectiveness, analysis. Value-based pricing and result-oriented financing as a pathway to sustainability for the national health system in Spain

    Directory of Open Access Journals (Sweden)

    Alvaro Hidalgo-Vega

    2017-01-01

    Full Text Available Beyond cost-effectiveness, analysis. Value-based pricing and result-oriented financing as a pathway to sustainability for the national health system in SpainThe editorial addresses the current use of economic evaluation in the assessment and potential funding and reimbursement of health technologies. Cost-effectiveness ratio and the acceptability thresholds are analyzed, pointing out the limitations that the current approach has for capturing the value of new technologies. A potential shift from National Health Systems to value-based prices is discussed, with a focus on health economics outcomes where multi-criteria analyses can be a complementary tool to traditional cost-effectiveness approaches.

  13. Network-Based Community Brings forth Sustainable Society

    Science.gov (United States)

    Kikuchi, Toshiko

    It has already been shown that an artificial society based on the three relations of social configuration (market, communal, and obligatory relations) functioning in balance with each other formed a sustainable society which the social reproduction is possible. In this artificial society model, communal relations exist in a network-based community with alternating members rather than a conventional community with cooperative mutual assistance practiced in some agricultural communities. In this paper, using the comparison between network-based communities with alternating members and conventional communities with fixed members, the significance of a network-based community is considered. In concrete terms, the difference in appearance rate for sustainable society, economic activity and asset inequality between network-based communities and conventional communities is analyzed. The appearance rate for a sustainable society of network-based community is higher than that of conventional community. Moreover, most of network-based communities had a larger total number of trade volume than conventional communities. But, the value of Gini coefficient in conventional community is smaller than that of network-based community. These results show that communal relations based on a network-based community is significant for the social reproduction and economic efficiency. However, in such an artificial society, the inequality is sacrificed.

  14. Literacy Education and Sustainable Development in Developing Societies

    Science.gov (United States)

    Oghenekohwo, Jonathan E.; Frank-Oputu, Ekima A.

    2017-01-01

    The development of a literate society is a pre-requisite for the emergence of a knowledge economy. The thesis advanced in this paper is that, without massive investment and promotion of literacy education, development that is targeted at the 17-point sustainable development goals (SDGs) will be bereft of citizen's empowerment, engagement,…

  15. Generating Sustainable Value from Open Data in a Sharing Society

    DEFF Research Database (Denmark)

    Jetzek, Thorhildur; Avital, Michel; Bjørn-Andersen, Niels

    2014-01-01

    Our societies are in the midst of a paradigm shift that transforms hierarchical markets into an open and networked economy based on digital technology and information. In that context, open data is widely presumed to have a positive effect on social, environmental and economic value; however...... the evidence to that effect has remained scarce. Subsequently, we address the question how the use of open data can stimulate the generation of sustainable value. We argue that open data sharing and reuse can empower new ways of generating value in the sharing society. Moreover, we propose a model...... that describes how different mechanisms that take part within an open system generate sustainable value. These mechanisms are enabled by a number of contextual factors that provide individuals with the motivation, opportunity and ability to generate sustainable value...

  16. How can plant genetic engineering contribute to cost-effective fish vaccine development for promoting sustainable aquaculture?

    Science.gov (United States)

    Clarke, Jihong Liu; Waheed, Mohammad Tahir; Lössl, Andreas G; Martinussen, Inger; Daniell, Henry

    2013-09-01

    Aquaculture, the fastest growing food-producing sector, now accounts for nearly 50 % of the world's food fish (FAO in The state of world fisheries and aquaculture. FAO, Rome, 2010). The global aquaculture production of food fish reached 62.7 million tonnes in 2011 and is continuously increasing with an estimated production of food fish of 66.5 million tonnes in 2012 (a 9.4 % increase in 1 year, FAO, www.fao.org/fishery/topic/16140 ). Aquaculture is not only important for sustainable protein-based food fish production but also for the aquaculture industry and economy worldwide. Disease prevention is the key issue to maintain a sustainable development of aquaculture. Widespread use of antibiotics in aquaculture has led to the development of antibiotic-resistant bacteria and the accumulation of antibiotics in the environment, resulting in water and soil pollution. Thus, vaccination is the most effective and environmentally-friendly approach to combat diseases in aquaculture to manage fish health. Furthermore, when compared to >760 vaccines against human diseases, there are only about 30 fish vaccines commercially available, suggesting the urgent need for development and cost-effective production of fish vaccines for managing fish health, especially in the fast growing fish farming in Asia where profit is minimal and therefore given high priority. Plant genetic engineering has made significant contributions to production of biotech crops for food, feed, valuable recombinant proteins etc. in the past three decades. The use of plants for vaccine production offers several advantages such as low cost, safety and easy scaling up. To date a large number of plant-derived vaccines, antibodies and therapeutic proteins have been produced for human health, of which a few have been made commercially available. However, the development of animal vaccines in plants, especially fish vaccines by genetic engineering, has not yet been addressed. Therefore, there is a need to exploit

  17. Cost-effectiveness of sustainable measures for water protection; Kosten-Wirksamkeitsanalyse von nachhaltigen Massnahmen im Gewaesserschutz

    Energy Technology Data Exchange (ETDEWEB)

    Boehm, E.; Hillenbrand, T.; Liebert, J.; Schleich, J.; Walz, R.

    2001-08-01

    The study continues the project 'Environmental Action Plan for Sustainable Water Resources Management' (UBA-Texte 25/99). The methodological basis in high-priority fields of water protection is improved and the available knowledge with regard to costs and effectiveness of the measures is evaluated systematically. Especially for the fields urban waste water, agriculture and morphological water structures the cost-effectiveness of different measures could be assessed. The results may be an important item for priority setting among different measures on a national basis. On the other hand these methods and data may be helpful for action plans in river basin management as well. (orig.) [German] Das Vorhaben hatte zum Ziel, anknuepfend an das Projekt 'Massnahmenplan Nachhaltige Wasserwirtschaft' (UBA-Texte 25/99), fuer besonders wichtige Zielbereiche des Gewaesserschutzes die methodische Basis fuer die Abschaetzung kurz- bis mittelfristiger Wirkungen zu verbessern und fuer diese Bereiche die aktuellen Kenntnisse zu den Kosten und Wirkungen systematisch auszuwerten. Insbesondere fuer die Schwerpunkte Siedlungsentwaesserung, Landwirtschaft und Verbesserung der Gewaesserstruktur konnten damit Aussagen zur Kosten-Wirksamkeit unterschiedlicher Massnahmen zum Gewaesserschutz getroffen werden, die ein wesentliches Element der Priorisierung denkbarer Massnahmen sein koennen. Gegenstand der Untersuchung waren Massnahmen auf nationaler Ebene, jedoch koennen die erarbeiteten Methoden und Daten auch als Orientierung fuer das Erstellen von Massnahmenplaenen fuer einzelne Flusseinzugsgebiete dienen. (orig.)

  18. Sustainability Ethics Emergency and Media Responsibility in the Consumption Society

    Directory of Open Access Journals (Sweden)

    Rogério Bianchi de Araujo

    2008-08-01

    Full Text Available In this article, it is discussed the sustainable development and the importance of the environmental cause, in order to create models of development that consider the sustainability and environmental preservation for the future generations. The participation of all society is essential in this debate. The establishment of new habits that do not compromise the subsistence and the conscience of the real self-destruction possibility must be studied and analysed; they consist in challenging intentions, which detach the relevance and the moral duty of the media to restore a new ethics and a new way to understand the reality, as well as to divulge the impact of this different perception in the human life. Therefore occurs the requirement of a responsible compromise relating to the development, by way of understanding the biosphere as the social life basis, considering that, in these ecosystems, the human being is only one of the many species that live in an interdependence relationship.

  19. Sustainable Design and Postindustrial Society: Our Ethical and Aesthetic Crossroads

    Directory of Open Access Journals (Sweden)

    Leonard Bachman

    2016-12-01

    Full Text Available Mid-20th century transitions from industrial product society to postindustrial information society have marked profound but now familiar conversions to service economy, knowledge workers, and cybernetic reasoning. Second order, but equally important consequences of this change involve the transformation from predominantly human-machine heroics to human-human collaboration. Collectively, these events have revolutionized the bases of production and value across the developed world. Less appreciated however, are the more subtle shifts of postindustrialism and their ultimate epochal transformations of contemporary life. The short list of these more elusive transitions includes local scale isolation to macro and global scale interaction, mechanistic routine to systemic reasoning, static to dynamic assumptions, short-termism to scenario planning, profit to value motives, hero to team attribution, intuitive to cybernetic decisions, and a move away from rote procedural expertise in favor of reasoned principle, wisdom, and theory. Our historical perspective thus argues for the relevance of postindustrial society in the emergence of a sustainable future, with particular reference to the built environment and to the complex, collaborative, evidence based and cybernetic processes it involves. The difficulty here is that without a vivid and operational understanding of the aesthetic connections and ethical mandates inherent in these more sublime postindustrial events; it is entirely possible that all the best scientific, technical, and political efforts toward sustainability are hampered by old habits of piecemeal procedures, mechanistic approaches, individual expertise, quick profit, and simplistic short-termism. Postindustrial ethics and aesthetics, on the other hand, offer a new and different apparatus by embracing complexity and dynamic interaction. Within that new aesthetic lies a set of principles and sensitivities towards postindustrial and

  20. Scalable, sustainable cost-effective surgical care: a model for safety and quality in the developing world, part III: impact and sustainability.

    Science.gov (United States)

    Campbell, Alex; Restrepo, Carolina; Mackay, Don; Sherman, Randy; Varma, Ajit; Ayala, Ruben; Sarma, Hiteswar; Deshpande, Gaurav; Magee, William

    2014-09-01

    The Guwahati Comprehensive Cleft Care Center (GCCCC) utilizes a high-volume, subspecialized institution to provide safe, quality, and comprehensive and cost-effective surgical care to a highly vulnerable patient population. The GCCCC utilized a diagonal model of surgical care delivery, with vertical inputs of mission-based care transitioning to investments in infrastructure and human capital to create a sustainable, local care delivery system. Over the first 2.5 years of service (May 2011-November 2013), the GCCCC made significant advances in numerous areas. Progress was meticulously documented to evaluate performance and provide transparency to stakeholders including donors, government officials, medical oversight bodies, employees, and patients. During this time period, the GCCCC provided free operations to 7,034 patients, with improved safety, outcomes, and multidisciplinary services while dramatically decreasing costs and increasing investments in the local community. The center has become a regional referral cleft center, and governments of surrounding states have contracted the GCCCC to provide care for their citizens with cleft lip and cleft palate. Additional regional and global impact is anticipated through continued investments into education and training, comprehensive services, and research and outcomes. The success of this public private partnership demonstrates the value of this model of surgical care in the developing world, and offers a blueprint for reproduction. The GCCCC experience has been consistent with previous studies demonstrating a positive volume-outcomes relationship, and provides evidence for the value of the specialty hospital model for surgical delivery in the developing world.

  1. Electricity Technology Roadmap. Technology for the Sustainable Society. 2025

    International Nuclear Information System (INIS)

    2002-01-01

    The Dutch Electricity Technology Roadmap Initiative is being developed by KEMA as a joint effort of Dutch and European experts of universities, industry and (non)governmental organisations. It aims to assess how to structure the ongoing collaborative research and technological advancement, the exploration of the opportunities and the threats for the electricity-based innovations over the next twenty-five years. In addition it analyses how to manage the transition towards a knowledge based economy and a more sustainable society. To date, about 100 organisations have participated with KEMA and its sponsors in shaping a comprehensive vision of the opportunities to structure the knowledge based economy in the Digital Society with as basis the increase of electricity's value to society. This vision is being translated into a set of technology development destinations and a total of six distinct initiatives for targeted projects. KEMA is leading this ongoing road-mapping effort, with the support of TENNET and EPRI (USA). The Dutch power generation utilities and the Ministry of Economics (EZ) financially support the work. It is an investment in the future of the Dutch knowledge based economy and a guidance to structure and strengthen the value of public and private RandD investments. The Electricity Technology Roadmap Initiative explores a period of fast regulatory, political, technological and institutional change in the electricity enterprise and in the society. The strategic choices made in this period of change can have profound consequences on whether future opportunities are opened or closed, and whether threats increase or are eliminated The reluctance to proceed with important changes is understandable, given the extreme uncertainty under which decisions must be made. No regrets solutions may be appropriate in some circumstances. These situations highlight the need for foresight and the importance of strategic roadmapping. The first year of the Roadmap

  2. Metrics for value creation in a sustainable knowledge society

    Energy Technology Data Exchange (ETDEWEB)

    Huovila, P., Email: pekka.huovila@vtt.fi

    2012-06-15

    This paper highlights the need to create potential value metrics for sustainable neighbourhoods, capable of working simultaneously at a variety of spatial scales for different stakeholders (multi-scalar reciprocity), moving from top-down imposed metrics towards bottom-up formulated ones. Metrics for Value Creation should be constituted using different approaches. One dimension is the built environment, where the present rating schemes focus on the environmental impact of the use of buildings, namely energy use. Another dimension is the corporate aspect, where triple bottom line reporting also emphasises environmental and social issues, but the discursive civic square environment risks domination by economic sustainability of the production and growth-oriented business environment. The third dimension is the city itself with its social networks, concerning indicators for employment and crime, for example. The fourth dimension aims to measure the quality of life of individual citizens, which is not easy to define. At present, all four approaches are used separately without interoperability between the systems. Current environmental rating schemes, such as BREEAM, CASBEE, Green Star, HQE, LEED, PromisE, etc. are able to structure the processes of setting objectives, monitoring the process and assessing the state of buildings by some simple indicators. Mostly they focus on resource use and environmental impacts, but also cover some performance parameters, such as indoor environmental quality or aspects of accessibility. However, they are not contributing to the objectives of value creation in a knowledge society. This paper discusses major limitations of current sustainability indicator sets and rating tools. Finally, it describes a new approach to value metrics for sustainable neighbourhoods, using the LivingLab approach. This is a user-centric multidisciplinary research approach and a user community-driven innovation based on real-life experiments. The benefits of

  3. The Carpathians. Integrating nature and society towards sustainability

    Energy Technology Data Exchange (ETDEWEB)

    Kozak, Jacek; Ostapowicz, Katarzyna [Jagiellonian Univ., Krakow (Poland). Inst. of Geography and Spatial Management; Bytnerowicz, Andrzej [Pacific Southwest Research Station, Riverside, CA (United States). USDA Forest Service; Wyzga, Bartlomiej (eds.) [Polish Academy of Sciences, Krakow (Poland). Inst. of Nature Conservation

    2013-06-01

    Provides an interdisciplinary approach. Explores ways to generate value for the Carpathian mountain region. Gives a new insight into the Carpathian mountain region. The Carpathians are a distinct mountain chain in the core of Central and Eastern Europe holding valuable biological resources and a rich cultural heritage. The last twenty years have witnessed an increasing awareness of the Carpathians' value for European society and strengthened research cooperation in the region, especially after the enlargement of the European Union in 2004 and 2007. This book presents a wide range of problems related to sustainable development in the Carpathian region that were discussed during the 1{sup st} Forum Carpaticum held in 2010 in Krakow, Poland. The four sections of the book deal with various issues related to the abiotic environment, forests and biodiversity, human activities, and research methods allowing a better understanding of the past, present and future of the Carpathians.

  4. The Impact of Civil Society Organizations on Sustainable ...

    African Journals Online (AJOL)

    Civil society groups are agents of development in any nation. Civil society organizations appear to play important role in social, political and economic development activities. The transformation of any society or system, particularly the developing societies like Nigeria depend on the effectiveness and efficiency of its civil ...

  5. Impact of geohazards on sustainable development of society

    International Nuclear Information System (INIS)

    Blistan, P.

    2015-01-01

    In this paper the authors analyze environmental risk factors in Slovakia in terms of sustainable development within environmental conditions and perspectives. Geological and geomorphological conditions affecting sustainable development are analyzed. Monitoring system of the environment and the need for sustainable development is presented.

  6. The indispensable role of thorium for creating a sustainable society

    International Nuclear Information System (INIS)

    Kamei, T.

    2012-01-01

    Several approaches are required in parallel for constructing a sustainable society. One of them is to fight against global warming. The other one is to make this world nuclear weapon free. Nuclear power has been used for peaceful purpose because nuclear power produces electricity without emitting CO 2 . Nearly 15% of world electricity is produced by nuclear power. Through nuclear power plant has a possibility of severe accident such as Fukushima Daiichi, its advantage is still valuable for the world. President Obama's speech in Prague in 2009 brought a impact to the world to move toward the world without nuclear weapon. The remaining subject is how to treat dismantled fissionable materials. Existing nuclear power plants utilize uranium because only uranium contains natural occurring fissionable material, uranium-235. The spent uranium fuel contains fissionable plutonium-239. Thus, uranium fuel cycle always accompanies possibility of nuclear proliferation. Thorium plays an important role for both solving global warming and nuclear weapon. Fertile thorium can be used as nuclear fuel by support of fissionable plutonium-239 from spent uranium fuel or weapon head. Preliminary calculation indicates that the USA's and Russia's dismantle nuclear weapon enable to start more than 10 GWe of thorium nuclear power plants. In addition, plutonium-239 obtained from uranium fuel is available of 392 GWe of thorium nuclear power. Uranium-233 coming from thorium is also a fissionable but it is hard to be used for weapon because of its accompanied gamma-ray. Thorium itself is now obtained as by-product of rare-earth mining, which is used for high-tech products including photovoltaic cell, wind-mill, and hybrid-vehicle. However, thorium is not taken care adequately and becomes environmental hazard. Both to take care of environment, to support implementation of high-tech product and to make the world without nuclear weapon, a comprehensive role of thorium will be presented

  7. The Impact of Civil Society Organizations on Sustainable ...

    African Journals Online (AJOL)

    Toshiba

    society organizations appear to play important role in social, political and economic ... depend on the effectiveness and efficiency of its civil societies. This ..... media provided a strong leadership and organized protests against unpopular ...

  8. Nuclear fuel: sustainable source of energy or burden on society?

    International Nuclear Information System (INIS)

    Williams, T.; Klaiber, G.

    2007-01-01

    In the past, the question concerning the sustainability of a resource primarily addressed its finite nature. Accordingly, electricity production using renewable energies was clearly sustainable. Contrasting this are systems based on oil, gas, coal or uranium. However, from the perspective of 'neo-sustainability' being analyzed today, this assessment appears less clear-cut, especially in light of the definition of sustainability as provided by the Brundtland report. Nowadays, the depletion time of fuel resources is thus not the only significant aspect, but factors such as efficiency, ecofriendliness and social responsibility also figure in. The nuclear fuel supply is analyzed from a sustainability perspective. After a short description of the supply chain, each of the most important aspects of sustainability are related to the individual stages of the supply chain and evaluated. This method aims at answering the question concerning to what extent nuclear fuel is a sustainable source of energy. Although the recycling of fissile materials from reprocessing and the deployment of advanced reactors are key factors as regards the issue of sustainability, these topics are deliberately only touched on. The main focus lies on the sustainability of the nuclear fuel cycle as it is currently utilized in light water reactors, without discussing the subject of reprocessing. (orig.)

  9. Social sustainability in an ageing chinese society : Towards an integrative conceptual framework

    NARCIS (Netherlands)

    Liu, Yafei; Dijst, Martin; Geertman, Stan; Cui, Can

    2017-01-01

    Social sustainability is a relatively underexposed dimension of the sustainability debate. Diversified and discipline-specific study perspectives and the lack of contextualization make it difficult to gain a comprehensive understanding of social sustainability in non-Western societies. In examining

  10. AN APROACH OF LOCAL FINANCIAL AUTONOMY AND IMPLICATION OVER SUSTAINABLE DEVELOPMENT IN THE KNOWLEDGE SOCIETY

    Directory of Open Access Journals (Sweden)

    Elena CIGU

    2014-12-01

    Full Text Available Local governments play an important role in sustainable development processes based on their administrative and financial autonomy. Policies and programs undertaken to assure sustainable development by local governments produce benefits for persistence of the knowledge society. This paper will try to highlight the implication of local financial autonomy over sustainable development of local communities in a knowledge society, based especially on local financial autonomy theory approach.

  11. AN APROACH OF LOCAL FINANCIAL AUTONOMY AND IMPLICATION OVER SUSTAINABLE DEVELOPMENT IN THE KNOWLEDGE SOCIETY

    OpenAIRE

    Elena CIGU

    2014-01-01

    Local governments play an important role in sustainable development processes based on their administrative and financial autonomy. Policies and programs undertaken to assure sustainable development by local governments produce benefits for persistence of the knowledge society. This paper will try to highlight the implication of local financial autonomy over sustainable development of local communities in a knowledge society, based especially on local financial autonomy theory approach.

  12. The Cost-Effectiveness of Investments to Meet the Guiding Principles for High-Performance Sustainable Buildings on the PNNL Campus

    Energy Technology Data Exchange (ETDEWEB)

    Cort, Katherine A.; Judd, Kathleen S.

    2014-08-29

    As part its campus sustainability efforts, Pacific Northwest National Laboratory (PNNL) has invested in eight new and existing buildings to ensure they meet the U.S. Department of Energy’s requirements for high performance sustainable buildings (HPSB) at DOE sites. These investments are expected to benefit PNNL by reducing the total life-cycle cost of facilities, improving energy efficiency and water conservation, and making buildings safer and healthier for the occupants. This study examines the cost-effectiveness of the implementing measures that meet the criteria for HPSBs in 3 different types of buildings on the PNNL campus: offices, scientific laboratories, and data centers. In each of the three case studies examined the investments made to achieve HPSB status demonstrated a high return on the HPSB investments that have taken place in these varied environments. Simple paybacks for total investments in the three case study buildings ranged from just 2 to 5 years; savings-to-investment ratios all exceeded the desirable threshold of 1; and the net present values associated with these investments were all positive.

  13. Generating Sustainable Value from Open Data in a Sharing Society

    DEFF Research Database (Denmark)

    Jetzek, Thorhildur; Avital, Michel; Bjørn-Andersen, Niels

    2014-01-01

    Our societies are in the midst of a paradigm shift that transforms hierarchical markets into an open and networked economy based on digital technology and information. In that context, open data is widely presumed to have a positive effect on social, environmental and economic value; however...

  14. The role of soils in sustaining society and the environment

    NARCIS (Netherlands)

    Hartemink, A.E.; McBratney, A.B.; White, R.E.

    2009-01-01

    This four-volume set, edited by leading experts in soil science, brings together in one collection a series of papers that have been fundamental to the development of soil science as a defined discipline. Volume 4 on The Role of Soils in Society and the Environment covers: - Soils and the

  15. Sustainable tourism as a method of forming a tolerant society

    Directory of Open Access Journals (Sweden)

    Dryga Svetlana

    2016-01-01

    Full Text Available The article concentrates on potential capabilities for the development of sustainable tourism, as well as its role in the formation of tolerant social relations. The authors revealed the profound impact of sustainable and hike tourism on emergence of the phenomenon ‘new tourist’. They also offered the description of levels of tolerance and their influence on the sustainable tendencies in modern tourism. There is a growing trend for tourism in modern international community to act as a high-powered regulator of socio-cultural relations and, simultaneously, as the crucial factor of counteraction to that xenophobia. A head-on clash of local and foreign cultures, which is an integral part of the very notion of tourism, is not supposed to assume itself in highly extreme forms, with the air of predominance of any of them, moreover, to be based on national, racial, religious, linguistic or educational differences. To put the idea across more efficiently, the authors resorted to exploiting such useful tools as the analysis and synthesis methodology, as well as that of comparison and prognostics. What is produced in the outcome of this study is revealing and emphasizing the levels of tolerance, characterizing the uneasy interrelationships between the so-called ‘new’ tourists and local community. The research findings could find practical applications for designing of new tourist products and elaborating of new networks of footpaths for walking tours.

  16. 'Energy for a sustainable society'. Recommendations of the Panel

    International Nuclear Information System (INIS)

    1997-10-01

    On June 18 and 19, 1997, The Norwegian Research Council arranged a series of national conferences on sustainable development. A panel has followed up the conferences with the present report. The priority is on issues of importance for the development of policies and political means in the climate area. This is because the climate challenges are essential for a sustainable global development. Without doubt, it takes long for the temperature of the atmosphere to stabilise after a change in the CO 2 content, several decades. Greatly reduced anthropogenic emissions of greenhouse gases cannot prevent a delayed temperature increase, which calls for precautionary measures. Norwegian policy should be based on the assumption that the emission negotiations will lead to emission restrictions for most of the industrialised countries. However, one-sided focus on national emission goals may lead to unwanted increase in other countries' emissions following Norwegian decreases. The panel suggests that Norwegian measures should be oriented along the following: (1) Energy efficiency, (2) Social planning, (3) Renewable energy sources, (4) De-carbonisation of fossil energy carriers

  17. 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.

  18. INFORMATION SOCIETY AND FINANCIAL SUSTAINABILITY OF THE ROMANIAN HEALTH SYSTEM

    Directory of Open Access Journals (Sweden)

    TATIANA BOGDAN

    2016-06-01

    Full Text Available The financial sustainability of the health systems often reveals the ability of policy makers to finance healthcare in the face of growing cost pressures, with populations ageing, new technologies and increased patient expectations for healthcare coverage and quality. Thus, the healthcare systems need to reinvent themselves by using innovative financing mechanisms coupled with electronic information and communication systems, while offering greater transparency, flexibility and choice and increasing access to the services available. The paper analyses the healthcare financing models: the national health system, the social insurance or the private insurance model so that the Romanian health care reform should preserve the best elements of its existing system while selectively adapt techniques and processes that seemed to have been successful in other countries. Moreover, the application of information and communication technologies – eHealth offers new possibilities for improving almost every aspect of healthcare, from making medical systems more powerful and responsive to providing better health information to all.

  19. Innovating engineering study programs for a sustainable society

    DEFF Research Database (Denmark)

    Schjær-Jacobsen, Hans; Andersen, Birte Møller; Molin, Jesper

    2011-01-01

    The Danish government as well as regional and municipal authority has issued ambitious goals and plans for building a sustainable future by developing and implementing alternative practices and technological solutions to societal needs. As an educational institution Copenhagen University College ...... mass and earth energy, monitoring and reducing energy consumption in buildings and transport, and application of cradle-to-cradle concepts in product development and manufacturing including circular logistics....... in order to comply with society’s ambitions. Further, the new learning elements introduced in the curriculum of study programs are described and examples of theoretical and practical implementations of specific technical solutions developed by the students are presented. Focus is on such areas as wind, bio...

  20. Sustaining Tunisian SMEs' Competitiveness in the Knowledge Society

    Science.gov (United States)

    Del Vecchio, Pasquale; Elia, Gianluca; Secundo, Giustina

    The paper aims to contribute to the debate about knowledge and digital divide affecting countries' competitiveness in the knowledge society. A survey based on qualitative and quantitative data collection has been performed to analyze the level of ICTs and e-Business adoption of the Tunisian SMEs. The results shows that to increase the SMEs competitiveness is necessary to invest in all the components of Intellectual capital: human capital (knowledge, skills, and the abilities of people for using the ICTs), structural capital (supportive infrastructure such as buildings, software, processes, patents, and trademarks, proprietary databases) and social capital (relations and collaboration inside and outside the company). At this purpose, the LINCET "Laboratoire d'Innovation Numerique pour la Competitivité de l'Entreprise Tunisienne" project is finally proposed as a coherent proposition to foster the growth of all the components of the Intellectual Capital for the benefits of competitiveness of Tunisian SMEs.

  1. Energy for a sustainable post-carbon society

    Directory of Open Access Journals (Sweden)

    Antonio García-Olivares

    2016-09-01

    Full Text Available A feasible way to avoid the risk of energy decline and to combat climate change is to build a worldwide, 100% renewable energy mix. Renewable energy can be scaled up to the range of 12 electric terawatts (TWe if 10% of continental shelves are exploited with floating turbines to depths as low as 225 m, 5% of continents with ground turbines, and 5% of the main deserts with concentrating solar power (CSP farms. However, a globally electrified economy cannot grow much above 12 TWe without approaching the limit of terrestrial copper reserves. New photovoltaic silicon panels do not use silver metallization pastes and could contribute up to 1 TW of decentralized residential power. Hydroelectricity has a potential of 1 TW but a fraction of this would have to be sacrificed for energy storage purposes. Hydro, CSP, wave energy and grid integration at continental scales may be sufficient to fit supply to demand, avoiding intermittency. The renewable energy mix would have an energy return on energy invested about 18, which is 25% lower than the estimated present one. That should be sufficient to sustain an industrialized economy provided that the substitution of electricity for fossil fuels is done intelligently.

  2. Social Media Research, Human Behavior, and Sustainable Society

    Directory of Open Access Journals (Sweden)

    Quan Li

    2017-03-01

    Full Text Available A bibliometric analysis was conducted to review social media research from different perspectives during the period of 2008–2014 based on the Science Citation Index and Social Science Citation Index database. Using a collection of 10,042 articles related to social media, the bibliometric analysis revealed some interesting patterns and trend of the scientific outputs, major journals, subject categories, spatial distribution, international collaboration, and temporal evolution in keywords usage in social media studies. The research on social media has been characterized by rapid growth and dynamic collaboration, with a rising number of publications and citation. Communication, Sociology, Public, Environment & Occupational Health, Business, and Multidisciplinary Psychology were the five most common categories. Computers in Human Behavior was the journal with the most social media publications, and Computers & Education ranked first according to the average citations. The two most productive countries were the U.S. and UK, delivering about half of the publications. The proportion of China’s internationally collaborative publications was the highest. The University of Wisconsin, the University of Michigan, and Harvard University were three most productive institutions. Several keywords, such as “Facebook”, “Twitter”, “communication”, “Social Networking Sites”, “China”, “climate change”, “big data” and “social support” increasingly gained the popularity during the study period, indicating the research trends on human behavior and sustainability.

  3. Visualizing the application of GIS in transformation towards a sustainable development and a low carbon society

    International Nuclear Information System (INIS)

    Ahmad, M H; Ariffin, A; Malik, T A

    2014-01-01

    A strategy for sustainable development is a significant milestone on the road to a more socially, economically and environmentally responsible society. It creates a framework within which the stakeholders can make a strong contribution to a better future. Because of the merits and growing interest in sustainable development, the race is on for researchers and stakeholders in the construction sector to initiate actions to reduce the negative impacts of development and sharpen their competitive edge. The cities should be created with a vision which supports harmonious communities and living conditions through sustainable urban development. The resources must be used efficiently while reducing the development impact on human health and environment during the buildings' life cycle. Environmental auditing and pressure-state response based models to monitor sustainable development in Malaysia should be developed. A data availability and sharing system should be developed and implemented to facilitate for the use in the establishment of sustainable development and low carbon society. Ideas which affect millions of people and guide the policies of nations must be accessible to all. Only thus can they permeate the institutions from the local to the global level. Creating sustainable development and low carbon societies depends on the knowledge and involvement of all stakeholders in the industry. So what is our level of understanding of GIS and its application? The development of geospatial data in Malaysia is important because the successful implementation of sustainable development and low carbon projects depend largely on the availability of geospatial information. It would facilitate the stakeholders and resolve some of the problems regarding the availability, quality, organisation, accessibility and sharing of spatial information. The introduction of GIS may change the way for better sustainable urban development and low carbon society performance. The use of GIS

  4. Visualizing the application of GIS in transformation towards a sustainable development and a low carbon society

    Science.gov (United States)

    Ahmad, M. H.; Ariffin, A.; Malik, T. A.

    2014-02-01

    A strategy for sustainable development is a significant milestone on the road to a more socially, economically and environmentally responsible society. It creates a framework within which the stakeholders can make a strong contribution to a better future. Because of the merits and growing interest in sustainable development, the race is on for researchers and stakeholders in the construction sector to initiate actions to reduce the negative impacts of development and sharpen their competitive edge. The cities should be created with a vision which supports harmonious communities and living conditions through sustainable urban development. The resources must be used efficiently while reducing the development impact on human health and environment during the buildings' life cycle. Environmental auditing and pressure-state response based models to monitor sustainable development in Malaysia should be developed. A data availability and sharing system should be developed and implemented to facilitate for the use in the establishment of sustainable development and low carbon society. Ideas which affect millions of people and guide the policies of nations must be accessible to all. Only thus can they permeate the institutions from the local to the global level. Creating sustainable development and low carbon societies depends on the knowledge and involvement of all stakeholders in the industry. So what is our level of understanding of GIS and its application? The development of geospatial data in Malaysia is important because the successful implementation of sustainable development and low carbon projects depend largely on the availability of geospatial information. It would facilitate the stakeholders and resolve some of the problems regarding the availability, quality, organisation, accessibility and sharing of spatial information. The introduction of GIS may change the way for better sustainable urban development and low carbon society performance. The use of GIS is to

  5. Operationalising the Sustainable Knowledge Society Concept through a Multi-dimensional Scorecard

    Science.gov (United States)

    Dragomirescu, Horatiu; Sharma, Ravi S.

    Since the early 21st Century, building a Knowledge Society represents an aspiration not only for the developed countries, but for the developing ones too. There is an increasing concern worldwide for rendering this process manageable towards a sustainable, equitable and ethically sound societal system. As proper management, including at the societal level, requires both wisdom and measurement, the operationalisation of the Knowledge Society concept encompasses a qualitative side, related to vision-building, and a quantitative one, pertaining to designing and using dedicated metrics. The endeavour of enabling policy-makers mapping, steering and monitoring the sustainable development of the Knowledge Society at national level, in a world increasingly based on creativity, learning and open communication, led researchers to devising a wide range of composite indexes. However, as such indexes are generated through weighting and aggregation, their usefulness is limited to retrospectively assessing and comparing levels and states already attained; therefore, to better serve policy-making purposes, composite indexes should be complemented by other instruments. Complexification, inspired by the systemic paradigm, allows obtaining "rich pictures" of the Knowledge Society; to this end, a multi-dimensional scorecard of the Knowledge Society development is hereby suggested, that seeks a more contextual orientation towards sustainability. It is assumed that, in the case of the Knowledge Society, the sustainability condition goes well beyond the "greening" desideratum and should be of a higher order, relying upon the conversion of natural and productive life-cycles into virtuous circles of self-sustainability.

  6. SUSTAINING CLIMATE CHANGE MITIGATION—POLICY, TECHNOLOGY, AND SOCIETY

    Directory of Open Access Journals (Sweden)

    Andreas Rechkemmer

    2010-01-01

    Full Text Available In a world that is becoming more and more exposed and vulnerable to the effects of global climate change, combining integrated risk assessment tools with effective strategies for both mitigation and adaptation is a key prerogative for policy-making. With the focus of both researchers and decision-makers gradually shifting from observing and assessing the bio-physical aspects of climate change to a more human and society centered understanding of the nature of the problem, the social, behavioral, economic and technological aspects have entered center stage of the public discourse. Responses to the climate change challenge have to establish an optimal interplay between mitigation, adaptation and socio-economic instruments. Yet, given the band-width and scale of the climate problematique and its projected impacts, very ambitious mitigation measures have to be undertaken without delays, a fact that is particularly true for emerging economies with their very rapid and unprecedented growth rates, both in GDP and GHG emissions terms. The challenge for the next years is to harmonize poverty eradication and attaining the Millenium Development Goals through stable economic growth with mitigating the effects of climate change. Therefore, “inclusive green growth” has become the motto of the day. But how can this goal be achieved? Obviously, quite fundamental changes have to be introduced that affect both the production and the consumption sectors and allow for real innovation in technologies and energy, in urban mobility, infrastructure and transportation grids. This paper illustrates the deep social and societal nature of climate change response strategies, especially in the area of mitigation, and shows that transitions to green and low-carbon economies will have to embed policies, incentive schemes and economic instruments in a larger societal context of social learning and behavioral change.

  7. CONSEQUENCES OF ORGANIC FARMING ON THE SUSTAINABLE SOCIETY - ROMANIA AND EU

    Directory of Open Access Journals (Sweden)

    BURJA CAMELIA

    2017-02-01

    Full Text Available A major trend adopted by the European Union member countries that are making efforts for sustainable development is the development of organic farming. The article studies the influences generated by the organic farming development in the EU countries, in the period 2006-2014, in terms of sustainable society. The statistical analysis is based on the use of certain variables that have a significant influence on the components of sustainable society. The identification of estimators for panelling data showed the favourable consequences of increasing the organic area for many indicators underpinning the economic, environmental and human wellbeing. The results confirm that the organic farming is a viable alternative to the conventional agriculture for raising the quality of life. The paper essentially quantifies the multiple effects of the organic farming for sustainable development and demonstrates that one of the directions to accelerate the development of the European economy on a sustainable basis is to stimulate the organic farming.

  8. 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.

  9. Business travel and sustainability. Part III. In: Handbook of Sustainable Travel: People, Society, and Transportation Systems

    OpenAIRE

    AGUILERA, Anne

    2013-01-01

    Business travel has been relatively neglected in strategies to promote sustainable travel. A two-stage approach is taken beginning by showing how sustainability of business travel is relevant not only environmentally, but also from an economic and social perspective. On the one hand, this form of travel helps to generate jobs in numerous business sectors, not only in transportation. On the other hand, the social dimension cannot be ignored either, since business travel is often a source of fa...

  10. Environmental Sustainability of Gm Crops for Food Safety on Risk Society

    Directory of Open Access Journals (Sweden)

    Gil Ramos de Carvalho Neto

    2016-10-01

    Full Text Available GM crops are presented as an alternative to the erradication of hunger. The risk society, however, considering the brazilian environmental law - specially the brazilian legislation on biosafety - the food safety and nutritional law and the economic and social data on the subject, it appears that the environmental sustainability of these crops is not yet complete. Producers should adopt additional safeguards if they wish a sustainable agriculture with effective food security.

  11. Implementing Sustainability Co-Creation between Universities and Society: A Typology-Based Understanding

    Directory of Open Access Journals (Sweden)

    Gregory Trencher

    2017-04-01

    Full Text Available Universities are under mounting pressure to partner with societal stakeholders and organizations to collaboratively create and implement sustainability-advancing knowledge, tools, and societal transformations. Simultaneously, an increasing number of societal organizations are reaching out to partner with universities to achieve organizational objectives and increase the effectiveness of strategies to further societal sustainability. Using a conceptual framework of “sustainability co-creation”, this study empirically examines the historical and ongoing experiences of five organizations in Japan that actively partner with universities to enhance sustainability activities and strategies to transform society. We examine motivations for partnering with universities, innovative models of practice, factors hampering the co-creative potential of the university, and desired changes to overcome these. Our empirical study leads to the proposal of a typology that might assist in categorizing and understanding key attributes of differing types of sustainability co-creation. We build our typology from two perspectives: First, in terms of the primary objective of the co-creation (ranging from knowledge production to the transformation of society, and second, in terms of the approach taken (ranging from either socially or technologically-centered. We then reflect on the organizations’ experiences to offer several strategies that could increase the effectiveness of the university when partnering with stakeholders in sustainability co-creation. We also highlight several factors effecting the university’s capacity to move beyond knowledge production towards implementation measures to transform society with external stakeholders.

  12. Toward a Sustainable Society in the Mena (Middle East and North Africa) Region: Roadmap and Priorities

    Science.gov (United States)

    El-Bassiouny, Noha

    2012-01-01

    The Business and Society Research Cluster (BSRC) at the German University in Cairo, the El-Khazindar Business Research and Case Center at the American University in Cairo and Misr El-Kheir (MEK) Foundation, Egypt, hosted the region's first sustainability and corporate social responsibility (CSR) case studies conference, entitled "Toward a…

  13. COOPERATION AND SUSTAINABILITY CASE STUDY OF A SOCIETY OF SOCIAL SOLIDARITY

    Directory of Open Access Journals (Sweden)

    Graciela Carrillo González

    2013-04-01

    Full Text Available Sustainability studies have been addressed from an economic, social, cultural, and environmental point of view. They have exceeded dimensions and developed mechanisms, which have involved various elements to establish cooperation and social networks. The aim of this paper is to analyze cooperation and establishment of farmers' organizations as critical factors in achieving sustainable local projects oriented to reforestation and land recovery, illustrating with the case of a triple S (Society of Social Solidarity, in the town of Zapotitlan Lagunas in the State of Oaxaca. Positive effects derived from these kinds of societies are reforestation in the area, land recovery, consolidation of social relationships and job creations. Therefore, thinking and acting locally is a condition to positively impact on the environment and add a social and economic vision can contribute to sustainability.

  14. Tunisia-Japan Symposium: R&D of Energy and Material Sciences for Sustainable Society

    Science.gov (United States)

    Akimoto, Katsuhiro; Suzuki, Yoshikazu; Monirul Islam, Muhammad

    2015-04-01

    This volume of the Journal of Physics: Conference Series contains papers presented at the Tunisia-Japan Symposium: R&D of Energy and Material Sciences for Sustainable Society (TJS 2014) held at Gammarth, Republic of Tunisia on November 28-30, 2014. The TJS 2014 is based on the network of the Tunisia-Japan Symposium on Science, Society and Technology (TJASSST) which has been regularly organized since 2000. The symposium was focused on the technological developments of energy and materials for the realization of sustainable society. To generate technological breakthrough and innovation, it seems to be effective to discuss with various fields of researchers such as solid-state physicists, chemists, surface scientists, process engineers and so on. In this symposium, there were as many as 109 attendees from a wide variety of research fields. The technical session consisted of 106 contributed presentations including 3 plenary talks and 7 key-note talks. We hope the Conference Series and publications like this volume will contribute to the progress in research and development in the field of energy and material sciences for sustainable society and in its turn contribute to the creation of cultural life and peaceful society.

  15. LOCAL WISDOM OF SABANG ISLAND SOCIETY (ACEH, INDONESIA IN BUILDING ECOLOGICAL INTELLIGENCE TO SUPPORT SUSTAINABLE TOURISM

    Directory of Open Access Journals (Sweden)

    Dian ASWITA

    2018-05-01

    Full Text Available One of the existing natural and environmental uses in Aceh (Indonesia is tourism. One of the aspects that determine the development and sustainability of tourism is the institutional and community aspects. Sustainable tourism is a picture of the ecosystem sustainability and socio-economic development of the community. This study aims to reveal and find local wisdom practices and explore local knowledge owned by Sabang Island community in the management and conservation of the environment so as to support the realization of sustainable tourism. This study uses rationalistic paradigm and uses qualitative research method. The data that has been collected is analyzed descriptively. Local wisdom and local knowledge are reflected in how society has a unique way of looking at and understanding nature and interacting with it. In the Aceh community, there are customary institutions that regulate the rules or interactions of the community with the environment, including “panglima laot”, “keujreun blang”, “peutua seuneubok”, “pawang glee or peutua uteun”, “haria peukan” and “syahbanda”. Local wisdom and local knowledge have great potential in maintaining, preserving and sustainability of the environment used by communities to meet their living needs. Ecological, social and religious intelligence formed through local wisdom and local knowledge can be an aspect in maintaining environmental sustainability in order to build sustainable tourism on Sabang Island.

  16. Role of Mass Media in the Disaster Preparedness and Sustainable Development of Society

    International Nuclear Information System (INIS)

    Seid-Aliyeva, Dinara E.

    2006-01-01

    Better understanding of the causes and effects of large earthquakes can assists in mitigation of damage and loss of lives as a result of destructive natural events. Well-informed and educated population living in geological hazard-prone regions can reduce catastrophic consequences of natural disasters and guaranty the sustainable development of healthy society. A development of information service for disaster management is of importance in reduction of the disaster's consequences

  17. Beyond the Conflict and Weak Civil Society; Stories from Ukraine: Cases of Grassroots Initiatives for Sustainable Development

    Directory of Open Access Journals (Sweden)

    Oksana Udovyk

    2017-09-01

    Full Text Available This study explores the diversity of grassroots initiatives (GIs for sustainable development that are emerging in post-EuroMaidan Ukraine. It first focuses on an overview of different theories on civil society and trends in Ukrainian civil society development. Eight cases of GIs are selected to represent different pillars of sustainability work done by the initiatives (economic, social, environmental, and political-institutional. These cases question the arguments behind the weak and pseudo-plenipotentiary vision of civil society in Ukraine, and demonstrate mechanisms of sustainable development suggested by analyzed GIs. In general, this study challenges the myth of a weak civil society in Ukraine, opens up a broader discussion on the meaning and role of civil society, and provides new ideas for building a sustainable society.

  18. Sustainable and participatory society for the realization of urban settlement (Case study: Green kampong, Malang City)

    Science.gov (United States)

    Purnamasari, W. D.; Kirana, V.; Wardhani, D. K.

    2017-06-01

    Green Kampong is one of the participatory development to conserve our environment. RW 03 Sukun, Malang City has chosen by researcher become case study because it has be successful to obtain a predicate as “Green Kampong” by following environmental management contests through the participatory society. There was some purpose of this study. The first aim was to find out the level of participation at every kind of the social activities such as waste separation for households, bio-pores project, stone massage therapy on the road, and other greening acts. The second aim was to evaluate the level for sustainable society which consists of: the leadership, the social capital, the internal controls activity, the use of technology, and also the finance of physical development in green kampong. The researcher has used the scoring and schema methods in this study. The result showed that the activity that has reached the maintenance phase are sorting waste and greening, whilst the activity that only reached the stage of control are bio-pores development and stone therapy. The social activities with highest participation was taken by greening act and the lowest was taken by bio-pores project. The sustainability of the community rw 03 Sukun known that of the five components aspects the sustainability of, three of whom were have achieved good progress toward the sustainability of the aspects leadership, social capital, and technology facilities and infrastructure while two aspects of whom were still achieved a good start toward sustainability of the aspects monitoring and evaluation and financing.

  19. Transdisciplinary Challenges for Sustainable Management of Mediterranean Landscapes in the Global Information Society

    Directory of Open Access Journals (Sweden)

    Zev Naveh

    2009-11-01

    Full Text Available The present chaotic transformation from the industrial to the global information society is accelerating the ecological, social and economic unsustainability. The rapidly growing unsustainable, fossil energy powered urbanindustrial technosphere and their detrimental impacts on nature and human well-being are threatening the solar energy powered natural and seminatural biosphere landscapes and their vital ecosystem services. A sustainability revolution is therefore urgently needed, requiring a shift from the „fossil age“ to the „solar age“ of a new world economy, coupled with more sustainable lifestyles and consumption patterns. The sustainable future of viable multifunctional biosphere landscapes of the Mediterranean Region and elsewhere and their biological and cultural richness can only be ensured by a post-industrial symbiosis between nature and human society. For this purpose a mindset shift of scientists and professionals from narrow disciplinarity to transdisciplinarity is necessary, dealing with holistic land use planning and management, in close cooperation with land users and stakeholders. To conserve and restore the rapidly vanishing and degrading Mediterranean uplands and highest biological ecological and cultural landscape ecodiversity, their dynamic homeorhetic flow equilibrium, has to be maintained by continuing or simulating all anthropogenic processes of grazing, browsing by wild and domesticated ungulates. Catastrophic wildfires can be prevented only by active fire and fuel management, converting highly inflammable pine forests and dense shrub thickets into floristically enriched, multi- layered open woodlands and recreation forests.

  20. Towards Sustainable Lifestyles. A Variety of Lifestyles for a Post-carbon Society

    International Nuclear Information System (INIS)

    Huber, Andreas; Le Marre, Pierre; Girard, Sebastien

    2013-01-01

    In 2009 a programme 'Re-thinking Society in a Post-carbon Society'- steered jointly by the Foresight Department of the French Ecology Ministry and the French Environment and Energy Management Agency (ADEME), was launched in France. It is still ongoing and aims to produce a final report in 2013. The idea of a transition towards a 'post- carbon' society includes four main objectives: reducing greenhouse gas emissions by 2050 to one quarter of what they were in 1990; near-autonomy with regard to carbon energies (petrol, gas, coal); an adequate capacity to adapt to climate change and, lastly, greater attention to situations of 'energy precariousness'. As part of the dossier Futuribles is devoting to this programme this month, Andreas Huber, Sebastien Girard and Pierre Le Marre lay out in this article the results of the studies they have carried out on 'sustainable urban milieus'. After a presentation of the notion of 'milieu' (based here on a segmentation using the Socio-milieus R method) and of the typology employed (nine main social milieus, three emergent milieus and 16 contrasting profiles), the authors show the extent to which individuals' carbon foot - prints vary, depending upon lifestyles, and what a determining effect these lifestyles have in the fields of housing and transport. They then specify the various factors influencing behaviour in the direction of sustain - able consumption (or not) and the different types of strategies of intervention that are likely to modify those behaviours. Lastly, they detail two targeted strategies, one aimed at the 'precarious seniors' milieu and the other at the 'eco-elite' milieu. Despite certain imperfections that remain to be sorted out in the study of sustainable urban milieus, these studies open up new perspectives for the development of sociologically targeted policies for a post-carbon transition. (authors)

  1. Sustainable development in city districts: BaLaLuZ project - Society; Schlussbericht 'Gesellschaft' - Phase 1

    Energy Technology Data Exchange (ETDEWEB)

    Arend, M

    2004-07-01

    This final report for the Swiss Federal Office of Energy (SFOE) is one of a series of reports concerning municipal development in various cities in Switzerland. The four city districts involved include Basel (Gundeldinger Feld), Lausanne (Bellevaux), Lucerne (Basel-/Bernstrasse) and Zurich (Werdwies). This paper takes a look at society aspects in the four districts and examines the factors that influence the sustainable development of the districts. Topics discussed include basic residential needs, safety, health, and supply along with culture and education. Also examined are the possible topics equality and fairness and participation along with geographical reference and neighbourhood relations. A project for this area of investigation is suggested.

  2. Globalization of the economy and women's work in a sustainable society.

    Science.gov (United States)

    Mies, M

    1998-01-01

    This article critiques theories of development and growth models, which are not compatible with conservation of resources, women's empowerment, and a sustainable society. Affluent societies are using up most of the world's resources in unsustainable ways. Industrial giants have co-opted the term "sustainability." This gender discussion addresses the issue of patriarchal and capitalist systems and presents a new theoretical framework. The author disagrees with the global division of labor, where women are manipulated as producer-housewives and consumer-housewives, and with the global level of violence against women, in general. Gender equality is not viable in the present patriarchal order. In all economic theories, women's work is a free resource and invisible as unpaid housework and nurturing work. The globalization of the economy leads to greater capital and power concentration in the hands of a few. Women are ill served by structural adjustment policies. New global restructuring has improved the welfare of Third World elites. Globalization of capital and new technology makes ethics obsolete. A new economic model must be based on the preservation of life at the center, with livelihood based on wage labor and unpaid work, control of communal assets, and solidarity of communities. Unpaid necessary social labor must be shared by men and women equally. The checklist for change includes, for example, that money would be a means of circulation, not of accumulation. Nature would be reintegrated into economics. There must be new meanings for work, productive labor, economics, the good life, satisfaction of needs, and political structures.

  3. A randomised controlled trial and cost-effectiveness evaluation of 'booster' interventions to sustain increases in physical activity in middle-aged adults in deprived urban neighbourhoods.

    Science.gov (United States)

    Goyder, Elizabeth; Hind, Daniel; Breckon, Jeff; Dimairo, Munyaradzi; Minton, Jonathan; Everson-Hock, Emma; Read, Simon; Copeland, Robert; Crank, Helen; Horspool, Kimberly; Humphreys, Liam; Hutchison, Andrew; Kesterton, Sue; Latimer, Nicolas; Scott, Emma; Swaile, Peter; Walters, Stephen J; Wood, Rebecca; Collins, Karen; Cooper, Cindy

    2014-02-01

    More evidence is needed on the potential role of 'booster' interventions in the maintenance of increases in physical activity levels after a brief intervention in relatively sedentary populations. To determine whether objectively measured physical activity, 6 months after a brief intervention, is increased in those receiving physical activity 'booster' consultations delivered in a motivational interviewing (MI) style, either face to face or by telephone. Three-arm, parallel-group, pragmatic, superiority randomised controlled trial with nested qualitative research fidelity and geographical information systems and health economic substudies. Treatment allocation was carried out using a web-based simple randomisation procedure with equal allocation probabilities. Principal investigators and study statisticians were blinded to treatment allocation until after the final analysis only. Deprived areas of Sheffield, UK. Previously sedentary people, aged 40-64 years, living in deprived areas of Sheffield, UK, who had increased their physical activity levels after receiving a brief intervention. Participants were randomised to the control group (no further intervention) or to two sessions of MI, either face to face ('full booster') or by telephone ('mini booster'). Sessions were delivered 1 and 2 months post-randomisation. The primary outcome was total energy expenditure (TEE) per day in kcal from 7-day accelerometry, measured using an Actiheart device (CamNtech Ltd, Cambridge, UK). Independent evaluation of practitioner competence was carried out using the Motivational Interviewing Treatment Integrity assessment. An estimate of the per-participant intervention costs, resource use data collected by questionnaire and health-related quality of life data were analysed to produce a range of economic models from a short-term NHS perspective. An additional series of models were developed that used TEE values to estimate the long-term cost-effectiveness. In total, 282 people were

  4. Landscapes of Lost Energy: Counterfactual Geographical Imaginary for A More Sustainable Society

    Directory of Open Access Journals (Sweden)

    van der Horst Dan

    2014-07-01

    Full Text Available The quest for sustainable energy, one of the greatest challenges of the 21st century, calls for more input from academics than 'simply' producing good science. Geographical imaginations are as old as storytelling and mapmaking, but this essay is neither about 'long ago and far away', nor about utopian energy futures. This is a call to geographers to engage with 'alternative present' energy scenarios, using the full range of analytical and discursive tools at our disposal. Drawing on a diverse tradition of imagined spaces and the awareness of absences (material, relational or otherwise, geographers should be able to contribute to the quest for a more sustainable society by assessing, envisaging, and communicating a counterfactual 'here and now', based on good practices existing right now, but not (yet right here. We need to understand how much more sustainable our bit of the planet would be if we could just, environmentally speaking, 'keep up' with the best of our neighbours. This counterfactual present should be seen as neither radical nor utopian, because it only assumes the historic adoption of best practices which we now know to be feasible and successful. And if thi alternative current scenario looks radically different from the 'real' state we are in, then this goes to show how radically unsustainable our business-as-usual approach has been.

  5. Challenges to achievement of metal sustainability in our high-tech society.

    Science.gov (United States)

    Izatt, Reed M; Izatt, Steven R; Bruening, Ronald L; Izatt, Neil E; Moyer, Bruce A

    2014-04-21

    Achievement of sustainability in metal life cycles from mining of virgin ore to consumer and industrial devices to end-of-life products requires greatly increased recycling rates and improved processing of metals using conventional and green chemistry technologies. Electronic and other high-tech products containing precious, toxic, and specialty metals usually have short lifetimes and low recycling rates. Products containing these metals generally are incinerated, discarded as waste in landfills, or dismantled in informal recycling using crude and environmentally irresponsible procedures. Low recycling rates of metals coupled with increasing demand for high-tech products containing them necessitate increased mining with attendant environmental, health, energy, water, and carbon-footprint consequences. In this tutorial review, challenges to achieving metal sustainability, including projected use of urban mining, in present high-tech society are presented; health, environmental, and economic incentives for various government, industry, and public stakeholders to improve metal sustainability are discussed; a case for technical improvements, including use of molecular recognition, in selective metal separation technology, especially for metal recovery from dilute feed stocks is given; and global consequences of continuing on the present path are examined.

  6. The Impact of Brands on People, Markets and Society : Build Bridge Bond Method for Sustainable Brand Leadership

    NARCIS (Netherlands)

    Schoppen, Hendrik Sietze

    2017-01-01

    The Impact of Brands on People, Markets and Society Build Bridge Bond Method for Sustainable Brand Leadership Authorized translation of the chapter ‘Impact of brands on people, markets and society’ (prepublication Build Bridge Bond, method for sustainable leadership and building future-proof trust)

  7. The contribution of the European Society for Soil Conservation (ESSC) to scientific knowledge, education and sustainability

    Science.gov (United States)

    Dazzi, Carmelo; Fullen, Michael A.; Costantini, Edoardo A. C.; Theocharopoulos, Sid; Rickson, Jane; Kasparinskis, Raimonds; Lo Papa, Giuseppe; Peres, Guenola; Sholten, Thomas; Kertész, Adam; Vasenev, Ivan; Dumitru, Mihail; Cornelis, Wim; Rubio, José L.

    2017-04-01

    Soil is an integral component of the global environmental system that supports the quality and diversity of terrestrial life on Earth. Therefore, it is vital to consider the processes and impacts of soil degradation on society, especially on the provision of environmental goods and services, including food security and climate change mitigation and adaptation. Scientific societies devoted to Soil Science play significant roles in promoting soil security by advancing scientific knowledge, education and environmental sustainability. The European Society for Soil Conservation (ESSC) was founded in Ghent (Belgium) on 4 November 1988 by a group of 23 researchers from several European countries. It is an interdisciplinary, non-political association with over 500 members in 56 countries. The ESSC produces and distributes a hardcopy Newsletter twice a year and maintains both a website and Facebook page: http://www.soilconservation.eu/ https://www.facebook.com/European-Society-for-Soil-Conservation-ESSC-100528363448094/ The ESSC aims to: • Support research on soil degradation, soil protection and soil and water conservation. • Provide a network for the exchange of knowledge about soil degradation processes and soil conservation research and practises. • Produce publications on major issues relating to soil degradation and soil and water conservation. • Advise regulators and policy-makers on soil issues, especially soil degradation, protection and conservation. The ESSC held its First International Congress in Silsoe (UK) in 1992. Further International Congresses were held in Munich (1996), Valencia (2000), Budapest (2004), Palermo (2007), Thessaloniki (2011) and Moscow (2015). The Eighth International Congress will be held in Lleida (Spain) in June 2017: http://www.consowalleida2017.com/ Interspersed between these international congresses, the ESSC organizes annual international conferences on specific topics. These include Imola, Italy (Biogeochemical Processes at

  8. 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.

  9. WATER SUPPLY PIPE REPLACEMENT CONSIDERING SUSTAINABLE TRANSITION TO POPULATION DECREASED SOCIETY

    Science.gov (United States)

    Hosoi, Yoshihiko; Iwasaki, Yoji; Aklog, Dagnachew; Masuda, Takanori

    Social infrastructures are aging and population is decreasing in Japan. The aged social infrastructures should be renewed. At the same time, they are required to be moved into new framework suitable for population decreased societies. Furthermore, they have to continue to supply sufficient services even during transition term that renewal projects are carried out. Authors propose sustainable soft landing management of infrastructures and it is tried to apply to water supply pipe replacement in this study. Methodology to replace aged pipes not only aiming for the new water supply network which suits for population decreased condition but also ensuring supply service and feasibility while the project is carried out was developed. It is applied for a model water supply network and discussions were carried out.

  10. Toward commercialization of FBR cycle (1). Promotion of R and D on technologies maintaining sustainable society

    International Nuclear Information System (INIS)

    Nagaoki, Yoshihiro; Nagura, Fuminori; Sakaguchi, Tomoyoshi; Kawasaki, Hirotsugu; Kikuchi, Shin

    2008-01-01

    The FBR cycle is a key technology maintaining a sustainable society through efficient utilization of limited uranium resources and conformance to global environmental protection. The domestic and overseas R and D of the FBR cycle entered on a new phase aiming at its commercialization and JAEA started the Fast Reactor Cycle Technology Development (FaCT) project. The FaCT project targeted at international standardization of the FBR fuel cycle and promoting the advanced R and D on the innovative technologies to increase cost-efficiency and reliability for the commercialization under international competition and cooperation. The combination of a sodium cooled FBR and advanced fuel cycle system with advanced aqueous reprocessing and simplified pelletizing fuel fabrication was selected a major concept. (T. Tanaka)

  11. @AACAnatomy twitter account goes live: A sustainable social media model for professional societies.

    Science.gov (United States)

    Benjamin, Hannah K; Royer, Danielle F

    2018-05-01

    Social media, with its capabilities of fast, global information sharing, provides a useful medium for professional development, connecting and collaborating with peers, and outreach. The goals of this study were to describe a new, sustainable model for Twitter use by professional societies, and analyze its impact on @AACAnatomy, the Twitter account of the American Association of Clinical Anatomists. Under supervision of an Association committee member, an anatomy graduate student developed a protocol for publishing daily tweets for @AACAnatomy. Five tweet categories were used: Research, Announcements, Replies, Engagement, and Community. Analytics from the 6-month pilot phase were used to assess the impact of the new model. @AACAnatomy had a steady average growth of 33 new followers per month, with less than 10% likely representing Association members. Research tweets, based on Clinical Anatomy articles with an abstract link, were the most shared, averaging 5,451 impressions, 31 link clicks, and nine #ClinAnat hashtag clicks per month. However, tweets from non-Research categories accounted for the highest impression and engagement metrics in four out of six months. For all tweet categories, monthly averages show consistent interaction of followers with the account. Daily tweet publication resulted in a 103% follower increase. An active Twitter account successfully facilitated regular engagement with @AACAnatomy followers and the promotion of clinical anatomy topics within a broad community. This Twitter model has the potential for implementation by other societies as a sustainable medium for outreach, networking, collaboration, and member engagement. Clin. Anat. 31:566-575, 2018. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  12. Sustainable development tables for science teachers training within the information society

    Energy Technology Data Exchange (ETDEWEB)

    Horta, L.M.P. [Portuguese Ministry of Education' s Secondary School at Sabugal, Sabugal (Portugal)

    2006-07-01

    Certain essential criteria are needed to achieve sustainable development. These include information about the benefits of investment and public awareness about environmental education, training, appropriate energy technologies, energy storage strategies, the availability of renewable energy sources and cleaner technologies. This paper reported on the value of the Internet in providing new opportunities to both students and teachers to improve their knowledge in renewable energy technologies and environment awareness. The Internet provides a starting point for pedagogical projects. The Internet's capability of providing ideas for secondary and post secondary teachers in chemistry, physics, biology, and engineering was discussed with reference to the Science Technology and Society (Environmental) approach in the Portuguese National Education Curriculum. The approach provides opportunities for improving the image of science to students and offers the use of laboratory experiments to motivate students. It was concluded that public awareness and education on issues concerning sustainable development, such as renewable energies, energy efficiency, can be promoted by the Internet. 106 refs., 2 tabs.

  13. The perspective of sustainability in networked knowledge society: governance, education, ethics

    Directory of Open Access Journals (Sweden)

    Pilar AZNAR MINGUET

    2013-12-01

    Full Text Available This article aims to stimulate thinking about entering the perspective of sustainability in new information societies and knowledge supported by ICTs, and characterized by globalization is far from inclusive. It involves the construction of a global system that promotes the pursuit of environmental quality, social justice and an equitable economy and viable long term. UNESCO has identified three basic ways to get it: governance, education and ethics.Governance can promote equitable social connectivity, changes in patterns of production and consumption and application search and real solutions to the socio-environmental. Education can foster continuing education of those critical, responsible and committed attitudes of respect and harmony with the natural and social environment, international organizations like the OECD, UN and governments through the development of their educational systems, have shaped the competency-based training model, including skills for sustainability are key consider. And all from ethical approaches to guide human capacity to think, act and promote the defense of life on our planet.

  14. Building a Sustainable Society: The Necessity to Change the Term 'Consumer'

    Directory of Open Access Journals (Sweden)

    Sabrina Chakori

    2017-10-01

    Full Text Available The profit-seeking system leads to many negative environmental impacts. Within this economic system, consumption reflects an important relationship between humans and nature. However, despite the growing international attention to environmental sustainability, our society does not necessarily acknowledge consumerism as the cause of global environmental degradation. Deconstructing the consumption culture and redefining what determines well-being, this paper will attempt to provide a comprehensive overview of the existing definition of people in the economic system. Many authors have defined our role in the economy; however, in terms of customer, citizen-consumer, and socially conscious consumer, most of the literature in this domain remains rooted in consumerism. Consumerism cannot be fixed with further consumerism; therefore this paper discusses the importance of reclaiming our identity and the need to define new terms for people in a new economic system. Any new terms should integrate interests and responsibilities that go beyond simple utility maximization. Moving beyond the term “consumer” will change our worldview. This cultural transformation may help facilitate long-term environmental sustainability.

  15. For sustainable participation by civil society in Europe in the oversight of nuclear activities

    International Nuclear Information System (INIS)

    Delalonde, J.C.

    2010-01-01

    The Aarhus Convention on access to information, public participation in decision-making and access to justice in environmental matters, was signed in 1998 by the European Community and European countries including the 27 Member States of the European Union (EU). That same year, the Committee of the Regions adopted a resolution on nuclear safety and local and regional democracy. These two texts indicate strong political and legal recognition of access to information and participation in the nuclear field. Ten years later, it would seem to be important to observe how these principles are actually implemented. As of 2009, the ANCCLI and the European Commission opened an 18-month European dialogue on the practical application of the Aarhus Convention in the nuclear field. The principle of this approach, called ACN for Aarhus Convention and Nuclear, is to promote feedback about practical application of the Aarhus Convention in the nuclear field in the various European countries, and to share this feedback in order to identify both difficulties and good practices and to initiate progress jointly with the various stakeholders concerned (authorities, civil society, operators, experts, local authorities, etc.). It is also an opportunity to look at the conditions for sustainable participation by civil society in monitoring nuclear issues. (author)

  16. The value of the phenomenon of communication for the sustainable development of modern society

    Directory of Open Access Journals (Sweden)

    O. I. Plaksina

    2016-06-01

    On this basis the substantial potential of communication is determined. A di-verse range of communication’s actions is presented. Communication carries out satisfaction the people’s need in emotional resonance and empathy; penetration into the inner world of Another, co-presence, being «here» and «now» together with Another; integration, unity, feeling part of a whole people and becoming related; finding a certain sense; producing and approving of values, humanization; realiza-tion of the basic human need - to be included in society and culture, i.e., generic quality of sociality which is inherent to man; improvisation, in conjunction with the presence of algorithms in the communication; preventing, overcoming an inferiority of people’s objectivisation, de-objectivisation; counteracting to the massification, standardization, «oversimplification» of consciousness and personality. Thereby this paper shows that communication efficiently overcomes and blocks the most of the challenges/risks, which might lead to instability of the socie-ty’s development in the informational stage of history - the four groups from six groups, which were identified in this article. As a result, the positive influence of communication on the sustainability of modern society in a global scale has been substantiated and proven.

  17. Scalable, sustainable cost-effective surgical care: a model for safety and quality in the developing world, part I: challenge and commitment.

    Science.gov (United States)

    Campbell, Alex; Restrepo, Carolina; Mackay, Don; Sherman, Randy; Varma, Ajit; Ayala, Ruben; Sarma, Hiteswar; Deshpande, Gaurav; Magee, William

    2014-09-01

    With an estimated backlog of 4,000,000 patients worldwide, cleft lip and cleft palate remain a stark example of the global burden of surgical disease. The need for a new paradigm in global surgery has been increasingly recognized by governments, funding agencies, and professionals to exponentially expand care while emphasizing safety and quality. This three-part article examines the evolution of the Operation Smile Guwahati Comprehensive Cleft Care Center (GCCCC) as an innovative model for sustainable cleft care in the developing world. The GCCCC is the result of a unique public-private partnership between government, charity, and private enterprise. In 2009, Operation Smile, the Government of Assam, the National Rural Health Mission, and the Tata Group joined together to work towards the common goal of creating a center of excellence in cleft care for the region. This partnership combined expertise in medical care and training, organizational structure and management, local health care infrastructure, and finance. A state-of-the-art surgical facility was constructed in Guwahati, Assam which includes a modern integrated operating suite with an open layout, advanced surgical equipment, sophisticated anesthesia and monitoring capabilities, central medical gases, and sterilization facilities. The combination of established leaders and dreamers from different arenas combined to create a synergy of ambitions, resources, and compassion that became the backbone of success in Guwahati.

  18. Transition management. Key to a sustainable society; Transitiemanagement. Sleutel voor een duurzame samenleving

    Energy Technology Data Exchange (ETDEWEB)

    Rotmans, J. [International Centre for Integrative Studies ICIS, Universiteit Maastricht, Maastricht (Netherlands)

    2003-07-01

    Via transitions outdated societal systems need to be replaced by new societal and sustainable systems. In this book attention is paid to how the renewal process can be steered. The first part deals with the transition philosophy, while the second part is dedicated to a series of practical examples in the field of water, agriculture, energy, construction, mobility and biodiversity which must bring us to a new, sustainable society. [Dutch] Het creeren van een duurzame samenleving is van levensbelang voor de huidige en toekomstige generaties. Toch krijgt duurzaamheid van de politiek nog steeds niet de aandacht die zij verdient. Dit boek biedt daarom een vernieuwende en uitdagende kijk op deze grote maatschappelijke opgave. Onze tegenwoordige samenleving is verre van duurzaam; ondanks het veelgeroemde 'poldermodel' zijn we er tot nu toe niet in geslaagd de hardnekkige problemen in sectoren als de landbouw, de gezondheidszorg en de energievoorziening het hoofd te bieden. Meer en meer wordt duidelijk dat een duurzame samenleving een echte cultuuromslag vergt. Via transities - maatschappelijke overgangen die tijd, durf en energie vergen - zullen verouderde maatschappelijke systemen (deels) moeten worden afgebroken om vervolgens opnieuw te worden opgebouwd. Dit boek gaat in op de wijze waarop dit noodzakelijke vernieuwingsproces kan worden gestuurd. Het eerste deel behandelt het transitiedenken, inclusief de achterliggende filosofie. In het tweede deel staat het transitiehandelen centraal, aan de hand van een serie praktijkvoorbeelden op de terreinen water, landbouw, energie, de bouwsector, mobiliteit en biodiversiteit. Een inspirerend boek voor iedereen die een bijdrage wil leveren aan de totstandkoming van een nieuwe, duurzame samenleving.

  19. Power Electronics and Renewable Energy Systems – a perfect match for a sustainable society

    Directory of Open Access Journals (Sweden)

    Frede Blaabjerg

    2015-08-01

    Full Text Available The energy consumption is steadily increasing very rapid due to more people on the earth, betterliving conditions as well as we are trying to live in areas where the energy demand is high. Theeconomy growth in the last century has not been possible without low prize of energy which has beenachieved by fossil fuels. Looking into the future – the fossil fuel resources have a time limit – whichcan appear faster than expected – both because of the limited resources but also because the marketcan suddenly increase the prize. Therefore there is a demand to come up with sustainable energysolutions for energy production like wind turbines, hydro power as well as photovoltaics. At the sametime it is evident that by the use of new technology it is possible to make energy saving. In bothsituations power electronics are making this possible – we are using power electronics to interfacerenewable sources to maximize the energy yield from wind turbines and photovoltaics as well assmoothly integrate it to the grid. Also in many applications we use power electronics to interface a loadwith the grid and control the behavior of the electrical equipment according to the demand. In manycases power electronics is able to ensure a large amount of energy saving like in pumps, compressorsas well as in ventilation systems. Also the transportation gain a lot of using electricity instead of fossilfuel – clearly made possible due to the power electronics. Denmark is one of the societies which have been the frontier of implementing the renewabletechnology and has today covered more than 50 % of the electrical energy consumption by means ofrenewable and has as ambition to be fully independent on fossil fuels in 2050. Already in 2035 100 %of the electricity will be covered by renewables. At the same time the energy consumption has notreally increased for 20 years despite the GDP has grown by more than 60 % - much is enabled byenergy efficient technologies based on

  20. HAS THE INFORMATION SOCIETY SUCCEEDED TO IMPROVE THE COMPETITIVENESS OF EUROPEAN SUSTAINABLE TOURISM ECONOMY?

    Directory of Open Access Journals (Sweden)

    GHITA Simona

    2015-06-01

    Full Text Available Europe represents one of the most significant tourism destinations in the world, but, nowadays, it is more and more important the issue of adapting the tourism demand and supply to the need of sustainability. Information Technologies can help to increase the competitiveness of the tourism industry, creating a bridge between tourism supply and demand. According to the figures presented by the UNWTO, the growth rate of international tourist arrivals in 2013 compared to 2012 was of 5% (meaning 52 million international tourists arrivals, reaching 1,09 billion arrivals in 2013. The highest absolute growth was experienced by Europe (29 million arrivals in 2013, while the highest relative growth was registered in Asia and the Pacific (6%. The average international tourist receipt exceeded US$700 per person, while total tourists’ expenditures leveled more than $1,4 trillion. Tourism sector, including the related industries, contributed in 2013 by 9,5% to the total global Gross Domestic Product (GDP and created approximately 10% of the jobs worldwide. In Romania the ascending trend of tourists’ arrivals in accommodation establishments was interrupted by decreases in 2009 and 2010, due to the global economic-financial crisis. The indicator “Nights spent at tourist accommodation establishments by residents” experienced a similar evolution. Revenues from tourism and its contribution to GDP can be improved through the usage of information technology services. The present paper gives a possible answer to the following questions: can Information Society improve the competitiveness of European Sustainable Tourism Economy? Are there evidences of the impact of modern informational technologies on trends in sustainable tourism economy? In the analysis, the author used EUROSTAT data for European countries, 2000-2013 time-series. Statistical indicators used in the analysis are grouped by three areas of interest: Tourism Area (Arrivals of residents

  1. Sustained effectiveness and cost-effectiveness of Counselling for Alcohol Problems, a brief psychological treatment for harmful drinking in men, delivered by lay counsellors in primary care: 12-month follow-up of a randomised controlled trial.

    Science.gov (United States)

    Nadkarni, Abhijit; Weiss, Helen A; Weobong, Benedict; McDaid, David; Singla, Daisy R; Park, A-La; Bhat, Bhargav; Katti, Basavaraj; McCambridge, Jim; Murthy, Pratima; King, Michael; Wilson, G Terence; Kirkwood, Betty; Fairburn, Christopher G; Velleman, Richard; Patel, Vikram

    2017-09-01

    Counselling for Alcohol Problems (CAP), a brief intervention delivered by lay counsellors, enhanced remission and abstinence over 3 months among male primary care attendees with harmful drinking in a setting in India. We evaluated the sustainability of the effects after treatment termination, the cost-effectiveness of CAP over 12 months, and the effects of the hypothesized mediator 'readiness to change' on clinical outcomes. Male primary care attendees aged 18-65 years screening with harmful drinking on the Alcohol Use Disorders Identification Test (AUDIT) were randomised to either CAP plus enhanced usual care (EUC) (n = 188) or EUC alone (n = 189), of whom 89% completed assessments at 3 months, and 84% at 12 months. Primary outcomes were remission and mean standard ethanol consumed in the past 14 days, and the proposed mediating variable was readiness to change at 3 months. CAP participants maintained the gains they showed at the end of treatment through the 12-month follow-up, with the proportion with remission (AUDIT score costs and better outcomes; uncertainty analysis showed a 99% chance of CAP being cost-effective per remission achieved from a health system perspective, using a willingness to pay threshold equivalent to 1 month's wages for an unskilled manual worker in Goa. Readiness to change level at 3 months mediated the effect of CAP on mean standard ethanol consumption at 12 months (indirect effect -6.014 [95% CI -13.99, -0.046]). Serious adverse events were infrequent, and prevalence was similar by arm. The methodological limitations of this trial are the susceptibility of self-reported drinking to social desirability bias, the modest participation rates of eligible patients, and the examination of mediation effects of only 1 mediator and in only half of our sample. CAP's superiority over EUC at the end of treatment was largely stable over time and was mediated by readiness to change. CAP provides better outcomes at lower costs from a societal

  2. Sustainable development - opening address 29th Annual Canadian Nuclear Society Conference

    International Nuclear Information System (INIS)

    Lamarre, P.

    2008-01-01

    This paper discusses sustainable development which in a broad sense incorporates three dimensions: economic growth, environmental protection, and social welfare. The challenge for sustainable development is to address these three dimensions in a balanced way

  3. Sustainability - What are the Odds? Guessing the Future of our Environment, Economy, and Society

    Science.gov (United States)

    This article examines the concept of sustainability from a global perspective, describing how alternative futures might develop in the environmental, economic, and social dimensions. The alternatives to sustainability appear to be (a) a catastrophic failure of life support, econo...

  4. Earth Stewardship: An initiative by the Ecological Society of America to foster engagement to sustain Planet Earth

    Science.gov (United States)

    Chapin, F. Stuart; Pickett, S.T.A.; Power, Mary E.; Collins, Scott L.; Baron, Jill S.; Inouye, David W.; Turner, Monica G.

    2017-01-01

    The Ecological Society of America (ESA) has responded to the growing commitment among ecologists to make their science relevant to society through a series of concerted efforts, including the Sustainable Biosphere Initiative (1991), scientific assessment of ecosystem management (1996), ESA’s vision for the future (2003), Rapid Response Teams that respond to environmental crises (2005), and the Earth Stewardship Initiative (2009). During the past 25 years, ESA launched five new journals, largely reflecting the expansion of scholarship linking ecology with broader societal issues. The goal of the Earth Stewardship Initiative is to raise awareness and to explore ways for ecologists and other scientists to contribute more effectively to the sustainability of our planet. This has occurred through four approaches: (1) articulation of the stewardship concept in ESA publications and Website, (2) selection of meeting themes and symposia, (3) engagement of ESA sections in implementing the initiative, and (4) outreach beyond ecology through collaborations and demonstration projects. Collaborations include societies and groups of Earth and social scientists, practitioners and policy makers, religious and business leaders, federal agencies, and artists and writers. The Earth Stewardship Initiative is a work in progress, so next steps likely include continued nurturing of these emerging collaborations, advancing the development of sustainability and stewardship theory, improving communication of stewardship science, and identifying opportunities for scientists and civil society to take actions that move the Earth toward a more sustainable trajectory.

  5. Challenges of science-society interactions in the frame of sustainable development: A case-study of contemporary Bulgaria

    Directory of Open Access Journals (Sweden)

    Paneva Aneliya

    2016-01-01

    Full Text Available Effectively tackling problems of sustainable development such as climate change, poverty, and biodiversity loss requires a different perspective on the role of science in society. Building on the understanding that knowledge production processes shall go hand in hand with governance processes, sustainability science and ecological economics promote transdisciplinarity and participatory procedures as a key requirement for scientific work on nature-society interactions. Involving non-academic actors such as local lay persons, civil society representatives, businesses, and decision makers in the research process promises the discovery of practical solutions to related problems and empowerment of communities. While this novel research approach has been increasingly applied in Western societies, its adoption by scientific actors in the context of Central and Eastern Europe, however, remains relatively low. Employing Bulgaria as a case study, this investigation examined the inter-actions between academia and practice through a series of expert interviews and a review of policy documents, thus offering insights into the specific conditions of implementing science for sustainable development. It emerges that knowledge transfer and experience exchange in the field are needed. Promoting social learning in this domain requires clarification of the roles of actors and institutions for sustainable development. Finally, recommendations for science related policies and scientific work are given.

  6. A SUSTAINABLE COMPANY AND ITS CONTRIBUTIONS TO SOCIETY: CASE STUDY OF EDP-ENERGIAS DO BRAZIL SA

    Directory of Open Access Journals (Sweden)

    Leonardo Fabris Lugoboni

    2014-06-01

    Full Text Available Sustainability is a reality that can be understood as the use of resources to meet the need of the present without compromising the ability of future generations to meet their own needs. This article seeks to highlight the importance of sustainability in the business environment and show how companies are pressured by the market, the society - more aware of its role - and regulators that not only alert and educate, but are also more rigorous in their inspections so that their activities are permeated with social and environmental responsability. It is an exploratory and descriptive study as it addresses generally the importance of sustainability for business by providing benefits related to corporate image, tax incentives and credit facilitation as well as contribution to society through cultural projects and environmental policies.

  7. Systems, Society, Sustainability and the Geosciences: A Workshop to Create New Curricular Materials to Integrate Geosciences into the Teaching of Sustainability

    Science.gov (United States)

    Gosselin, D. C.; Manduca, C. A.; Oches, E. A.; MacGregor, J.; Kirk, K. B.

    2012-12-01

    Sustainability is emerging as a central theme for teaching about the environment, whether it be from the perspective of science, economics, or society. The Systems, Society, Sustainability and the Geosciences workshop provided 48 undergraduate faculty from 46 institutions a forum to discuss the challenges and possibilities for integrating geoscience concepts with a range of other disciplines to teach about the fundamentals of sustainability. Participants from community college to doctorate-granting universities had expertise that included geosciences, agriculture, biological sciences, business, chemistry, economics, ethnic studies, engineering, environmental studies, environmental education, geography, history, industrial technology, landscape design, philosophy, physics, and political science. The workshop modeled a range of teaching strategies that encouraged participants to network and collaborate, share successful strategies and materials for teaching sustainability, and identify opportunities for the development of new curricular materials that will have a major impact on the integration of geosciences into the teaching of sustainability. The workshop design provided participants an opportunity to reflect upon their teaching, learning, and curriculum. Throughout the workshop, participants recorded their individual and collective ideas in a common online workspace to which all had access. A preliminary synthesis of this information indicates that the concept of sustainability is a strong organizing principle for modern, liberal education requiring systems thinking, synthesis and contributions from all disciplines. Sustainability is inherently interdisciplinary and provides a framework for educational collaboration between and among geoscientists, natural/physical scientists, social scientists, humanists, engineers, etc.. This interdisciplinary framework is intellectually exciting and productive for educating students at all levels of higher education

  8. Sustainable Civil-Society Engagement: Potentials of a Transnational Civil Society in French-German, Polish-German, and Czech-German Border Regions

    Directory of Open Access Journals (Sweden)

    Klaus Boehnke

    2015-04-01

    Full Text Available Based on representative survey data, the present study examines potentials for the sustainable development of a transnational civil society in French-German, Polish-German, and Czech-German border regions. The theoretical framework is a social capital approach in the tradition of Putnam. Transnational engagement is seen as a key element for the development of a border-crossing civil society. For the analysis, existing forms of social capital were classified according to their bridging and bonding functions and the potentials of local and transnational activities are described. Furthermore, using multilevel analysis, the predictive power of different variables like individual dispositions and specific contexts of the regions on cross-border activities are examined. Descriptively, the expected lower level of local civil-society engagement, in general, and also with regard to the transnational activities was found for post-socialist border regions. It is shown that, first and foremost, existing experience in civil-society engagement in the local context is a high-impact predictor for both transnational activities and an interest in such activities. Other variables like feelings of a historical burden or the economic situation of the region are less important.

  9. Transitioning to a More Sustainable Society: Unpacking the Role of the Learning-Action Nexus

    Science.gov (United States)

    Moyer, Joanne M.; Sinclair, A. John; Quinn, Lisa

    2016-01-01

    In recent years, action on sustainability has been highly influential around the globe and many now recognize the importance of individual and social learning for inspiring action and achieving sustainability outcomes. Transformative learning theory has been criticized, however, for insufficient development of the link between learning and action.…

  10. Distributed GIS for automated natural hazard zonation mapping Internet-SMS warning towards sustainable society

    Directory of Open Access Journals (Sweden)

    Devanjan Bhattacharya

    2014-12-01

    Full Text Available Today, open systems are needed for real time analysis and warnings on geo-hazards and over time can be achieved using Open Source Geographical Information System (GIS-based platform such as GeoNode which is being contributed to by developers around the world. To develop on an open source platform is a very vital component for better disaster information management as far as spatial data infrastructures are concerned and this would be extremely vital when huge databases are to be created and consulted regularly for city planning at different scales, particularly satellite images and maps of locations. There is a big need for spatially referenced data creation, analysis, and management. Some of the salient points that this research would be able to definitely contribute with GeoNode, being an open source platform, are facilitating the creation, sharing, and collaborative use of geospatial data. The objective is development of an automated natural hazard zonation system with Internet-short message service (SMS warning utilizing geomatics for sustainable societies. A concept of developing an internet-resident geospatial geohazard warning system has been put forward in this research, which can communicate alerts via SMS. There has been a need to develop an automated integrated system to categorize hazard and issue warning that reaches users directly. At present, no web-enabled warning system exists which can disseminate warning after hazard evaluation at one go and in real time. The objective of this research work has been to formalize a notion of an integrated, independent, generalized, and automated geo-hazard warning system making use of geo-spatial data under popular usage platform. In this paper, a model of an automated geo-spatial hazard warning system has been elaborated. The functionality is to be modular in architecture having GIS-graphical user interface (GUI, input, understanding, rainfall prediction, expert, output, and warning modules. A

  11. Psychological science's contributions to a sustainable environment: extending our reach to a grand challenge of society.

    Science.gov (United States)

    Kazdin, Alan E

    2009-01-01

    Climate change and degradation of the environment are global problems associated with many other challenges (e.g., population increases, reduction of glaciers, and loss of critical habitats). Psychological science can play a critical role in addressing these problems by fostering a sustainable environment. Multiple strategies for fostering a sustainable environment could draw from the diversity of topics and areas of specialization within psychology. Psychological research on fostering environmentally sustainable behaviors is rather well developed, as illustrated by interventions focusing on education of the public, message framing, feedback, decision making, the media, incentives and disincentives, and social marketing. Other sciences and professions as well as religion and ethics are actively involved in fostering a sustainable environment. Psychology ought to be more involved directly, systematically, and visibly to draw on our current knowledge and to have palpable impact. We would serve the world very well and in the process our discipline and profession.

  12. DASEES: A Tripartite Decision Analysis Framework to Achieve Sustainable Environment, Economy & Society Growth and Management Goals

    Science.gov (United States)

    Many of Societies management and growth decisions are often made without a balanced consideration of pertinent factors from environmental, economic and societal perspectives. All three of these areas are key players in many of the decisions facing societies as they strive to ope...

  13. Society, materiality, resilience and sustainability: inquiries from the fields of industrial waste management, urban climate science and eco-urbanism

    Science.gov (United States)

    MacKillop, Fionn

    2018-06-01

    This paper aims to investigate the links between materiality and society at a conceptual level, using examples from the author's decade of research in several fields relevant to the issue. With current talk of the need for `sustainability' and `resilience' reaching fever pitch in industry, politics and other arenas, there is a regrettable tendency to muddle the meaning of these words. Drawing on original research carried out in the UK, China, Germany, and Australia, and using the conceptual approaches of actor-network theory (ANT) and urban political ecology (UPE), the author invites us to re-engage with the materiality of society and how we, as businesses, consumers and thinkers, can advance sustainability and resilience through this re-engagement. We will ask what sustainability and resilience mean, for whom and in what context. We will also look at how we can shift thinking and reinvigorate these words, by contributing to the dialogue between the social sciences and business and industry. Specific examples will be taken from the UK and Chinese steel industries; climate-sensitive urban design in Manchester and Stuttgart; and housing construction and affordability in Scotland and Australia, thus covering a wide range of issues related to urban sustainability and resilience in relation to materiality.

  14. The 1.5 kilowatt society: Towards a sustainable, equitable, and habitable world

    International Nuclear Information System (INIS)

    Duerr, H.P.

    1998-01-01

    Numerous tremblings around the globe painfully signal that the end of the Cold War has not carried mankind to the envisaged less troubled political and economical waters. The defects of the present industrial civilization present mankind today with a formidable challenge to fulfil successfully and simultaneously to reconcile three incompatible requirements: ecological sustainability; social sustainability; individual sustainability; energy resources, their abundance, accessibility and if scarce possible substitutions, or in case of renewable resources possibilities of their regeneration; environmentally and socially tolerable deposition of the non-recycled remnants of non-renewable fuels (safe removal of radioactive wastes in case of nuclear energy, and the release of carbondioxide in case of fossil fuels without climatic changes); appropriate limitation of local and global primary energy conversion because of the negative side effects of human energy applications, and in view of limited robustness of the earth's ecosystem

  15. PREFACE: International Symposium on Materials Science and Innovation for Sustainable Society - Eco-Materials and Eco-Innovation for Global Sustainability - The 21st Iketani Conference 2011

    Science.gov (United States)

    Takahashi, Yasuo

    2012-08-01

    Conference logo The 21st century has been called the century of environmental revolution. Green innovations and environmentally friendly production systems based on physics, chemistry, materials science, and electronic engineering will be indispensable for ensuring renewable energy and establishing a sustainable society. In particular, production design, materials processing, and fabrication technologies such as welding and joining will be very important components of such green innovations. For these reasons, the International Symposium on Materials Science and Innovation for Sustainable Society - eco-materials and eco-innovation for global sustainability - (ECO-MATES 2011) was organized by the Joining and Welding Research Institute (JWRI) and the Center of Environmental Innovation Design for Sustainability (CEIDS), Osaka University. ECO-MATES 2011 was held at Hotel Hankyu Expo Park, Osaka, Japan from 28-30 November 2011. 435 participants from 20 countries around the world attended the symposium. 149 oral presentations including 60 invited talks and 160 posters were presented at the symposium to discuss the latest research and developments in green innovations in relation to environmental issues. The topics of the symposium covered all environmentally related fields including renewable energy, energy-materials, environment and resources, waste and biomass, power electronics, semiconductor, rare-earth metals, functional materials, organic electronics materials, electronics packaging, smart processing, joining and welding, eco-efficient processes, and green applied physics and chemistry. Therefore, 55 full papers concerning green innovations and environmentally benign production were selected and approved by the editorial board and the program committee of ECO-MATES 2011. All papers were accepted through peer review processes. I believe that all the papers have many informative contents. On behalf of the steering committee of the symposium, I would like to express

  16. Simulated Sustainable Societies: Students' Reflections on Creating Future Cities in Computer Games

    Science.gov (United States)

    Nilsson, Elisabet M.; Jakobsson, Anders

    2011-01-01

    The empirical study, in this article, involved 42 students (ages 14-15), who used the urban simulation computer game SimCity 4 to create models of sustainable future cities. The aim was to explore in what ways the simulated "real" worlds provided by this game could be a potential facilitator for science learning contexts. The topic investigated is…

  17. Mapping a sustainable future: Community learning in dialogue at the science-society interface

    Science.gov (United States)

    Barth, Matthias; Lang, Daniel J.; Luthardt, Philip; Vilsmaier, Ulli

    2017-12-01

    In 2015, the German Federal Ministry of Education and Research (BMBF) announced that the Science Year 2015 would focus on the "City of the Future". It called for innovative projects from cities and communities in Germany dedicated to exploring future options and scenarios for sustainable development. Among the successful respondents was the city of Lüneburg, located in the north of Germany, which was awarded funding to establish a community learning project to envision a sustainable future ("City of the Future Lüneburg 2030+"). What made Lüneburg's approach unique was that the city itself initiated the project and invited a broad range of stakeholders to participate in a community learning process for sustainable development. The authors of this article use the project as a blueprint for sustainable city development. Presenting a reflexive case study, they report on the process and outcomes of the project and investigate community learning processes amongst different stakeholders as an opportunity for transformative social learning. They discuss outputs and outcomes (intended as well as unintended) in relation to the specific starting points of the project to provide a context-sensitive yet rich narrative of the case and to overcome typical criticisms of case studies in the field.

  18. Toward a Unified Knowledge-based Society for Sustainability -- Developing a Synthesis on the Methodological Level

    Science.gov (United States)

    Alec A. Schaerer

    2006-01-01

    The debates on development manifest an increasing concern for sustainability, but as yet little awareness of the hierarchy in the ideas through which humans contribute to the problem. This gap is widened by a widespread but nevertheless unnecessary acceptance of unreasonable elements such as paradoxes, or the general fragmentation in knowledge, or allegedly general...

  19. Sustained effectiveness and cost-effectiveness of Counselling for Alcohol Problems, a brief psychological treatment for harmful drinking in men, delivered by lay counsellors in primary care: 12-month follow-up of a randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Abhijit Nadkarni

    2017-09-01

    Full Text Available Counselling for Alcohol Problems (CAP, a brief intervention delivered by lay counsellors, enhanced remission and abstinence over 3 months among male primary care attendees with harmful drinking in a setting in India. We evaluated the sustainability of the effects after treatment termination, the cost-effectiveness of CAP over 12 months, and the effects of the hypothesized mediator 'readiness to change' on clinical outcomes.Male primary care attendees aged 18-65 years screening with harmful drinking on the Alcohol Use Disorders Identification Test (AUDIT were randomised to either CAP plus enhanced usual care (EUC (n = 188 or EUC alone (n = 189, of whom 89% completed assessments at 3 months, and 84% at 12 months. Primary outcomes were remission and mean standard ethanol consumed in the past 14 days, and the proposed mediating variable was readiness to change at 3 months. CAP participants maintained the gains they showed at the end of treatment through the 12-month follow-up, with the proportion with remission (AUDIT score < 8: 54.3% versus 31.9%; adjusted prevalence ratio [aPR] 1.71 [95% CI 1.32, 2.22]; p < 0.001 and abstinence in the past 14 days (45.1% versus 26.4%; adjusted odds ratio 1.92 [95% CI 1.19, 3.10]; p = 0.008 being significantly higher in the CAP plus EUC arm than in the EUC alone arm. CAP participants also fared better on secondary outcomes including recovery (AUDIT score < 8 at 3 and 12 months: 27.4% versus 15.1%; aPR 1.90 [95% CI 1.21, 3.00]; p = 0.006 and percent of days abstinent (mean percent [SD] 71.0% [38.2] versus 55.0% [39.8]; adjusted mean difference 16.1 [95% CI 7.1, 25.0]; p = 0.001. The intervention effect for remission was higher at 12 months than at 3 months (aPR 1.50 [95% CI 1.09, 2.07]. There was no evidence of an intervention effect on Patient Health Questionnaire 9 score, suicidal behaviour, percentage of days of heavy drinking, Short Inventory of Problems score, WHO Disability Assessment Schedule 2.0 score, days

  20. Sustained effectiveness and cost-effectiveness of the Healthy Activity Programme, a brief psychological treatment for depression delivered by lay counsellors in primary care: 12-month follow-up of a randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Benedict Weobong

    2017-09-01

    Full Text Available The Healthy Activity Programme (HAP, a brief behavioural intervention delivered by lay counsellors, enhanced remission over 3 months among primary care attendees with depression in peri-urban and rural settings in India. We evaluated the sustainability of the effects after treatment termination, the cost-effectiveness of HAP over 12 months, and the effects of the hypothesized mediator of activation on clinical outcomes.Primary care attendees aged 18-65 years screened with moderately severe to severe depression on the Patient Health Questionnaire 9 (PHQ-9 were randomised to either HAP plus enhanced usual care (EUC (n = 247 or EUC alone (n = 248, of whom 95% completed assessments at 3 months, and 91% at 12 months. Primary outcomes were severity on the Beck Depression Inventory-II (BDI-II and remission on the PHQ-9. HAP participants maintained the gains they showed at the end of treatment through the 12-month follow-up (difference in mean BDI-II score between 3 and 12 months = -0.34; 95% CI -2.37, 1.69; p = 0.74, with lower symptom severity scores than participants who received EUC alone (adjusted mean difference in BDI-II score = -4.45; 95% CI -7.26, -1.63; p = 0.002 and higher rates of remission (adjusted prevalence ratio [aPR] = 1.36; 95% CI 1.15, 1.61; p < 0.009. They also fared better on most secondary outcomes, including recovery (aPR = 1.98; 95% CI 1.29, 3.03; p = 0.002, any response over time (aPR = 1.45; 95% CI 1.27, 1.66; p < 0.001, higher likelihood of reporting a minimal clinically important difference (aPR = 1.42; 95% CI 1.17, 1.71; p < 0.001, and lower likelihood of reporting suicidal behaviour (aPR = 0.71; 95% CI 0.51, 1.01; p = 0.06. HAP plus EUC also had a marginal effect on WHO Disability Assessment Schedule score at 12 months (aPR = -1.58; 95% CI -3.33, 0.17; p = 0.08; other outcomes (days unable to work, intimate partner violence toward females did not statistically significantly differ between the two arms. Economic analyses

  1. Sustained effectiveness and cost-effectiveness of the Healthy Activity Programme, a brief psychological treatment for depression delivered by lay counsellors in primary care: 12-month follow-up of a randomised controlled trial

    Science.gov (United States)

    Weobong, Benedict; Singla, Daisy R.; Hollon, Steven D.; Nadkarni, Abhijit; Park, A-La; Bhat, Bhargav; Anand, Arpita; Dimidjian, Sona; King, Michael; Vijayakumar, Lakshmi; Wilson, G. Terence; Velleman, Richard

    2017-01-01

    Background The Healthy Activity Programme (HAP), a brief behavioural intervention delivered by lay counsellors, enhanced remission over 3 months among primary care attendees with depression in peri-urban and rural settings in India. We evaluated the sustainability of the effects after treatment termination, the cost-effectiveness of HAP over 12 months, and the effects of the hypothesized mediator of activation on clinical outcomes. Methods and findings Primary care attendees aged 18–65 years screened with moderately severe to severe depression on the Patient Health Questionnaire 9 (PHQ-9) were randomised to either HAP plus enhanced usual care (EUC) (n = 247) or EUC alone (n = 248), of whom 95% completed assessments at 3 months, and 91% at 12 months. Primary outcomes were severity on the Beck Depression Inventory–II (BDI-II) and remission on the PHQ-9. HAP participants maintained the gains they showed at the end of treatment through the 12-month follow-up (difference in mean BDI-II score between 3 and 12 months = −0.34; 95% CI −2.37, 1.69; p = 0.74), with lower symptom severity scores than participants who received EUC alone (adjusted mean difference in BDI-II score = −4.45; 95% CI −7.26, −1.63; p = 0.002) and higher rates of remission (adjusted prevalence ratio [aPR] = 1.36; 95% CI 1.15, 1.61; p behaviour (aPR = 0.71; 95% CI 0.51, 1.01; p = 0.06). HAP plus EUC also had a marginal effect on WHO Disability Assessment Schedule score at 12 months (aPR = −1.58; 95% CI −3.33, 0.17; p = 0.08); other outcomes (days unable to work, intimate partner violence toward females) did not statistically significantly differ between the two arms. Economic analyses indicated that HAP plus EUC was dominant over EUC alone, with lower costs and better outcomes; uncertainty analysis showed that from this health system perspective there was a 95% chance of HAP being cost-effective, given a willingness to pay threshold of Intl$16,060—equivalent to GDP per capita in Goa

  2. Simulated Sustainable Societies: Students' Reflections on Creating Future Cities in Computer Games

    Science.gov (United States)

    Nilsson, Elisabet M.; Jakobsson, Anders

    2011-02-01

    The empirical study, in this article, involved 42 students (ages 14-15), who used the urban simulation computer game SimCity 4 to create models of sustainable future cities. The aim was to explore in what ways the simulated "real" worlds provided by this game could be a potential facilitator for science learning contexts. The topic investigated is in what way interactions in this gaming environment, and reflections about these interactions, can form a context where the students deal with real world problems, and where they can contextualise and apply their scientific knowledge. Focus group interviews and video recordings were used to gather data on students' reflections on their cities, and on sustainable development. The findings indicate that SimCity 4 actually contributes to creating meaningful educational situations in science classrooms, and that computer games can constitute an important artefact that may facilitate contextualisation and make students' use of science concepts and theories more explicit.

  3. Is human society in denial regarding the tough questions about sustainability?

    Directory of Open Access Journals (Sweden)

    John Cairns, Jr.

    2004-07-01

    Full Text Available The news media report daily on unsustainable practices and events that impede progress toward sustainable use of the planet - production of greenhouse gases, biotic impoverishment, depletion of fossil waters (aquifers, human population growth, production of persistent toxic substances, loss of agricultural topsoil and land, rapid loss of old growth forests, and so on. Exponential economic growth both depletes natural capital more rapidly than it is regenerated and also gives an illusion of sustainable prosperity. Failure to act more expeditiously is almost certainly due to a number of factors; however, denial that a problem exists is, arguably, one of the most likely reasons. Just as an alcoholic or drug addict must first acknowledge that a problem exists before successful treatment is possible, so must those addicted to exponential growth on a finite planet.

  4. State of the World: 1987. A Worldwatch Institute Report on Progress toward a Sustainable Society.

    Science.gov (United States)

    Brown, Lester R.; And Others

    This book was developed to highlight the risks that confront societies, and to indicate the most promising avenues for preemptive policies and actions. The document contains chapters on: (1) the emergence of change; (2) analyzing demographic factors; (3) assessing the future of urbanization; (4) reassessing nuclear power (including an analysis of…

  5. Civil society contributions to a sustainable health workforce in the European Union

    NARCIS (Netherlands)

    Mans, Linda; van de Pas, Remco; Marschang, Sascha

    Background: Following the adoption of the World Health Organization’s Global Code of Practice on the International Recruitment of Health Personnel (WHO Code), eight civil society organizations implemented the European Union (EU) funded project “Health Workers for All and All for Health Workers”

  6. Investment strategy for sustainable society by development of regional economies and prevention of industrial pollutions in Japanese manufacturing sectors

    International Nuclear Information System (INIS)

    Sueyoshi, Toshiyuki; Goto, Mika

    2014-01-01

    A balance between industrial pollution prevention and economic growth becomes a world-wide issue to develop a sustainable society in many industrial nations. To discuss the issue, this study proposes a new use of DEA environmental assessment to determine how to effectively allocate capital for developing regional industries. The amount of capital is used to invest for technology innovation for both local economic growth and environmental protection. In this study, the proposed approach separates outputs into desirable and undesirable categories. Inputs are also separated into two categories, one of which indicates an amount of investment on capital assets. The other category is used for production activities. The proposed approach unifies them by two disposability concepts. This study has evaluated the performance of manufacturing industries in 47 prefectures (local government units in Japan) by Unified Efficiency under Natural disposability (UEN), Unified Efficiency under Managerial disposability (UEM) and Unified Efficiency under Natural and Managerial disposability (UENM). The UENM is further separated into its two cases: with and without a possible occurrence on desirable congestion, or technology innovation, on undesirable outputs. This study has empirically confirmed that Japanese manufacturing industries need to make their efforts to reduce greenhouse gas emissions and air pollution substances by investing in technology innovation. Furthermore, most of economic activities are currently located at metropolitan regions (e.g., Tokyo) in Japan. To develop a sustainable society, Japan needs to allocate capital into regions with a high level of investment effectiveness by shifting the manufacturing industries from the metropolitan regions to much promising local areas identified in this study. Such a shift, along with technology innovation, makes it possible to reduce air pollutions in the entire Japan by balancing economic growth and pollution prevention. This

  7. Sustainable development in city districts: BaLaLuZ project - Society; Schlussbericht 'Gesellschaft' - Phase 1

    Energy Technology Data Exchange (ETDEWEB)

    Arend, M.

    2004-07-01

    This final report for the Swiss Federal Office of Energy (SFOE) is one of a series of reports concerning municipal development in various cities in Switzerland. The four city districts involved include Basel (Gundeldinger Feld), Lausanne (Bellevaux), Lucerne (Basel-/Bernstrasse) and Zurich (Werdwies). This paper takes a look at society aspects in the four districts and examines the factors that influence the sustainable development of the districts. Topics discussed include basic residential needs, safety, health, and supply along with culture and education. Also examined are the possible topics equality and fairness and participation along with geographical reference and neighbourhood relations. A project for this area of investigation is suggested.

  8. Sustainability.

    Science.gov (United States)

    Chang, Chein-Chi; DiGiovanni, Kimberly; Mei, Ying; Wei, Li

    2016-10-01

    This review on Sustainability covers selected 2015 publications on the focus of Sustainability. It is divided into the following sections : • Sustainable water and wastewater utilities • Sustainable water resources management • Stormwater and green infrastructure • Sustainability in wastewater treatment • Life cycle assessment (LCA) applications • Sustainability and energy in wastewater industry, • Sustainability and asset management.

  9. Energy for a sustainable society. Recommendations of the Panel; Energi for et baerekraftig samfunn. Panelets anbefalinger

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-10-01

    On June 18 and 19, 1997, The Norwegian Research Council arranged a series of national conferences on sustainable development. A panel has followed up the conferences with the present report. The priority is on issues of importance for the development of policies and political means in the climate area. This is because the climate challenges are essential for a sustainable global development. Without doubt, it takes long for the temperature of the atmosphere to stabilise after a change in the CO{sub 2} content, several decades. Greatly reduced anthropogenic emissions of greenhouse gases cannot prevent a delayed temperature increase, which calls for precautionary measures. Norwegian policy should be based on the assumption that the emission negotiations will lead to emission restrictions for most of the industrialised countries. However, one-sided focus on national emission goals may lead to unwanted increase in other countries' emissions following Norwegian decreases. The panel suggests that Norwegian measures should be oriented along the following: (1) Energy efficiency, (2) Social planning, (3) Renewable energy sources, (4) De-carbonisation of fossil energy carriers.

  10. Policy for material efficiency--sustainable taxation as a departure from the throwaway society.

    Science.gov (United States)

    Stahel, Walter R

    2013-03-13

    The present economy is not sustainable with regard to its per capita material consumption. A dematerialization of the economy of industrialized countries can be achieved by a change in course, from an industrial economy built on throughput to a circular economy built on stock optimization, decoupling wealth and welfare from resource consumption while creating more work. The business models of a circular economy have been known since the mid-1970s and are now applied in a number of industrial sectors. This paper argues that a simple and convincing lever could accelerate the shift to a circular economy, and that this lever is the shift to a tax system based on the principles of sustainability: not taxing renewable resources including human labour--work--but taxing non-renewable resources instead is a powerful lever. Taxing materials and energies will promote low-carbon and low-resource solutions and a move towards a 'circular' regional economy as opposed to the 'linear' global economy requiring fuel-based transport for goods throughput. In addition to substantial improvements in material and energy efficiency, regional job creation and national greenhouse gas emission reductions, such a change will foster all activities based on 'caring', such as maintaining cultural heritage and natural wealth, health services, knowledge and know-how.

  11. What is the Minimum EROI that a Sustainable Society Must Have?

    Directory of Open Access Journals (Sweden)

    David J.R. Murphy

    2009-01-01

    Full Text Available Economic production and, more generally, most global societies, are overwhelmingly dependant upon depleting supplies of fossil fuels. There is considerable concern amongst resource scientists, if not most economists, as to whether market signals or cost benefit analysis based on today’s prices are sufficient to guide our decisions about our energy future. These suspicions and concerns were escalated during the oil price increase from 2005 – 2008 and the subsequent but probably related market collapse of 2008. We believe that Energy Return On Investment (EROI analysis provides a useful approach for examining disadvantages and advantages of different fuels and also offers the possibility to look into the future in ways that markets seem unable to do. The goal of this paper is to review the application of EROI theory to both natural and economic realms, and to assess preliminarily the minimum EROI that a society must attain from its energy exploitation to support continued economic activity and social function. In doing so we calculate herein a basic first attempt at the minimum EROI for current society and some of the consequences when that minimum is approached. The theory of the minimum EROI discussed here, which describes the somewhat obvious but nonetheless important idea that for any being or system to survive or grow it must gain substantially more energy than it uses in obtaining that energy, may be especially important. Thus any particular being or system must abide by a “Law of Minimum EROI”, which we calculate for both oil and corn-based ethanol as about 3:1 at the mine-mouth/farm-gate. Since most biofuels have EROI’s of less than 3:1 they must be subsidized by fossil fuels to be useful.

  12. 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.

  13. Steering sustainability. On the potential of a radical energy tax subsidy scheme to move the Dutch society towards sustainable development in the energy domain

    International Nuclear Information System (INIS)

    Kamminga, K.J.

    2001-01-01

    After an introduction to the issue of sustainable development, relevant aspects of the discussion about sustainable development are discussed. In particular, various perspectives on sustainable development based on different views of nature. However, since sustainable development is such a broad and general concept, narrowing its reach is necessary to enlarge its applicability. From various observations, it is concluded that there are good reasons to focus the sustainable development discussion on the energy domain. First, the existence of sources of potential energy is the basis for all physical activity. Second, fossil fuel reserves -which are by far the most dominant types of energy in the western, industrialized world at present- are limited. Third, the extraction, transportation, use and/or combustion of fossil fuels give rise to serious pressure on the world's natural environment. On a global scale, this particularly concerns the emission of CO2. Starting from a system approach, the relationship between society (the production and consumption system) and nature (the natural system) is dealt with, distinguishing between two relevant views. The first one regards the production and consumption system as separated from, though interacting with, the natural system. Thus, two systems in fact exist next to each other. By contrast, the second view explicitly defines boundaries for the production and consumption system on biophysical grounds. According to this vision, the production and consumption system should be considered a subsystem of the natural system. Chapter 2 offers a first elaboration upon the relation between the two systems. From a historical perspective sustainable development is addressed against the background of the main development in economics over the last three centuries; that is, the development from the physiocrats and the classical economists to the theory of neoclassical economics. The issue of natural resources is chosen as a proxy of

  14. 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.

  15. Key features for more successful place-based sustainability research on social-ecological systems: A Programme on Ecosystem Change and Society (PECS) perspective

    NARCIS (Netherlands)

    Balvanera, P.; Daw, T.M.; Gardner, T.A.; Martín-López, B.; Norström, A.V.; Ifejika Speranza, C.; Spierenburg, M.J.; Bennett, E.M.; Farfán, M.; Hamann, M.; Kittinger, J.N.; Luthe, T.; Maass, M.; Peterson, G.D.; Pérez-Verdin, G.

    2017-01-01

    The emerging discipline of sustainability science is focused explicitly on the dynamic interactions between nature and society and is committed to research that spans multiple scales and can support transitions toward greater sustainability. Because a growing body of place-based social-ecological

  16. Evaluating the cost-effectiveness of ecosystem-based adaptation: Kamiesberg wetlands case study

    Directory of Open Access Journals (Sweden)

    David Black

    2016-12-01

    Full Text Available Ecosystem-based adaptation (EbA is increasingly being promoted as a cost-effective means of adaptation to climate change. However, in spite of considerable international press, there is still little evidence to substantiate this claim. This study proposes a method through which the cost-effectiveness of EbA strategies can be evaluated against alternative adaptation options, and contributes to South African literature on the subject. The potential cost-effectiveness of wetland restoration is assessed as a means of securing the carrying capacity of land for pastoralist communities of the Kamiesberg communal area in South Africa under projected future climate conditions. The conventional alternatives would be to respond to increasingly dry conditions by drilling boreholes and using supplemental feed for livestock. It was assumed that the EbA interventions would occur upfront, whereas the alternatives are more likely to be implemented in reaction to droughts over a longer time period. The study found the implementation of conventional alternatives to be more cost-effective than EbA as a means to sustaining livestock stocking rates, with EbA being twice as costly. However, this is framed from the perspective of those directly affected (the landowners, and does not include the benefits to broader society.

  17. Social responsibility (SR) of nuclear research and its practice for pursuing integrity and sustainability of nuclear research with society

    International Nuclear Information System (INIS)

    Tetsuo, Sawada; Naoki, Yamano; Yoshiko, Aoyama; Akiko, Shioda; Junichi, Mizuo; Yasuhiko, Fujii

    2007-01-01

    Corporate Social Responsibility (CSR), which includes compliance, engineering and business ethics, safety and security, and corporate governance, is being widely applied not only in the field of business administrations but also in academia and research communities. The basic 3 ideals of CSR are sustainability, stakeholder dialogue (stakeholder include consumers, suppliers, employees, investors and local communities) and triple basic constraints (be environment-friendly, competitive and beneficial for the society as a whole). A typical aspect of this trend is that most electric power company publishes documents such as Corporate Social Responsibility (CSR) reports which are the improved version of social-environmental reports. CSR reflects the very expectations from the society that how far the corporations and organizations including universities can resolve the issues in which the society is necessarily involved. The nuclear power generations and related facilities are sorts of societal systems and not merely technological systems. This paper describes the concept of CSR, its basic prerequisites and the framework of the civic forum that is a part of the practices of Nuclear CSR

  18. Agroecology to Promote Just Sustainability Transitions: Analysis of a Civil Society Network in the Rwenzori Region, Western Uganda

    Directory of Open Access Journals (Sweden)

    Ellinor Isgren

    2017-08-01

    Full Text Available Agroecology is gaining ground within the debate on how to address systemic social and environmental problems in agriculture. However, it remains marginalized in agricultural research and development plans around the world. This paper analyzes agroecology as a socio-technical niche in Uganda, where its emergence in part can be seen as an unintended consequence of neoliberalist development. The case studied is a civil society network that links farmer groups and non-governmental organizations across different levels. Through the analytical lens of regime dimensions, we find that agroecology is practiced as a smallholder-centric approach that champions collective action, locally appropriate technologies, participatory methods in research and extension, and calls for more active state guidance of agricultural change along specific principles. However, two major concerns are raised; the niche converges with the dominant discourse around commercialization, and policy advocacy is hampered by the apolitical history of NGOs and an increasingly tense political climate. These two areas are critical for agroecology to contribute to just sustainability transitions, and civil society organizations with strong links to smallholder farmers need to be included in the growing scholarly debate both to inform it and to receive guidance from it. Transition frameworks can help facilitate the development of viable institutional designs and explicitly transformative strategies, but we also point towards the need for engagement with theories on civil society collective action and political mobilization.

  19. Proceedings of the International Conferences on Internet Technologies & Society (ITS), Education Technologies (ICEduTECH), and Sustainability, Technology and Education (STE) (Melbourne, Australia, December 6-8, 2016)

    Science.gov (United States)

    Kommers, Piet, Ed.; Issa, Tomayess, Ed.; Issa, Theodora, Ed.; McKay, Elspeth, Ed.; Isias, Pedro, Ed.

    2016-01-01

    These proceedings contain the papers and posters of the International Conferences on Internet Technologies & Society (ITS 2016), Educational Technologies (ICEduTech 2016) and Sustainability, Technology and Education (STE 2016), which have been organised by the International Association for Development of the Information Society and…

  20. 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)

  1. Design for a sustainable society utilizing information and communication technologies (ICT) - proposal: a new EcoDesign method and its application

    Energy Technology Data Exchange (ETDEWEB)

    Fujimoto, J. [Research Center for Advanced Science and Technology, the Univ. of Tokyo (Japan); Matsumoto, M. [Fundamental and Environment Labs., NEC Corp. (Japan)

    2004-07-01

    We discuss a new EcoDesign method, with a goal of improving the economy, and its application to a sustainable networked society. The new EcoDesign method differs from conventional EcoDesign in three respects: it utilizes a top-down approach, project-style research, and fact-finding and benchmarking. We systematize EcoDesign for a networked society from the viewpoint of technology and divide it into four components. Feasibility studies of the individual components reveal that if we promote ICT diffusion with EcoDesign in mind, we can suppress CO2 emissions and move towards a more sustainable society. (orig.)

  2. Mapping of Norwegian civil society organizations working on energy and sustainable development

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-07-01

    This study provides a mapping of Norwegian CSOs working on energy and development issues in developing countries and an overview assessment of how the CSOs fit with the priorities of the Norwegian Governments Clean Energy for Development Initiative. The study has been commissioned by Norad, the Norwegian agency for development aid. The study surveys 10 Norwegian CSOs, five of which are primarily environmentally oriented (Bellona, FIVAS, Naturvernforbundet, WWF-Norway and Zero, with green backgrounds in the tables) and five of which are primarily socially oriented (ARC-Aid, Kirkens Noedhjelp, Misjonsalliansen, Norges Vel and Utviklingsfondet, with reddish background in the tables). The study is based on a desk-top review of available material from the CSOs as well as semi-structured interviews. The goal of the Clean Energy for Development Initiative is to increase access to clean energy at an affordable price based on the long-term management of natural resources and efficient energy use. Activities shall also contribute to sustainable economic and social development in selected partner countries and to international efforts to reduce greenhouse gas emissions.The study shows that many Norwegian CSOs have potential to contribute further to effective implementation of Clean Energy for Development Initiative strategies and realization of goals: At least five Cos are already carrying out relevant work in the Initiatives core countries (ref. table A below). In addition, most of the Cos surveyed have a long track-record of relevant activities in non-core countries (ref. table A), something which provides substantial potential for transfer of relevant experience and concepts from non-core countries to work in core countries. Most of the Cos have a relevant and professional competence base, capacity and plans for scaling-up Clean Energy for Development Initiative related work.The CSOs engaged in clean energy for development activities are mainly engaged in developing clean

  3. Inspections - a cost effective approach

    International Nuclear Information System (INIS)

    Joseph, C.

    1981-01-01

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

  4. Can a Costly Intervention Be Cost-effective?

    Science.gov (United States)

    Foster, E. Michael; Jones, Damon

    2009-01-01

    Objectives To examine the cost-effectiveness of the Fast Track intervention, a multi-year, multi-component intervention designed to reduce violence among at-risk children. A previous report documented the favorable effect of intervention on the highest-risk group of ninth-graders diagnosed with conduct disorder, as well as self-reported delinquency. The current report addressed the cost-effectiveness of the intervention for these measures of program impact. Design Costs of the intervention were estimated using program budgets. Incremental cost-effectiveness ratios were computed to determine the cost per unit of improvement in the 3 outcomes measured in the 10th year of the study. Results Examination of the total sample showed that the intervention was not cost-effective at likely levels of policymakers' willingness to pay for the key outcomes. Subsequent analysis of those most at risk, however, showed that the intervention likely was cost-effective given specified willingness-to-pay criteria. Conclusions Results indicate that the intervention is cost-effective for the children at highest risk. From a policy standpoint, this finding is encouraging because such children are likely to generate higher costs for society over their lifetimes. However, substantial barriers to cost-effectiveness remain, such as the ability to effectively identify and recruit such higher-risk children in future implementations. PMID:17088509

  5. Civil Society

    Science.gov (United States)

    Social Media Facebook @oasofficial Facebook Twitter @oas_official Twitter Newsletters Documents OAS Technology Social Development Summits of the Americas Sustainable Development T Telecommunications Terrorism Tourism Trade Treaties and Agreements W Women Y Youth Strategic Partners Permanent Observers Civil Society

  6. The Role of Formal and Informal Forces in Shaping Consumption and Implications for a Sustainable Society. Part I

    Directory of Open Access Journals (Sweden)

    Oksana Mont

    2010-07-01

    Full Text Available Addressing climate change and the collapse of ecosystems without threatening the economy, while simultaneously improving the well-being of all people and ensuring social justice and equality, seems to be the largest challenge in the history of mankind. So far, all the efforts to address growing environmental and human problems through technological solutions and policy measures have been largely outpaced by growing population and increasing consumption levels. Therefore, an understanding of the essential driving forces and complexities of consumption, and of how environmental impacts from rising consumption can be reduced, is becoming increasingly important. This understanding can be achieved by analyzing not only economic frameworks, political settings, business models, and technological innovations, but also social norms, psychological factors, and collective and individual decision-making processes. This article, Part I, provides a meta-analysis of the main political, economic, technological, and business drivers of contemporary consumption and offers a systematic discussion of the relevance of these factors for the instigation of change towards sustainable patterns and levels of consumption. The main conclusion from Part I and II is that a systems-thinking approach is required in order to understand how various political, technical, social, economic, and psychological drivers overlap and influence each other in creating our consumer society.

  7. Cost-effectiveness analysis of computer-based assessment

    Directory of Open Access Journals (Sweden)

    Pauline Loewenberger

    2003-12-01

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

  8. Development of the consumption behavior that promotes sustainable society: Focusing on recycling of small waste home appliances

    Science.gov (United States)

    Ichinose, Takae

    2015-04-01

    Hiroshima University High School (HUHS) became the first UNESCO Associated School in Japan in 1953, and since then it has practiced ESD in various educational activities in all ranges of education. As a teacher of home economics, I have focused on consumer affairs and encouraged my students to consider what each of them can do as an individual consumer in order to create a sustainable society. In Japan, several acts related to consumer affairs have been enforced in recent years. "Act on Promotion of Consumer Education" was enforced in December 2012, and construction of the "Consumer Citizen Society" was proposed. It places emphasis not only on environmental concerns but also on the initiative of consumers and its influence on social and economic trends. In addition, "Act on Promotion of Recycling of Small Waste Electrical and Electronic Equipment" was enforced in April, 2013. It aims at protecting living environment and healthy development of the national economy by appropriate treatment of waste materials and effective use of resources. For my lessons on "food, clothing and shelter in relation to consumption behavior and environmental problems", I took up "the recycling of small waste home appliances" as the teaching materials to raise awareness on resources recycling. The purpose of the lessons is three-fold: (1) to make students aware of environmental load; (2) to deepen the understanding of the influence which excessive consumption has on developing countries; (3) to encourage the students to think positively toward the solution of the problems. I am currently practicing the lessons, and I have shown below the summary of the instruction. Lesson 1: Give a quiz based on the database on environmental label from Ministry of the Environment website. Then show a film on whereabouts of the hi-tech industrial waste (e-waste). After the film, show some everyday products for which mineral resources are used in order to impress the idea of "urban mine". Lesson 2: Show a

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

    Science.gov (United States)

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

    2016-04-01

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

  10. Cost-effectiveness of a pressure ulcer quality collaborative

    Directory of Open Access Journals (Sweden)

    Bal Roland

    2010-06-01

    Full Text Available Abstract Background A quality improvement collaborative (QIC in the Dutch long-term care sector (nursing homes, assisted living facilities, home care used evidence-based prevention methods to reduce the incidence and prevalence of pressure ulcers (PUs. The collaborative consisted of a core team of experts and 25 organizational project teams. Our aim was to determine its cost-effectiveness from a healthcare perspective. Methods We used a non-controlled pre-post design to establish the change in incidence and prevalence of PUs in 88 patients over the course of a year. Staff indexed data and prevention methods (activities, materials. Quality of life (Qol weights were assigned to the PU states. We assessed the costs of activities and materials in the project. A Markov model was built based on effectiveness and cost data, complemented with a probabilistic sensitivity analysis. To illustrate the results of longer term, three scenarios were created in which change in incidence and prevalence measures were (1 not sustained, (2 partially sustained, and (3 completely sustained. Results Incidence of PUs decreased from 15% to 4.5% for the 88 patients. Prevalence decreased from 38.6% to 22.7%. Average Quality of Life (Qol of patients increased by 0.02 Quality Adjusted Life Years (QALYs in two years; healthcare costs increased by €2000 per patient; the Incremental Cost-effectiveness Ratio (ICER was between 78,500 and 131,000 depending on whether the changes in incidence and prevalence of PU were sustained. Conclusions During the QIC PU incidence and prevalence significantly declined. When compared to standard PU care, the QIC was probably more costly and more effective in the short run, but its long-term cost-effectiveness is questionable. The QIC can only be cost-effective if the changes in incidence and prevalence of PU are sustained.

  11. Cost-effectiveness of a pressure ulcer quality collaborative.

    Science.gov (United States)

    Makai, Peter; Koopmanschap, Marc; Bal, Roland; Nieboer, Anna P

    2010-06-01

    A quality improvement collaborative (QIC) in the Dutch long-term care sector (nursing homes, assisted living facilities, home care) used evidence-based prevention methods to reduce the incidence and prevalence of pressure ulcers (PUs). The collaborative consisted of a core team of experts and 25 organizational project teams. Our aim was to determine its cost-effectiveness from a healthcare perspective. We used a non-controlled pre-post design to establish the change in incidence and prevalence of PUs in 88 patients over the course of a year. Staff indexed data and prevention methods (activities, materials). Quality of life (Qol) weights were assigned to the PU states. We assessed the costs of activities and materials in the project. A Markov model was built based on effectiveness and cost data, complemented with a probabilistic sensitivity analysis. To illustrate the results of longer term, three scenarios were created in which change in incidence and prevalence measures were (1) not sustained, (2) partially sustained, and (3) completely sustained. Incidence of PUs decreased from 15% to 4.5% for the 88 patients. Prevalence decreased from 38.6% to 22.7%. Average Quality of Life (Qol) of patients increased by 0.02 Quality Adjusted Life Years (QALY)s in two years; healthcare costs increased by euro2000 per patient; the Incremental Cost-effectiveness Ratio (ICER) was between 78,500 and 131,000 depending on whether the changes in incidence and prevalence of PU were sustained. During the QIC PU incidence and prevalence significantly declined. When compared to standard PU care, the QIC was probably more costly and more effective in the short run, but its long-term cost-effectiveness is questionable. The QIC can only be cost-effective if the changes in incidence and prevalence of PU are sustained.

  12. Exercise on Transdisciplinarity: Lessons from a Field-Based Course on Rural Sustainability in an Aging Society

    Directory of Open Access Journals (Sweden)

    Shogo Kudo

    2018-04-01

    Full Text Available Sustainability science emerged as a new academic field to address complex sustainability challenges. To train sustainability experts, sustainability science programs and sustainability-focused courses are offered in higher education, especially at the graduate level. Given the diverse topics and the complex structures of sustainability challenges, what are the required knowledge and skills needed for sustainability experts? Although the earlier literature identified key features and competencies, empirical studies on how educational programs in sustainability science provide the necessary training are still scarce. This study addresses this gap by illustrating how a field-based course can contribute in developing core skills for fostering sustainability experts through a case study of field-based course called Global Field Exercise (GFE in the Graduate Program in Sustainability Science-Global Leadership Initiative (GPSS-GLI at The University of Tokyo. Literature review on the competencies in sustainability science suggests a three-way typology of descriptive-analytical skills, solution-oriented skills, and attitudinal skills. A group of students joined a GFE unit in Akita, Japan, and set “local food and place attachment” as the topic for their fieldwork. The participants conducted semi-structured interviews to three generational groups to illustrate the different perceptions of local food and places. The alternative mechanism of knowledge transmission across generations by local festivals and school events was found. The authors observed the implemented field-based course provided unique learning opportunities to acquire: (i the ability to perform key competencies collectively instead of individually; (ii an interdisciplinary-mindset to acknowledge multiple views to topics during group discussions among researchers; (iii a transdisciplinary-mindset to communicate research outputs with local residents in a communicable way; (iv the ability to

  13. RESULTS OF ANALYSIS OF BENCHMARKING METHODS OF INNOVATION SYSTEMS ASSESSMENT IN ACCORDANCE WITH AIMS OF SUSTAINABLE DEVELOPMENT OF SOCIETY

    Directory of Open Access Journals (Sweden)

    A. Vylegzhanina

    2016-01-01

    Full Text Available In this work, we introduce results of comparative analysis of international ratings indexes of innovation systems for their compliance with purposes of sustainable development. Purpose of this research is defining requirements to benchmarking methods of assessing national or regional innovation systems and compare them basing on assumption, that innovation system is aligned with sustainable development concept. Analysis of goal sets and concepts, which underlie observed international composite innovation indexes, comparison of their metrics and calculation techniques, allowed us to reveal opportunities and limitations of using these methods in frames of sustainable development concept. We formulated targets of innovation development on the base of innovation priorities of sustainable socio-economic development. Using comparative analysis of indexes with these targets, we revealed two methods of assessing innovation systems, maximally connected with goals of sustainable development. Nevertheless, today no any benchmarking method, which meets need of innovation systems assessing in compliance with sustainable development concept to a sufficient extent. We suggested practical directions of developing methods, assessing innovation systems in compliance with goals of societal sustainable development.

  14. KRAS early testing: consensus initiative and cost-effectiveness evaluation for metastatic colorectal patients in an Italian setting.

    Directory of Open Access Journals (Sweden)

    Carlo Barone

    Full Text Available KRAS testing is relevant for the choice of the most appropriate first-line therapy of metastatic colorectal cancer (CRC. Strategies for preventing unequal access to the test should be implemented, but their relevance in the practice is related to economic sustainability. The study adopted the Delphi technique to reach a consensus on several topics. Issues related to execution of KRAS testing were identified by an expert's board and proposed to 108 Italian oncologists and pathologists through two subsequent questionnaires. The emerging proposal was evaluated by decision analyses models employed by technology assessment agencies in order to assess cost-effectiveness. Alternative therapeutic strategies included most commonly used chemotherapy regimens alone or in combination with cetuximab or bevacizumab. The survey indicated that time interval for obtaining KRAS test should not exceed 15 days, 10 days being an optimal interval. To assure the access to proper treatment, a useful strategy should be to anticipate the test after radical resection in patients at high risk of relapse. Early KRAS testing in high risk CRC patients generates incremental cost-effectiveness ratios between 6,000 and 13,000 Euro per quality adjusted life year (QALY gained. In extensive sensitivity analyses ICER's were always below 15,000 Euro per QALY gained, far within the threshold of 60,000 Euro/QALY gained accepted by regulatory institutions in Italy. In metastatic CRC a time interval higher than 15 days for result of KRAS testing limits access to therapeutic choices. Anticipating KRAS testing before the onset of metastatic disease in patients at high risk does not affect the sustainability and cost-effectiveness profile of cetuximab in first-line mCRC. Early KRAS testing may prevent this inequality in high-risk patients, whether they develop metastases, and is a cost-effective strategy. Based on these results, present joined recommendations of Italian societies of

  15. Tuition fees and sunk-cost effects

    NARCIS (Netherlands)

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

    2016-01-01

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

  16. 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…

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

    Directory of Open Access Journals (Sweden)

    Gabriel Otieno

    2016-03-01

    which produces health improvements in the most cost effective way for different epidemiological zones. This offers the good value for money for the public health programs and can guide in the allocation of malaria control resources for the post-2015 malaria eradication strategies and the achievement of the Sustainable Development Goals.

  18. Cost-effectiveness of using small vertebrates as indicators of disturbance.

    Science.gov (United States)

    Peck, Mika Robert; Maddock, Simon T; Morales, Jorge Noe; Oñate, Hugolino; Mafla-Endara, Paola; Peñafiel, Vanessa Aguirre; Torres-Carvajal, Omar; Pozo-Rivera, Wilmer E; Cueva-Arroyo, Xavier A; Tolhurst, Bryony A

    2014-10-01

    In species-rich tropical forests, effective biodiversity management demands measures of progress, yet budgetary limitations typically constrain capacity of decision makers to assess response of biological communities to habitat change. One approach is to identify ecological-disturbance indicator species (EDIS) whose monitoring is also monetarily cost-effective. These species can be identified by determining individual species' responses to disturbance across a gradient; however, such responses may be confounded by factors other than disturbance. For example, in mountain environments the effects of anthropogenic habitat alteration are commonly confounded by elevation. EDIS have been identified with the indicator value (IndVal) metric, but there are weaknesses in the application of this approach in complex montane systems. We surveyed birds, small mammals, bats, and leaf-litter lizards in differentially disturbed cloud forest of the Ecuadorian Andes. We then incorporated elevation in generalized linear (mixed) models (GL(M)M) to screen for EDIS in the data set. Finally, we used rarefaction of species accumulation data to compare relative monetary costs of identifying and monitoring EDIS at equal sampling effort, based on species richness. Our GL(M)M generated greater numbers of EDIS but fewer characteristic species relative to IndVal. In absolute terms birds were the most cost-effective of the 4 taxa surveyed. We found one low-cost bird EDIS. In terms of the number of indicators generated as a proportion of species richness, EDIS of small mammals were the most cost-effective. Our approach has the potential to be a useful tool for facilitating more sustainable management of Andean forest systems. © 2014 Society for Conservation Biology.

  19. 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.

  20. Impacts of optimum cost effective energy efficiency standards

    International Nuclear Information System (INIS)

    Brancic, A.B.; Peters, J.S.; Arch, M.

    1991-01-01

    Building Codes are increasingly required to be responsive to social and economic policy concerns. In 1990 the State of Connecticut passes An Act Concerning Global Warming, Public Act 90-219, which mandates the revision of the state building code to require that buildings and building elements be designed to provide optimum cost-effective energy efficiency over the useful life of the building. Further, such revision must meet the American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) Standard 90.1 - 1989. As the largest electric energy supplier in Connecticut, Northeast Utilities (NU) sponsored a pilot study of the cost effectiveness of alternative building code standards for commercial construction. This paper reports on this study which analyzed design and construction means, building elements, incremental construction costs, and energy savings to determine the optimum cost-effective building code standard. Findings are that ASHRAE 90.1 results in 21% energy savings and alternative standards above it result in significant additional savings. Benefit/cost analysis showed that both are cost effective

  1. Local perceptions as a guide for the sustainable management of natural resources: empirical evidence from a small-scale society in Bolivian Amazonia

    Directory of Open Access Journals (Sweden)

    Álvaro Fernández-Llamazares

    2016-03-01

    Full Text Available Research on natural resource management suggests that local perceptions form the basis upon which many small-scale societies monitor availability and change in the stock of common-pool natural resources. In contrast, this literature debates whether local perceptions can be effective in guiding the sustainable management of natural resources. With empirical evidence on this matter still highly limited, we explored the role of local perceptions as drivers of harvesting and management behavior in a small-scale society in Bolivian Amazonia. We conducted structured interviews to capture local perceptions of availability and change in the stock of thatch palm (Geonoma deversa among the Tsimane', an indigenous society of foragers-horticulturalists (n = 296 adults in 13 villages. We analyzed whether perceptions of availability match estimates of abundance obtained from ecological data and whether differences in perception help to explain harvesting behavior and local management of thatch palm. Perceptions of availability of G. deversa are highly contingent upon the social, economic, and cultural conditions within which the Tsimane' have experienced changes in the availability of the resource, thus giving a better reflection of the historical, rather than of the ecological, dimensions of the changes undergone. Although local perceptions might fall short in precision when scrutinized from an ecological standpoint, their importance in informing sustainable management should not be underestimated. Our findings show that most of the harvesting and management actions that the Tsimane' undertake are, at least partially, shaped by their local perceptions. This paper contributes to the broader literature on natural resource management by providing empirical evidence of the critical role of local perceptions in promoting collective responses for the sustainable management of natural resources.

  2. 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.)

  3. 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.)

  4. Central venous catheter infections in home parenteral nutrition patients: Outcomes from Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care.

    Science.gov (United States)

    Ross, Vicki M; Guenter, Peggi; Corrigan, Mandy L; Kovacevich, Debra; Winkler, Marion F; Resnick, Helaine E; Norris, Tina L; Robinson, Lawrence; Steiger, Ezra

    2016-12-01

    Home parenteral nutrition (HPN) is a high-cost, complex nutrition support therapy that requires the use of central venous catheters. Central line-associated bloodstream infections (CLABSIs) are among the most serious risks of this therapy. Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care (Sustain registry) provides the most current and comprehensive data for studying CLABSI among a national cohort of HPN patients in the United States. This is the first Sustain registry report detailing longitudinal data on CLABSI among HPN patients. To describe CLABSI rates for HPN patients followed in the Sustain registry from 2011-2014. Descriptive, χ 2 , and t tests were used to analyze data from the Sustain registry. Of the 1,046 HPN patients from 29 sites across the United States, 112 (10.7%) experienced 194 CLABSI events during 223,493 days of HPN exposure, for an overall CLABSI rate of 0.87 episodes/1,000 parenteral nutrition-days. Although the majority of patients were female (59%), adult (87%), white (75%), and with private insurance or Medicare (69%), CLABSI episodes per 1,000 parenteral nutrition-days were higher for men (0.69 vs 0.38), children (1.17 vs 0.35), blacks (0.91 vs 0.41), and Medicaid recipients (1.0 vs 0.38 or 0.39). Patients with implanted ports or double-lumen catheters also had more CLABSIs than those with peripherally inserted or central catheters or single-lumen catheters. Staphylococci were the most commonly reported pathogens. These data support findings of smaller studies about CLABSI risk for children and by catheter type and identify new potential risk factors, including gender, race, and insurance type. Additional studies are needed to determine effective interventions that will reduce HPN-associated CLABSI. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  5. Cost effectiveness of radon mitigation in Canada

    International Nuclear Information System (INIS)

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

    1992-01-01

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

  6. Green Infrastructure Siting and Cost Effectiveness Analysis

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Parcel scale green infrastructure siting and cost effectiveness analysis. You can find more details at the project's website.

  7. The Role of Formal and Informal Forces in Shaping Consumption and Implications for Sustainable Society: Part II

    Directory of Open Access Journals (Sweden)

    Oksana Mont

    2010-08-01

    Full Text Available Looking at consumption from a societal perspective, we can see that purchasing and behavior decisions are influenced by many factors, not the least which are what the people around us and in the media are doing. Other factors include economic influences, the marketing of products and technological innovations, and regulations governing consumption. This article, Part II, argues that in order to understand consumption, we need to move beyond the dominant (economic understanding of consumers and consumer behavior, and think about the origins of our preferences, needs, and desires. A thorough understanding of consumption is informed by the contributions of sociologists, psychologists, anthropologists, and behavioral scientists, who study the socio-cultural, social, and psychological contexts in which consumer behavior is embedded. These disciplines offer rich and complex explanations of human behavior, which in turn illuminate the discussion on how consumer behavior can be made more sustainable.

  8. Transforming Shell and Society Elements in Human Settlements for Sustainable Tourism Development: Setu Babakan, South Jakarta, Indonesia

    Science.gov (United States)

    Koncara, R. M. P.; Tiarasari, R.; Pratiwi, W. D.

    2018-05-01

    The government has established the settlements around Setu Babakan as Betawi Cultural Village (PBB). The goal of PBB Setu Babakan is to preserve Betawi culture which is fading, and realized by making the location as a tourism destination in South Jakarta. This paper discusses the transformation on the two ekistics elements in human settlements around Setu Babakan; shell and society in the development of tourism. Shell as a physical element is reflected in the citizen’s houses which are adapted into traditional Betawi houses. While the society refers to Setu Babakan’s citizen who participated as economic actors by selling traditional Betawi food and beverages, as well as a performers at the Betawi traditional art performances. In its application, the adaptation of citizen’s houses into traditional Betawi house cannot be done completely. The adaptation that can be done to the residents’ houses is by beautification in the appearance of the building. The application of typical Betawi ornaments makes the settlement feels like Betawi traditional village. This is one of the attractions for tourists. They can enjoy the atmosphere of Betawi village, enjoy Betawi food and beverages, watch Betawi art performance, and enjoy the lake tour at PBB Setu Babakan.

  9. Sustainable development through nuclear technology : 29th annual conference of the Canadian Nuclear Society and 32nd CNS/CNA student conference

    International Nuclear Information System (INIS)

    2008-01-01

    The 29th Annual Conference of the Canadian Nuclear Society and 32nd CNS/CNA Student Conference on Sustainable Development through Nuclear Technology was held on June 1-4, 2008 in Toronto, Ontario, Canada. The theme of the conference was 'Nuclear Sustainability'. The central objective of this conference was to provide a forum for exchange of views on how this technical enterprise can best serve the needs of humanity, now and in the future. The renewed global interest in nuclear technology is based on a recognition of its potential to meet economic and environmental targets more favourably than competing technologies. Although many of these attractions are short-term in nature, they stem from a broader potential of nuclear technology to drive all aspects of development (social, environmental, economic) in a sustainable in this area. (author) a terial in support of fuel resources themselves. The conference drew a record attendance of over 450 delegates. Over 100 technical papers were presented within 15 technical sessions, as well as over 30 student papers in 5 sessions. The following list of session titles indicates the diversity of the technical papers: advanced reactors; plant and components; process systems; thermalhydraulics; safety and licensing; hydrogen; human factors; physics; instrumentation and control; environment and waste management; and plant operation. (author)

  10. Focus 2012. Awakening into a new age - Elements of a sustainable energy supply. Ressource efficiency - key competency of sustainable societies, Sustainable chemistry - fundamental building blocks of a green economy. Annual report; Schwerpunkte 2012. Aufbruch ins neue Zeitalter - Elemente einer nachhaltigen Energieversorgung, Ressourceneffizienz - Schluesselkompetenz zukunftsfaehiger Gesellschaften, Nachhaltige Chemie - elementarer Baustein einer Green Economy. Jahrespublikation

    Energy Technology Data Exchange (ETDEWEB)

    Mavromati, Fotini; Ittershagen, Martin [comps.

    2012-05-30

    The Federal Environmental Agency (Dessau-Rosslau, Federal Republic of Germany) sees excellent opportunities to move the economic regeneration forward by means of environmental protection. Under this aspect, the annual report ''Focus 2012'' under consideration presents the following contributions: (1) Green Economy as a new model for economic development; (2) Elements of a sustainable energy supply; (3) Resource efficiency as a key competence for sustainable societies; (4) Green Chemistry as a fundamental building block of Green Economy.

  11. Focus 2012. Awakening into a new age - Elements of a sustainable energy supply. Ressource efficiency - key competency of sustainable societies, Sustainable chemistry - fundamental building blocks of a green economy. Annual report; Schwerpunkte 2012. Aufbruch ins neue Zeitalter - Elemente einer nachhaltigen Energieversorgung, Ressourceneffizienz - Schluesselkompetenz zukunftsfaehiger Gesellschaften, Nachhaltige Chemie - elementarer Baustein einer Green Economy. Jahrespublikation

    Energy Technology Data Exchange (ETDEWEB)

    Mavromati, Fotini; Ittershagen, Martin (comps.)

    2012-05-30

    The Federal Environmental Agency (Dessau-Rosslau, Federal Republic of Germany) sees excellent opportunities to move the economic regeneration forward by means of environmental protection. Under this aspect, the annual report ''Focus 2012'' under consideration presents the following contributions: (1) Green Economy as a new model for economic development; (2) Elements of a sustainable energy supply; (3) Resource efficiency as a key competence for sustainable societies; (4) Green Chemistry as a fundamental building block of Green Economy.

  12. Sustainability, Risk Society and Genetically Modified Foods: Definitions Disputes and the Bill Nº 4.148/08

    Directory of Open Access Journals (Sweden)

    Maria Claudia da Silva Antunes de Souza

    2016-10-01

    Full Text Available The paper has for object the analysis of the Bill n. 4.148/08, which significantly changes the way the labeling of GM foods, replacing the currently existing symbol by a phrase inserted between other label data. It is the goal of the reserach to show that this proposal, beyond a mere legislative amendment least, is embedded in a much larger context and is living proof of the hypothesis of Professor Ulrich Beck that socially recognized risks would be subject and object of definitions disputes much less depend on scientific knowledge of what actually the political game that involves power, money, information and media space. In addition, it follows the assertion  in response to the problem of the research  that, in the light of the sustainability paradigm, the PL 4.148/08 represents an environmental setback and itself a threat to the construction of this new ethical imperative. In the methodology we used the inductive method in the investigation phase; in the data processing phase the Cartesian method and in the research report was employed the inductive base. They were also triggered the techniques of reference, category, operational concepts, bibliographic research and book report.

  13. Innovative Promotion of Renewable Energy Development for Challenging Sustainable Low-Carbon Society: Case Study of Pingtung County, Taiwan

    Directory of Open Access Journals (Sweden)

    Wen-Tien Tsai

    2014-01-01

    Full Text Available Pingtung County, located in the southernmost part of Taiwan, has been selected as one of the Smarter Cities Challenge by the International Business Machines (IBM in 2013 due to its innovative promotion for renewable energy exploitation in recent years. In this regard, the objective of this paper will be to present an in-depth analysis of the success of environmental sustainability efforts through aggressive measures and profitable plans by this tropical county. The description in the paper is, thus, summarized on the central regulations and economic measures for promoting renewable energy in Taiwan, focusing on the feed-in tariff (FIT. Then, some innovative promotion plans for renewable energy in Pinugtung County, including swine-derived biogas-to-power and “Raise Water, Grow Electricity”, were further addressed to show the preliminary results under the funding supports of the central and local governments. With a practical basis of the total swine population (around 433,000 heads, from the farm scale of over 5,000 heads in Pingtung County, a preliminary analysis showed the annual benefits: methane reduction of 2.2 Gg, electricity generation of 8.3 × 106 kilowatt-hour (kW-h, equivalent electricity charge saving of 8.3 × 105 US Dollar (USD, and equivalent carbon dioxide mitigation of 50.9 thousand tons (Gg.

  14. Biosimilar medicines and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Steven Simoens

    2011-02-01

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

  15. The European Cystic Fibrosis Society Patient Registry: valuable lessons learned on how to sustain a disease registry.

    Science.gov (United States)

    Viviani, Laura; Zolin, Anna; Mehta, Anil; Olesen, Hanne Vebert

    2014-06-07

    Disease registries have the invaluable potential to provide an insight into the natural history of the disease under investigation, to provide useful information (e.g. through health indicators) for planning health care services and to identify suitable groups of patients for clinical trials enrolment. However, the establishment and maintenance of disease registries is a burdensome initiative from economical and organisational points of view and experience sharing on registries management is important to avoid waste of resources. The aim of this paper is to discuss the problems embedded in the institution and management of an international disease registry to warn against common mistakes that can derail the best of intentions: we share the experience of the European Cystic Fibrosis Society Patient Registry, which collects data on almost 30,000 patients from 23 countries. We discuss the major problems that researchers often encounter in the creation and management of disease registries: definition of the aims the registry has to reach, definition of the criteria for patients referral to the registry, definition of the information to record, set up of a data quality process, handling of missing data, maintenance of data confidentiality, regulation of data use and dissemination of research results. We give examples on how many crucial aspects were solved by the European Cystic Fibrosis Society Patient Registry regarding objectives, inclusion criteria and variables definition, data management, data quality controls, missing data handling, confidentiality maintenance, data use and results dissemination. We suggest an extensive literature research and discussions in working groups with different stake holders, including patient representatives, on the objectives, inclusion criteria and the information to record. We propose to pilot the recording of few variables and test the applicability of their definition first. The use of a shared electronic platform for data

  16. Key features for more successful place-based sustainability research on social-ecological systems: a Programme on Ecosystem Change and Society (PECS perspective

    Directory of Open Access Journals (Sweden)

    Patricia Balvanera

    2017-03-01

    Full Text Available The emerging discipline of sustainability science is focused explicitly on the dynamic interactions between nature and society and is committed to research that spans multiple scales and can support transitions toward greater sustainability. Because a growing body of place-based social-ecological sustainability research (PBSESR has emerged in recent decades, there is a growing need to understand better how to maximize the effectiveness of this work. The Programme on Ecosystem Change and Society (PECS provides a unique opportunity for synthesizing insights gained from this research community on key features that may contribute to the relative success of PBSESR. We surveyed the leaders of PECS-affiliated projects using a combination of open, closed, and semistructured questions to identify which features of a research project are perceived to contribute to successful research design and implementation. We assessed six types of research features: problem orientation, research team, and contextual, conceptual, methodological, and evaluative features. We examined the desirable and undesirable aspects of each feature, the enabling factors and obstacles associated with project implementation, and asked respondents to assess the performance of their own projects in relation to these features. Responses were obtained from 25 projects working in 42 social-ecological study cases within 25 countries. Factors that contribute to the overall success of PBSESR included: explicitly addressing integrated social-ecological systems; a focus on solution- and transformation-oriented research; adaptation of studies to their local context; trusted, long-term, and frequent engagement with stakeholders and partners; and an early definition of the purpose and scope of research. Factors that hindered the success of PBSESR included: the complexities inherent to social-ecological systems, the imposition of particular epistemologies and methods on the wider research group

  17. [Maintenance and health promotion of adolescent--pledge of sustainable development of society and state (current status of the issue)].

    Science.gov (United States)

    Baranov, A A; Namazova-Baranova, L S; Il'in, A G

    2014-01-01

    leading one is suicide. Road traffic accidents and accidental poisoning comes then. The medical and social consequences of high morbidity, disability and mortality rates of adolescent were considered as labour, reproductive and military potential of society and state. Short-term and long-term plans focused on decrease of morbidity, disability and mortality rates of adolescent were formulated on the basis of submitted data. search for solution is supposed to be nationwide and local as well (public health service, education, social protection).

  18. Cost-effectiveness analysis and innovation.

    Science.gov (United States)

    Jena, Anupam B; Philipson, Tomas J

    2008-09-01

    While cost-effectiveness (CE) analysis has provided a guide to allocating often scarce resources spent on medical technologies, less emphasis has been placed on the effect of such criteria on the behavior of innovators who make health care technologies available in the first place. A better understanding of the link between innovation and cost-effectiveness analysis is particularly important given the large role of technological change in the growth in health care spending and the growing interest of explicit use of CE thresholds in leading technology adoption in several Westernized countries. We analyze CE analysis in a standard market context, and stress that a technology's cost-effectiveness is closely related to the consumer surplus it generates. Improved CE therefore often clashes with interventions to stimulate producer surplus, such as patents. We derive the inconsistency between technology adoption based on CE analysis and economic efficiency. Indeed, static efficiency, dynamic efficiency, and improved patient health may all be induced by the cost-effectiveness of the technology being at its worst level. As producer appropriation of the social surplus of an innovation is central to the dynamic efficiency that should guide CE adoption criteria, we exemplify how appropriation can be inferred from existing CE estimates. For an illustrative sample of technologies considered, we find that the median technology has an appropriation of about 15%. To the extent that such incentives are deemed either too low or too high compared to dynamically efficient levels, CE thresholds may be appropriately raised or lowered to improve dynamic efficiency.

  19. Gedanken Experiments in Educational Cost Effectiveness

    Science.gov (United States)

    Brudner, Harvey J.

    1978-01-01

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

  20. Cost-effectiveness of colorectal cancer screening

    NARCIS (Netherlands)

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

    2011-01-01

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

  1. The Interpersonal Sunk-Cost Effect.

    Science.gov (United States)

    Olivola, Christopher Y

    2018-05-01

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

  2. [Cost-effectiveness of addiction care].

    Science.gov (United States)

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

    2015-01-01

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

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

    National Research Council Canada - National Science Library

    Tan Torres Edejer, Tessa

    2003-01-01

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

  4. 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

  5. Cost-effectiveness of the fenceline cow

    Energy Technology Data Exchange (ETDEWEB)

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

    1979-07-01

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

  6. 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.

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

    National Research Council Canada - National Science Library

    Tan Torres Edejer, Tessa

    2003-01-01

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

  8. Cost-Effectiveness and Clinical Practice Guidelines: Have We Reached a Tipping Point?-An Overview.

    Science.gov (United States)

    Garrison, Louis P

    2016-01-01

    Given recent developments in the United States, where professional clinical societies have attempted to define "value" and consider it in their deliberations about appropriate care, this thematic article describes those recent specialty society efforts in the United States in cardiology and oncology and the multispecialty efforts in the United Kingdom for over 10 years. Despite our high levels of health spending, and our field's long and consistent approach to the basic tools of cost-effectiveness analysis (CEA), US private and public payers are not routinely or explicitly using CEAs in their reimbursement decisions. This is a puzzle that raises the following question: Why does the United States have so many skilled pharmacoeconomic practitioners and produce so many CEAs given this apparent lack of interest and trust? There are multiple reasons, but the lack of incentives to use the information certainly matters. This article identifies and discusses a number of key issues and challenges for incorporating CEA into US clinical guidelines development: potential bias in manufacturer-sponsored CEAs, the role of societal perspective, payer-subscriber and physician-patient agency relationships, the need for disease area CEA studies and modeling, patient heterogeneity, investigators' conflicts of interest, assessing the quality of economic studies, and aggregation of information using multicriteria decision analysis. These developments suggest that the application of CEA in health care decision making in the United States is evolving and may be approaching a tipping point. With increasing pressures on drug prices, perhaps reflecting challenges to industry sustainability, payers, providers, and patients are looking for value for money. CEA should be an important part of this process. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  9. Cost-effectiveness Analysis with Influence Diagrams.

    Science.gov (United States)

    Arias, M; Díez, F J

    2015-01-01

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

  10. Cost-effectiveness Analysis for Technology Acquisition.

    Science.gov (United States)

    Chakravarty, A; Naware, S S

    2008-01-01

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

  11. Cost effectiveness of surveillance for GI cancers.

    Science.gov (United States)

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

    2016-12-01

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

  12. Is expanding Medicare coverage cost-effective?

    Directory of Open Access Journals (Sweden)

    Muennig Peter

    2005-03-01

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

  13. Cost-effectiveness of seven IVF strategies: results of a Markov decision-analytic model.

    Science.gov (United States)

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

    2009-07-01

    A selective switch to elective single embryo transfer (eSET) in IVF has been suggested to prevent complications of fertility treatment for both mother and infants. We compared seven IVF strategies concerning their cost-effectiveness using a Markov model. The model was based on a three IVF-attempts time horizon and a societal perspective using real world strategies and data, comparing seven IVF strategies, concerning costs, live births and incremental cost-effectiveness ratios (ICERs). In order to increase pregnancy probability, one cycle of eSET + one cycle of standard treatment policy [STP, i.e. eSET in patients IVF treatment, combining several transfer policies was not cost-effective. A choice has to be made between three cycles of eSET, STP or DET. It depends, however, on society's willingness to pay which strategy is to be preferred from a cost-effectiveness point of view.

  14. [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

  15. Cost effectiveness of rural development programme instruments in Denmark

    DEFF Research Database (Denmark)

    Jensen, J Dejgaard; Jakobsen, L; Madsen, B

    2011-01-01

    The objective of this study is to investigate the cost-effectiveness of selected instruments of the Danish Rural Development Programme 2007-2013, which constitutes the Danish implementation of the EU Rural Development Programme under Pillar Two of the Common Agricultural Policy. The Programme aims...... to support sustainable economic growth and income diversification in rural areas (and in particular in economically vulnerable areas). The study combines different datasets and simulation models at farm level (register data, Farm Accountancy Data, farm sector model, run-off models, etc.), municipality level...... (micro-based “National Accounts” for municipalities, municipality economic model) and national level (national economic model), which enables analysis at a fairly detailed geographical level and hence to evaluate the spatially distributed effects of the considered policy instruments, while at the same...

  16. 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.

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

    Science.gov (United States)

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

    2015-04-01

    Selection of areas for restoration should be based on cost-effectiveness analysis to attain the maximum benefit with a limited budget and overcome the traditional ad hoc allocation of funds for restoration projects. Restoration projects need to be planned on the basis of ecological knowledge and economic and social constraints. We devised a novel approach for selecting cost-effective areas for restoration on the basis of biodiversity and potential provision of 3 ecosystem services: carbon storage, water depuration, and coastal protection. We used Marxan, a spatial prioritization tool, to balance the provision of ecosystem services against the cost of restoration. We tested this approach in a mangrove ecosystem in the Caribbean. Our approach efficiently selected restoration areas that at low cost were compatible with biodiversity targets and that maximized the provision of one or more ecosystem services. Choosing areas for restoration of mangroves on the basis carbon storage potential, largely guaranteed the restoration of biodiversity and other ecosystem services. © 2014 Society for Conservation Biology.

  18. Cost effective material control and accountability training

    International Nuclear Information System (INIS)

    Robichaux, J.J.; Shull, L.M.; Salizzoni, L.M.

    1995-01-01

    DOE Order 5630.15, ''Safeguards and Security Training Program'' is being implemented at the Savannah River Site within the Westinghouse Savannah River Company's material control and accountability program. This paper reviews the development of a material control and accountability task analysis, the development of specific material control and accountability courses, and the cost effective and innovative strategies employed to implement the training program. The paper also discusses how the site material control and accountability policies and procedures are incorporated into the Westinghouse Savannah River Company training program to ensure that personnel receive the most current information

  19. 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

  20. Economical and ambient sustainability: an ideal of the international society Sustentabilidade econômica e ambiental: um ideal da sociedade internacional

    Directory of Open Access Journals (Sweden)

    Marlene Kempfer Bassoli

    2005-12-01

    Full Text Available The incorporation of the environmental issue by international offices and regional blocks in the last decades, has demonstrated a growing preoccupation with the road to sustainable socio-economic development. The contemporary development process, consolidated by the capitalist production model, has exercised great influence on society in general. This globalized economic model gave rise to a new network of relations which have affected the political structures of the States. Thus, among the many concerns involving these changes is the incorporation of environmental values to reach sustainable development, to promote economic development taking into account environment protection and social justice. In face of the transnacionality issue and the importance of the objective at hand, it is fundamental to raise people’s awareness of the legal harmonization issue.A incorporação do tema ambiental por organismos internacionais e blocos regionais, ao longo das últimas décadas do século XX, demonstra uma lenta preocupação com o caminho do desenvolvimento sócio-econômico sustentável. O processo de desenvolvimento, que se consolidou a partir do modo de produção capitalista, exerceu influência sobre a sociedade de um modo geral. Um modelo econômico de efeito globalizante, trouxe à tona uma nova rede de relações, com reflexos, inclusive, nas estruturas políticas dos Estados. Assim, entre as necessárias preocupações, diante das mudanças, está a incorporação de valores relacionados ao meio ambiente para alcançar o desenvolvimento sustentável, ou seja, desenvolvimento econômico com preservação do meio ambiente e justiça social. Diante da transnacionalidade da questão ambiental e para alcançar tal objetivo, é fundamental despertar para a consciência do caminho da harmonização legislativa.

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

    Directory of Open Access Journals (Sweden)

    Yolanda Hernández-Gago

    2017-03-01

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

  2. Is aggressive treatment of traumatic brain injury cost-effective?

    Science.gov (United States)

    Whitmore, Robert G; Thawani, Jayesh P; Grady, M Sean; Levine, Joshua M; Sanborn, Matthew R; Stein, Sherman C

    2012-05-01

    The object of this study was to determine whether aggressive treatment of severe traumatic brain injury (TBI), including invasive intracranial monitoring and decompressive craniectomy, is cost-effective. A decision-analytical model was created to compare costs, outcomes, and cost-effectiveness of 3 strategies for treating a patient with severe TBI. The aggressive-care approach is compared with "routine care," in which Brain Trauma Foundation guidelines are not followed. A "comfort care" category, in which a single day in the ICU is followed by routine floor care, is included for comparison only. Probabilities of each treatment resulting in various Glasgow Outcome Scale (GOS) scores were obtained from the literature. The GOS scores were converted to quality-adjusted life years (QALYs), based on expected longevity and calculated quality of life associated with each GOS category. Estimated direct (acute and long-term medical care) and indirect (loss of productivity) costs were calculated from the perspective of society. Sensitivity analyses employed a 2D Monte Carlo simulation of 1000 trials, each with 1000 patients. The model was also used to estimate these values for patients 40, 60, and 80 years of age. For the average 20-year-old, aggressive care yields 11.7 (± 1.6 [SD]) QALYs, compared with routine care (10.0 ± 1.5 QALYs). This difference is highly significant (p care remains significantly better at all ages. When all costs are considered, aggressive care is also significantly less costly than routine care ($1,264,000 ± $118,000 vs $1,361,000 ± $107,000) for the average 20-year-old. Aggressive care remains significantly less costly until age 80, at which age it costs more than routine care. However, even in the 80-year-old, aggressive care is likely the more cost-effective approach. Comfort care is associated with poorer outcomes at all ages and with higher costs for all groups except 80-year-olds. When all the costs of severe TBI are considered, aggressive

  3. Flexible embedded circuitry : a novel process for high density, cost effective electronics

    NARCIS (Netherlands)

    Brand, van den J.; Kusters, R.; Barink, M.; Dietzel, A.H.

    2010-01-01

    Flexible electronics are starting to emerge with all-printed but also hybrid cost effective, smart electronic products that will find a wide range of applications in large quantities in our society. Such products have to be built on low cost substrate materials like PEN or PET foils. Because of the

  4. A cost effective CO2 strategy

    DEFF Research Database (Denmark)

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

  5. On cost-effective communication network designing

    Science.gov (United States)

    Zhang, Guo-Qiang

    2010-02-01

    How to efficiently design a communication network is a paramount task for network designing and engineering. It is, however, not a single objective optimization process as perceived by most previous researches, i.e., to maximize its transmission capacity, but a multi-objective optimization process, with lowering its cost to be another important objective. These two objectives are often contradictive in that optimizing one objective may deteriorate the other. After a deep investigation of the impact that network topology, node capability scheme and routing algorithm as well as their interplays have on the two objectives, this letter presents a systematic approach to achieve a cost-effective design by carefully choosing the three designing aspects. Only when routing algorithm and node capability scheme are elegantly chosen can BA-like scale-free networks have the potential of achieving good tradeoff between the two objectives. Random networks, on the other hand, have the built-in character for a cost-effective design, especially when other aspects cannot be determined beforehand.

  6. 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)

  7. Deregulation and Nuclear Training: Cost Effective Alternatives

    International Nuclear Information System (INIS)

    Richard P. Coe; Patricia A. Lake

    2000-01-01

    Training is crucial to the success of any organization. It is also expensive, with some estimates exceeding $50 billion annually spent on training by U.S. corporations. Nuclear training, like that of many other highly technical organizations, is both crucial and costly. It is unlikely that the amount of training can be significantly reduced. If anything, current trends indicate that training needs will probably increase as the industry and workforce ages and changes. With the advent of energy deregulation in the United States, greater pressures will surface to make the costs of energy more cost-competitive. This in turn will drive businesses to more closely examine existing costs and find ways to do things in a more cost-effective way. The commercial nuclear industry will be no exception, and nuclear training will be equally affected. It is time for nuclear training and indeed the entire nuclear industry to begin using more aggressive techniques to reduce costs. This includes the need for nuclear training to find alternatives to traditional methods for the delivery of cost-effective high-quality training that meets regulatory requirements and produces well-qualified personnel capable of working in an efficient and safe manner. Computer-based and/or Web-based training are leading emerging technologies

  8. Use of cost-effective construction technologies in India to mitigate climate change

    Energy Technology Data Exchange (ETDEWEB)

    Sengupta, N. [Forum of Scientists, Engineers and Technologists, Kolkata (India)

    2008-01-10

    Concentration of greenhouse gases plays a major role in raising the earth's temperature. Carbon dioxide, produced from burning of fossil fuels, is the principle greenhouse gas and efforts are being made at international level to reduce its emission through adoption of energy-efficient technologies. The UN Conference on Environment and Development, 1992 made a significant development in this field by initiating the discussion on sustainable development under the Agenda 21. Cost-effective construction technologies can bring down the embodied energy level associated with production of building materials by lowering use of energy-consuming materials. This embodied energy is a crucial factor for sustainable construction practices and effective reduction of the same would contribute in mitigating global warming. The cost-effective construction technologies would emerge as the most acceptable case of sustainable technologies in India both in terms of cost and environment.

  9. Cost-effectiveness of interventions to prevent cardiovascular disease in Australia's indigenous population.

    Science.gov (United States)

    Ong, Katherine S; Carter, Rob; Vos, Theo; Kelaher, Margaret; Anderson, Ian

    2014-05-01

    Cardiovascular disease is the leading cause of disease burden in Australia's Indigenous population, and the greatest contributor to the Indigenous 'health gap'. Economic evidence can help identify interventions that efficiently address this discrepancy. Five interventions (one community-based and four pharmacological) to prevent cardiovascular disease in Australia's Indigenous population were subject to economic evaluation. Pharmacological interventions were evaluated as delivered either via Aboriginal Community Controlled Health Services or mainstream general practitioner services. Cost-utility analysis methods were used, with health benefit measured in disability-adjusted life-years saved. All pharmacological interventions produced more Indigenous health benefit when delivered via Indigenous health services, but cost-effectiveness ratios were higher due to greater health service costs. Cost-effectiveness ratios were also higher in remote than in non-remote regions. The polypill was the most cost-effective intervention evaluated, while the community-based intervention produced the most health gain. Local and decision-making contextual factors are important in the conduct and interpretation of economic evaluations. For Australia's Indigenous population, different models of health service provision impact on reach and cost-effectiveness results. Both the extent of health gain and cost-effectiveness are important considerations for policy-makers in light of government objectives to address health inequities and bridge the health gap. Copyright © 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.

  10. Cost Effectiveness of Screening Colonoscopy Depends on Adequate Bowel Preparation Rates - A Modeling Study.

    Directory of Open Access Journals (Sweden)

    James Kingsley

    Full Text Available Inadequate bowel preparation during screening colonoscopy necessitates repeating colonoscopy. Studies suggest inadequate bowel preparation rates of 20-60%. This increases the cost of colonoscopy for our society.The aim of this study is to determine the impact of inadequate bowel preparation rate on the cost effectiveness of colonoscopy compared to other screening strategies for colorectal cancer (CRC.A microsimulation model of CRC screening strategies for the general population at average risk for CRC. The strategies include fecal immunochemistry test (FIT every year, colonoscopy every ten years, sigmoidoscopy every five years, or stool DNA test every 3 years. The screening could be performed at private practice offices, outpatient hospitals, and ambulatory surgical centers.At the current assumed inadequate bowel preparation rate of 25%, the cost of colonoscopy as a screening strategy is above society's willingness to pay (<$50,000/QALY. Threshold analysis demonstrated that an inadequate bowel preparation rate of 13% or less is necessary before colonoscopy is considered more cost effective than FIT. At inadequate bowel preparation rates of 25%, colonoscopy is still more cost effective compared to sigmoidoscopy and stool DNA test. Sensitivity analysis of all inputs adjusted by ±10% showed incremental cost effectiveness ratio values were influenced most by the specificity, adherence, and sensitivity of FIT and colonoscopy.Screening colonoscopy is not a cost effective strategy when compared with fecal immunochemical test, as long as the inadequate bowel preparation rate is greater than 13%.

  11. Cost-Effective Fuel Treatment Planning

    Science.gov (United States)

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

    2014-12-01

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

  12. Solitary pulmonary nodules: impact of functional CT on the cost-effectiveness of FDG-PET

    International Nuclear Information System (INIS)

    Miles, K.A.; Keith, C.J.; Wong, D.C.; Griffiths, M.R.

    2002-01-01

    Full text: FDG-PET has been shown to be cost-effective for the evaluation of solitary pulmonary nodules (SPNs) in Australia. This study evaluates the impact on cost-effectiveness produced by incorporating a novel CT technique, functional CT, into diagnostic algorithms for characterisation of SPNs. Four diagnostic strategies were evaluated using decision tree sensitivity analysis. The first strategy comprised patients undergoing conventional CT alone (CT). The second comprised conventional CT followed by functional CT study (FCT), when the SPN was not benign on conventional CT. The third strategy comprised conventional CT, which if positive is followed by FDG-PET (PET) and a fourth strategy where patients with a positive conventional CT undergo functional CT, which if positive also undergo FDG-PET (FCT+PET). Values for disease prevalence and diagnostic accuracy of PET, CT and functional CT were obtained from a literature review, using Australia values where available. Procedure costs were derived from the Medicare Benefits Schedule and DRG Cost Weights for Australian public hospitals. The cost per patient, accuracy and Incremental Cost-Accuracy Ratio (ICAR) were determined for each strategy. Sensitivity analysis evaluated the effect of disease prevalence on cost-effectiveness. Results: At the prevalence of malignancy reported from Australian series (54%), the FCT strategy incurs the least cost ($5560/patient), followed by the FCT+PET ($5910/patient). The FCT+PET strategy is the most cost-effective strategy with an ICAR of $12059/patient, followed by the PET strategy with an ICAR of $12300/patient. At levels of disease prevalence below 54% the above relationship for cost-effectiveness remains the same. For high levels of disease prevalence, CT or FCT are found to be more cost-effective. At typical prevalence of malignancy the cost-effectiveness of PET is enhanced by the addition of functional CT, but at high prevalence functional CT alone is most cost-effective

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

    Science.gov (United States)

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

    2017-03-01

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

  14. Some Observations on Cost-Effectiveness Analysis in Education.

    Science.gov (United States)

    Geske, Terry G.

    1979-01-01

    The general nature of cost-effectiveness analysis is discussed, analytical frameworks for conducting cost-effectiveness studies are described, and some of the problems inherent in measuring educational costs and in assessing program effectiveness are addressed. (Author/IRT)

  15. OPCAB surgery is cost-effective for elderly patients

    DEFF Research Database (Denmark)

    Houlind, Kim Christian; Kjeldsen, Bo Juul; Madsen, Susanne Nørgaard

    2013-01-01

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

  16. Understanding Cost-Effectiveness of Energy Efficiency Programs

    Science.gov (United States)

    Discusses the five standard tests used to assess the cost-effectiveness of energy efficiency, how states are using these tests, and how the tests can be used to determine the cost-effectiveness of energy efficiency measures.

  17. Design And Implementation Of Cost Effective Inverter

    Directory of Open Access Journals (Sweden)

    Niaz Morshedul Haque

    2017-10-01

    Full Text Available This paper deals with the design and construct of a 100 Watt 220 Volt and 50 Hz Inverter. The system is designed without any microcontroller and it has a cost-effective design architecture. The elementary purpose of this device is to transmute 12 V DC to 220 V AC. Snubber technology is used to diminish the reverse potential transients and excessive heat of transformer winding and transistor switches. Switching pulse generated by NE 555 timer circuit and comparator circuit was used to take signal strength input from its rear as well as from both sides for triggering the MOSFET switches. Another switch is used to invert pulse between two switching circuitries. A 5 volts regulator IC 7805 was used to supply fixed 5V for biasing the switching and amplifying circuitry.

  18. Custom LSI plus hybrid equals cost effectiveness

    Science.gov (United States)

    Friedman, S. N.

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

  19. Cost-effective implementation of intelligent systems

    Science.gov (United States)

    Lum, Henry, Jr.; Heer, Ewald

    1990-01-01

    Significant advances have occurred during the last decade in knowledge-based engineering research and knowledge-based system (KBS) demonstrations and evaluations using integrated intelligent system technologies. Performance and simulation data obtained to date in real-time operational environments suggest that cost-effective utilization of intelligent system technologies can be realized. In this paper the rationale and potential benefits for typical examples of application projects that demonstrate an increase in productivity through the use of intelligent system technologies are discussed. These demonstration projects have provided an insight into additional technology needs and cultural barriers which are currently impeding the transition of the technology into operational environments. Proposed methods which addresses technology evolution and implementation are also discussed.

  20. Cost effectiveness of transportation fuels from biomass

    International Nuclear Information System (INIS)

    De Jager, D.; Faaij, A.P.C.; Troelstra, W.P.

    1998-06-01

    The aim of the study on the title subject was to investigate whether stimulation of the production and use of biofuels for transportation is worthwhile compared to the production of electricity from biomass. Several options are compared to each other and with reference technologies on the basis of the consumption or the avoided input of fossil fuels, emissions of greenhouse gases, specific costs and cost effectiveness. For each phase in the biomass conversion process (cultivation, pretreatment, transportation, conversion, distribution and final consumption) indicators were collected from the literature. Next to costs of the bioconversion routes attention is paid to other relevant aspects that are important for the introduction of the technological options in the Netherlands. 41 refs

  1. Energy, society and environment: considerations about the contribution of biofuels to sustainable development; Energia, sociedade e meio ambiente: consideracoes acerca da contribuicao dos biocombustiveis para o desenvolvimento sustentavel

    Energy Technology Data Exchange (ETDEWEB)

    Correia, Bruna de Barros [Universidade Estadual de Campinas (UNICAMP), SP (Brazil). Fac. de Engenharia Mecanica. Dept. de Energia

    2010-07-01

    The concept of development on the contemporary scene is limited to ideas of economic growth and consumption. In this context, arises the need for a new form of development, witch can be represented by the concept of sustainable development. The sustainability at the energy sector has a key role on mitigating environmental and social problems, and also contributes to security on energy supply. Therefore, the main purpose of the present paper is to understand the need for sustainable development at the contemporary scene and relate it to the energy context. To, then, analyze the prospect of biofuels on the three spheres of sustainable development: economic, social and environmental. (author)

  2. 10 CFR 455.63 - Cost-effectiveness testing.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Cost-effectiveness testing. 455.63 Section 455.63 Energy..., Hospitals, Units of Local Government, and Public Care Institutions § 455.63 Cost-effectiveness testing. (a... paragraph (a) of this section, if the State plan requires the cost effectiveness of an energy conservation...

  3. 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...

  4. 42 CFR 457.1015 - Cost-effectiveness.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Cost-effectiveness. 457.1015 Section 457.1015... Waivers: General Provisions § 457.1015 Cost-effectiveness. (a) Definition. For purposes of this subpart... may demonstrate cost-effectiveness by comparing the cost of coverage for the family to the cost of...

  5. 49 CFR 639.21 - Determination of cost-effectiveness.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Determination of cost-effectiveness. 639.21... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CAPITAL LEASES Cost-Effectiveness § 639.21 Determination of cost...-effectiveness comparison as described in this subpart, it may ask FTA to approve an alternate form of cost...

  6. Cost-effectiveness analysis of introducing universal human papillomavirus vaccination of girls aged 11 years into the National Immunization Program in Brazil.

    Science.gov (United States)

    Novaes, Hillegonda Maria Dutilh; de Soárez, Patrícia Coelho; Silva, Gulnar Azevedo; Ayres, Andreia; Itria, Alexander; Rama, Cristina Helena; Sartori, Ana Marli Christovam; Clark, Andrew D; Resch, Stephen

    2015-05-07

    To evaluate the impact and cost-effectiveness of introducing universal human papillomavirus (HPV) vaccination into the National Immunization Program (NIP) in Brazil. The Excel-based CERVIVAC decision support model was used to compare two strategies: (1) status quo (with current screening program) and (2) vaccination of a cohort of 11-year-old girls. National parameters for the epidemiology and costs of cervical cancer were estimated in depth. The estimates were based on data from the health information systems of the public health system, the PNAD 2008 national household survey, and relevant scientific literature on Brazil. Costs are expressed in 2008 United States dollars (US$), and a 5% discount rate is applied to both future costs and future health benefits. Introducing the HPV vaccine would reduce the burden of disease. The model estimated there would be 229 deaths avoided and 6677 disability-adjusted life years (DALYs) averted in the vaccinated cohort. The incremental cost-effectiveness ratios (ICERs) per DALY averted from the perspectives of the government (US$ 7663), health system (US$ 7412), and society (US$ 7298) would be considered cost-effective, according to the parameters adopted by the World Health Organization. In the sensitivity analysis, the ICERs were most sensitive to variations in discount rate, disease burden, vaccine efficacy, and proportion of cervical cancer caused by types 16 and 18. However, universal HPV vaccination remained a cost-effective strategy in most variations of the key estimates. Vaccine introduction could contribute additional benefits in controlling cervical cancer, but it requires large investments by the NIP. Among the essential conditions for attaining the expected favorable results are immunization program sustainability, equity in a population perspective, improvement of the screening program, and development of a surveillance system. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Cost effective water treatment program in Heavy Water Plant (Manuguru)

    International Nuclear Information System (INIS)

    Mohapatra, C.; Prasada Rao, G.

    2002-01-01

    Water treatment technology is in a state of continuous evolution. The increasing urgency to conserve water and reduce pollution has in recent years produced an enormous demand for new chemical treatment programs and technologies. Heavy water plant (Manuguru) uses water as raw material (about 3000 m 3 /hr) and its treatment and management has benefited the plant in a significant way. It is a fact that if the water treatment is not proper, it can result in deposit formation and corrosion of metals, which can finally leads to production losses. Therefore, before selecting treatment program, complying w.r.t. quality requirements, safety and pollution aspects cost effectiveness shall be examined. The areas where significant benefits are derived, are raw water treatment using polyelectrolyte instead of inorganic coagulant (alum), change over of regenerant of cation exchangers from hydrochloric acid to sulfuric acid and in-house development of cooling water treatment formulation. The advantages and cost effectiveness of these treatments are discussed in detail. Further these treatments has helped the plant in achieving zero discharge and indirectly increased cost reduction of final product (heavy water); the dosage of 3 ppm of polyelectrolyte can replace 90 ppm alum at turbidity level of 300 NTU of raw water which has resulted in cost saving of Rs. 15-20 lakhs in a year beside other advantages; the change over of regenerant from HCl to H 2 SO 4 will result in cost saving of at least Rs.1.4 crore a year besides other advantages; the change over to proprietary formulation to in-house formulation in cooling water treatment has resulted in a saving about Rs.11 lakhs a year. To achieve the above objectives in a sustainable way the performance results are being monitored. (author)

  8. 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

  9. 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

  10. Methodology for Evaluating Cost-effectiveness of Commercial Energy Code Changes

    Energy Technology Data Exchange (ETDEWEB)

    Hart, Philip R. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Liu, Bing [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2015-01-31

    This document lays out the U.S. Department of Energy’s (DOE’s) method for evaluating the cost-effectiveness of energy code proposals and editions. The evaluation is applied to provisions or editions of the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) Standard 90.1 and the International Energy Conservation Code (IECC). The method follows standard life-cycle cost (LCC) economic analysis procedures. Cost-effectiveness evaluation requires three steps: 1) evaluating the energy and energy cost savings of code changes, 2) evaluating the incremental and replacement costs related to the changes, and 3) determining the cost-effectiveness of energy code changes based on those costs and savings over time.

  11. Cost effectiveness of recycling: A systems model

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-11-15

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

  12. The sunk cost effect across species: A review of persistence in a course of action due to prior investment.

    Science.gov (United States)

    Magalhães, Paula; Geoffrey White, K

    2016-05-01

    The sunk cost effect is the bias or tendency to persist in a course of action due to prior investments of effort, money or time. At the time of the only review on the sunk cost effect across species (Arkes & Ayton, 1999), research with nonhuman animals had been ecological in its nature, and the findings about the effect of past investments on current choice were inconclusive. However, in the last decade a new line of experimental laboratory-based research has emerged with the promise of revolutionizing the way we approach the study of the sunk cost effect in nonhumans. In the present review we challenge Arkes and Ayton's conclusion that the sunk cost effect is exclusive to humans, and describe evidence for the sunk cost effect in nonhuman animals. By doing so, we also challenge the current explanations for the sunk cost effect in humans, as they are not applicable to nonhumans. We argue that a unified theory is called for, because different independent variables, in particular, investment amount, have the same influence on the sunk cost effect across species. Finally, we suggest possible psychological mechanisms shared across different species, contrast and depreciation, that could explain the sunk cost effect. © 2016 Society for the Experimental Analysis of Behavior.

  13. Cost-effectiveness of modern radiotherapy techniques in locally advanced pancreatic cancer.

    Science.gov (United States)

    Murphy, James D; Chang, Daniel T; Abelson, Jon; Daly, Megan E; Yeung, Heidi N; Nelson, Lorene M; Koong, Albert C

    2012-02-15

    Radiotherapy may improve the outcome of patients with pancreatic cancer but at an increased cost. In this study, the authors evaluated the cost-effectiveness of modern radiotherapy techniques in the treatment of locally advanced pancreatic cancer. A Markov decision-analytic model was constructed to compare the cost-effectiveness of 4 treatment regimens: gemcitabine alone, gemcitabine plus conventional radiotherapy, gemcitabine plus intensity-modulated radiotherapy (IMRT); and gemcitabine with stereotactic body radiotherapy (SBRT). Patients transitioned between the following 5 health states: stable disease, local progression, distant failure, local and distant failure, and death. Health utility tolls were assessed for radiotherapy and chemotherapy treatments and for radiation toxicity. SBRT increased life expectancy by 0.20 quality-adjusted life years (QALY) at an increased cost of $13,700 compared with gemcitabine alone (incremental cost-effectiveness ratio [ICER] = $69,500 per QALY). SBRT was more effective and less costly than conventional radiotherapy and IMRT. An analysis that excluded SBRT demonstrated that conventional radiotherapy had an ICER of $126,800 per QALY compared with gemcitabine alone, and IMRT had an ICER of $1,584,100 per QALY compared with conventional radiotherapy. A probabilistic sensitivity analysis demonstrated that the probability of cost-effectiveness at a willingness to pay of $50,000 per QALY was 78% for gemcitabine alone, 21% for SBRT, 1.4% for conventional radiotherapy, and 0.01% for IMRT. At a willingness to pay of $200,000 per QALY, the probability of cost-effectiveness was 73% for SBRT, 20% for conventional radiotherapy, 7% for gemcitabine alone, and 0.7% for IMRT. The current results indicated that IMRT in locally advanced pancreatic cancer exceeds what society considers cost-effective. In contrast, combining gemcitabine with SBRT increased clinical effectiveness beyond that of gemcitabine alone at a cost potentially acceptable by

  14. Cost effectiveness of regorafenib as second-line therapy for patients with advanced hepatocellular carcinoma.

    Science.gov (United States)

    Parikh, Neehar D; Singal, Amit G; Hutton, David W

    2017-10-01

    Regorafenib, a multikinase inhibitor, has demonstrated prolonged survival by 2.8 months as a second-line agent in patients with hepatocellular carcinoma (HCC) who progress on sorafenib therapy. The objective of the current study was to examine the cost effectiveness of regorafenib for the treatment of HCC. The authors constructed a Markov simulation model of patients with unresectable HCC and Child-Pugh A cirrhosis who received treatment with regorafenib versus best supportive care. Model inputs for regorafenib effectiveness and rates of adverse events in patients with HCC were based on published clinical trial data and literature review. Quality-adjusted life years (QALYs) were calculated along with the incremental cost-effectiveness ratio (ICER) of regorafenib therapy. One-way sensitivity analyses also were conducted simultaneously on all model parameters and on various Monte-Carlo simulation parameters, and the regorafenib cost threshold at which cost effectiveness would be achieved was determined. Regorafenib provided an increase of 0.18 QALYs at a cost of $47,112. The ICER for regorafenib, compared with best supportive care, was $224,362. In 1-way sensitivity analyses, there were no scenarios in which regorafenib was cost effective. In cost threshold analysis, regorafenib would have to be priced at or below $67 per pill to be cost effective at an ICER of $100,000. Regorafenib is not cost effective as a second-line agent in the treatment of HCC, with a marginal increase in QALYs at a high cost. Lowering the cost of regorafenib or improving the selection of patients who can achieve maximal survival benefit would improve its value as a second-line treatment option for patients with HCC. Cancer 2017;123:3725-3731. © 2017 American Cancer Society. © 2017 American Cancer Society.

  15. Cost-effectiveness analysis alongside a pilot study of prophylactic negative pressure wound therapy.

    Science.gov (United States)

    Heard, Christopher; Chaboyer, Wendy; Anderson, Vinah; Gillespie, Brigid M; Whitty, Jennifer A

    2017-02-01

    Negative pressure wound therapy (NPWT) is increasingly used prophylactically following surgery despite limited evidence of clinical or cost-effectiveness. To evaluate whether NPWT is cost-effective compared to standard care, for the prevention of surgical site infection (SSI) in obese women undergoing elective caesarean section, and inform development of a larger trial. An economic evaluation was conducted alongside a pilot randomised controlled trial at one Australian hospital, in which women were randomised to NPWT (n = 44) or standard care (n = 43). A public health care provider perspective and time horizon to four weeks post-discharge was adopted. Cost-effectiveness assessment was based on incremental cost per SSI prevented and per quality-adjusted life year (QALY) gained. Patients receiving NPWT each received health care costing AU$5887 (±1038) and reported 0.069 (±0.010) QALYs compared to AU$5754 (±1484) and 0.066 (±0.010) QALYs for patients receiving standard care. NPWT may be slightly more costly and more effective than standard care, with estimated incremental cost-effectiveness ratios (ICERs) of AU$1347 (95%CI dominant- $41,873) per SSI prevented and AU$42,340 (95%CI dominant- $884,019) per QALY gained. However, there was considerable uncertainty around these estimates. NPWT may be cost-effective in the prophylactic treatment of surgical wounds following elective caesarean section in obese women. Larger trials could clarify the cost-effectiveness of NPWT as a prophylactic treatment for SSI. Sensitive capture of QALYs and cost offsets will be important given the high level of uncertainty around the point estimate cost-effectiveness ratio which was close to conventional thresholds. ACTRN12612000171819. Copyright © 2016 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  16. 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.

  17. Taking democracy to the next level? Global civil society participation in the shaping of the Sustainable Development Goals from Rio to New York (2012-2015).

    NARCIS (Netherlands)

    Senit, C.A.

    2017-01-01

    During the negotiations of the Sustainable Development Goals, the United Nations consulted worldwide nearly 10 million people for their views. Such proliferating megaconsultations are often uncritically accepted as a remedy for an assumed democratic deficit of intergovernmental policymaking. The

  18. Cost effective waste management through composting in Africa

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-12-15

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

  19. Cost effective waste management through composting in Africa

    International Nuclear Information System (INIS)

    Couth, R.; Trois, C.

    2012-01-01

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

  20. Is prophylactic fixation a cost-effective method to prevent a future contralateral fragility hip fracture?

    Science.gov (United States)

    Faucett, Scott C; Genuario, James W; Tosteson, Anna N A; Koval, Kenneth J

    2010-02-01

    most analyses, the success of prophylactic fixation was highly sensitive to the effectiveness and the relative morbidity and mortality of the additional procedure. : Prophylactic fixation with a cephalomedullary nail was not found to be cost-effective for the average older woman who sustained a hip fracture. However, it may be appropriate for select patient populations. The study supports the need for basic science and clinical trials investigating the effectiveness of prophylactic fixation for patient populations at higher lifetime risk for contralateral hip fracture.

  1. Cost effectiveness of the Dutch incentive for the environmental quality of power generation (MEP)

    International Nuclear Information System (INIS)

    Melgerd, R.

    2005-01-01

    This article relates to research on the cost effectiveness of the MEP scheme ('Milieukwaliteit Elektriciteitsproductie' or Environmental Quality of Electricity Generation), carried out as a graduation project at the Vrije Universiteit, Amsterdam, Netherlands. MEP subsidies are intended to promote investment in sustainable energy sources in the Netherlands by offering investors more certainty and a simpler structure than previous energy subsidies. The MEP also helps prevent Dutch taxpayers' money 'leaking' abroad to purchase sustainable electricity produced cheaper elsewhere. This makes the MEP measurably more effective than its predecessors. The scheme is moreover a step towards the effective deployment of state funds for the reduction of CO2 emission [nl

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

    Directory of Open Access Journals (Sweden)

    Mitchell Aaron P

    2012-07-01

    Full Text Available Abstract Background The literature on the cost-effectiveness of statin drugs in primary prevention of coronary heart disease is complex. The objective of this study is to compare the disparate results of recent cost-effectiveness analyses of statins. Findings We conducted a systematic review of the literature on statin cost-effectiveness. The four studies that met inclusion criteria reported varying conclusions about the cost-effectiveness of statin treatment, without a clear consensus as to whether statins are cost-effective for primary prevention. However, after accounting for each study’s assumptions about statin costs, we found substantial agreement among the studies. Studies that assumed statins to be more expensive found them to be less cost-effective, and vice-versa. Furthermore, treatment of low-risk groups became cost-effective as statins became less expensive. Conclusions Drug price is the primary determinant of statin cost-effectiveness within a given risk group. As more statin drugs become generic, patients at low risk for coronary disease may be treated cost-effectively. Though many factors must be weighed in any medical decision, from a cost-effectiveness perspective, statins may now be considered an appropriate therapy for many patients at low risk for heart disease.

  3. Cost-effectiveness, feed utilization and body composition of african ...

    African Journals Online (AJOL)

    Cost-effectiveness, feed utilization and body composition of african sharptooth catfish ( Clarias gariepinus , Burchell 1822) fingerlings fed locally formulated and commercial pelleted diets in tarpaulin tanks.

  4. Cost-effectiveness of a smokeless tobacco control mass media campaign in India.

    Science.gov (United States)

    Murukutla, Nandita; Yan, Hongjin; Wang, Shuo; Negi, Nalin Singh; Kotov, Alexey; Mullin, Sandra; Goodchild, Mark

    2017-08-10

    Tobacco control mass media campaigns are cost-effective in reducing tobacco consumption in high-income countries, but similar evidence from low-income countries is limited. An evaluation of a 2009 smokeless tobacco control mass media campaign in India provided an opportunity to test its cost-effectiveness. Campaign evaluation data from a nationally representative household survey of 2898 smokeless tobacco users were compared with campaign costs in a standard cost-effectiveness methodology. Costs and effects of the Surgeon campaign were compared with the status quo to calculate the cost per campaign-attributable benefit, including quit attempts, permanent quits and tobacco-related deaths averted. Sensitivity analyses at varied CIs and tobacco-related mortality risk were conducted. The Surgeon campaign was found to be highly cost-effective. It successfully generated 17 259 148 additional quit attempts, 431 479 permanent quits and 120 814 deaths averted. The cost per benefit was US$0.06 per quit attempt, US$2.6 per permanent quit and US$9.2 per death averted. The campaign continued to be cost-effective in sensitivity analyses. This study suggests that tobacco control mass media campaigns can be cost-effective and economically justified in low-income and middle-income countries. It holds significant policy implications, calling for sustained investment in evidence-based mass media campaigns as part of a comprehensive tobacco control strategy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. Choice of Hemodialysis Access in Older Adults: A Cost-Effectiveness Analysis.

    Science.gov (United States)

    Hall, Rasheeda K; Myers, Evan R; Rosas, Sylvia E; O'Hare, Ann M; Colón-Emeric, Cathleen S

    2017-06-07

    month of dialysis diminishes with increasing age and lower life expectancy and is not the most cost-effective option for those with the most limited life expectancy. Copyright © 2017 by the American Society of Nephrology.

  6. 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

  7. 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

  8. Co-Producing Sustainability: Involving Parents and Civil Society in the Governance of School Meal Services. A Case Study from Pisa, Italy

    Directory of Open Access Journals (Sweden)

    Francesca Galli

    2014-03-01

    Full Text Available There is a rising awareness of the power of the public sector in enhancing sustainable consumption and production practices, in particular related to food procurement and its social, ethical, economical and environmental implications. School meal services have a high resonance in the debate on collective catering services because of the implications on the education to sustainable dietary habits and the orientation of the production system. This contribution focuses on the reciprocal relationship between professionals and users of school meal services as a driver to mobilize new resources—according to the theory of co-production—that steer service innovation and a shift towards more sustainable practices. We illustrate this through a case study on the school meal system in Pisa (Italy, where the Canteen Committee represents an institutional arena for participation and empowerment of actors that has gradually gained a central role in shaping this school meal service. Despite the challenges and obstacles, the institutionalized co-production of services allows consolidation of trust among key players and the introduction of innovations in the service, in the form of several projects oriented to sustainability which would not take place without the joint effort of actors involved, parents in the first place.

  9. Cost-effectiveness of Bezlotoxumab Compared With Placebo for the Prevention of Recurrent Clostridium difficile Infection.

    Science.gov (United States)

    Prabhu, Vimalanand S; Dubberke, Erik R; Dorr, Mary Beth; Elbasha, Elamin; Cossrow, Nicole; Jiang, Yiling; Marcella, Stephen

    2018-01-18

    Clostridium difficile infection (CDI) is the most commonly recognized cause of recurrent diarrhea. Bezlotoxumab, administered concurrently with antibiotics directed against C. difficile (standard of care [SoC]), has been shown to reduce the recurrence of CDI, compared with SoC alone. This study aimed to assess the cost-effectiveness of bezlotoxumab administered concurrently with SoC, compared with SoC alone, in subgroups of patients at risk of recurrence of CDI. A computer-based Markov health state transition model was designed to track the natural history of patients infected with CDI. A cohort of patients entered the model with either a mild/moderate or severe CDI episode, and were treated with SoC antibiotics together with either bezlotoxumab or placebo. The cohort was followed over a lifetime horizon, and costs and utilities for the various health states were used to estimate incremental cost-effectiveness ratios (ICERs). Both deterministic and probabilistic sensitivity analyses were used to test the robustness of the results. The cost-effectiveness model showed that, compared with placebo, bezlotoxumab was associated with 0.12 quality-adjusted life-years (QALYs) gained and was cost-effective in preventing CDI recurrences in the entire trial population, with an ICER of $19824/QALY gained. Compared with placebo, bezlotoxumab was also cost-effective in the subgroups of patients aged ≥65 years (ICER of $15298/QALY), immunocompromised patients (ICER of $12597/QALY), and patients with severe CDI (ICER of $21430/QALY). Model-based results demonstrated that bezlotoxumab was cost-effective in the prevention of recurrent CDI compared with placebo, among patients receiving SoC antibiotics for treatment of CDI. © 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.

  10. Cost Effectiveness of Monoclonal Antibody Therapy for Rare Diseases: A Systematic Review.

    Science.gov (United States)

    Park, Taehwan; Griggs, Scott K; Suh, Dong-Churl

    2015-08-01

    Monoclonal antibody (mAb)-based orphan drugs have led to advances in the treatment of diseases by selectively targeting molecule functions. However, their high treatment costs impose a substantial cost burden on patients and society. The study aimed to systematically review cost-effectiveness evidence of mAb orphan drugs. Ovid MEDLINE(®), EMBASE(®), and PsycINFO(®) were searched in June 2014 and articles were selected if they conducted economic evaluations of the mAb orphan drugs that had received marketing approval in the USA. The quality of the selected studies was assessed using the Quality of Health Economic Studies (QHES) instrument. We reviewed 16 articles that included 24 economic evaluations of nine mAb orphan drugs. Six of these nine drugs were included in cost-utility analysis studies, whereas three drugs were included in cost-effectiveness analysis studies. Previous cost-utility analysis studies revealed that four mAb orphan drugs (cetuximab, ipilimumab, rituximab, and trastuzumab) were found to be cost effective; one drug (bevacizumab) was not cost effective; and one drug (infliximab) was not consistent across the studies. Prior cost-effectiveness analysis studies which included three mAb orphan drugs (adalimumab, alemtuzumab, and basiliximab) showed that the incremental cost per effectiveness gained for these drugs ranged from $US4669 to $Can52,536 Canadian dollars. The quality of the included studies was good or fair with the exception of one study. Some mAb orphan drugs were reported as cost effective under the current decision-making processes. Use of these expensive drugs, however, can raise an equity issue which concerns fairness in access to treatment. The issue of equal access to drugs needs to be considered alongside other societal values in making the final health policy decisions.

  11. Cost-effectiveness of SHINE: A Telephone Translation of the Diabetes Prevention Program

    Directory of Open Access Journals (Sweden)

    Christopher S. Hollenbeak

    2016-01-01

    Full Text Available Background The Support, Health Information, Nutrition, and Exercise (SHINE trial recently showed that a telephone adaptation of the Diabetes Prevention Program (DPP lifestyle intervention was effective in reducing weight among patients with metabolic syndrome. The aim of this study is to determine whether a conference call (CC adaptation was cost effective relative to an individual call (IC adaptation of the DPP lifestyle intervention in the primary care setting. Methods We performed a stochastic cost-effectiveness analysis alongside a clinical trial comparing two telephone adaptations of the DPP lifestyle intervention. The primary outcomes were incremental cost-effectiveness ratios estimated for weight loss, body mass index (BMI, waist circumference, and quality-adjusted life years (QALYs. Costs were estimated from the perspective of society and included direct medical costs, indirect costs, and intervention costs. Results After one year, participants receiving the CC intervention accumulated fewer costs ($2,831 vs. $2,933 than the IC group, lost more weight (6.2 kg vs. 5.1 kg, had greater reduction in BMI (2.1 vs. 1.9, and had greater reduction in waist circumference (6.5 cm vs. 5.9 cm. However, participants in the CC group had fewer QALYs than those in the IC group (0.635 vs. 0.646. The incremental cost-effectiveness ratio for CC vs. IC was $9,250/QALY, with a 48% probability of being cost-effective at a willingness-to-pay of $100,000/QALY. Conclusions CC delivery of the DPP was cost effective relative to IC delivery in the first year in terms of cost per clinical measure (weight lost, BMI, and waist circumference but not in terms of cost per QALY, most likely because of the short time horizon.

  12. Cost effectiveness of haemophilia treatment : a cross-national assessment

    NARCIS (Netherlands)

    Lippert, B; Berger, K; Berntorp, E; Giangrande, P; van den Berg, M; Schramm, W; Siebert, U

    2005-01-01

    The aim of this study was to assess the incremental cost effectiveness of on-demand versus prophylactic haemophilia therapy in Germany, Sweden, the United Kingdom and The Netherlands from the third-party payers' perspective. Using a decision tree model, the cost effectiveness of on-demand versus

  13. Cost-effectiveness of antiplatelet drugs after percutaneous coronary intervention.

    Science.gov (United States)

    Wisløff, Torbjørn; Atar, Dan

    2016-01-01

    Clopidogrel has, for long time, been accepted as the standard treatment for patients who have undergone a percutaneous coronary intervention (PCI). The introduction of prasugrel-and more recently, ticagrelor-has introduced a decision-making problem for clinicians and governments worldwide: to use the cheaper clopidogrel or the more effective, and also more expensive prasugrel or ticagrelor. We aim to give helpful contributions to this debate by analysing the cost-effectiveness of clopidogrel, prasugrel, and ticagrelor compared with each other. We modified a previously developed Markov model of cardiac disease progression. In the model, we followed up cohorts of patients who have recently had a PCI until 100 years or death. Possible events are revascularization, bleeding, acute myocardial infarction, and death. Our analysis shows that ticagrelor is cost-effective in 77% of simulations at an incremental cost-effectiveness ratio of €7700 compared with clopidogrel. Ticagrelor was also cost-effective against prasugrel at a cost-effectiveness ratio of €7800. Given a Norwegian cost-effectiveness threshold of €70 000, both comparisons appear to be clearly cost-effective in favour of ticagrelor. Ticagrelor is cost-effective compared with both clopidogrel and prasugrel for patients who have undergone a PCI.

  14. Cost effectiveness of Tuberculosis Treatment from the Patients ...

    African Journals Online (AJOL)

    ... Directly Observed Treatment Short course is more cost effective from the patients' point of view. DOTS needs to be re-focused out of the hospitals and clinics and made community based in view of the increasing TB caseload occasioned by HI V/AIDS. Key Words: Cost effectiveness, Tuberculosis treatment, personal cost, ...

  15. Index method for analyzing cost effectiveness of drilling rigs

    Energy Technology Data Exchange (ETDEWEB)

    Batura, N P; Bocharov, V V

    1978-01-01

    The method for a complete analysis of the factors determining cost effectiveness of a drilling rig fleet is examined. The system of calculating production indexes from statistical reports is relatively simple and is not difficult to use for production organizations. The analytical results may be used to develop actual measures used to increase cost effectiveness of drilling operations.

  16. Cost-effectiveness of trachoma control in seven world regions.

    NARCIS (Netherlands)

    Baltussen, R.M.P.M.; Sylla, M.; Frick, K.D.; Mariotti, S.P.

    2005-01-01

    BACKGROUND/AIMS: The fight against blinding trachoma is being addressed with an integrated strategy of surgery, antibiotics, hygiene promotion, and environmental improvement-the SAFE strategy, but its cost-effectiveness is largely unknown. This paper estimates the cost effectiveness of surgery and

  17. The Cost-Effectiveness of NBPTS Teacher Certification

    Science.gov (United States)

    Yeh, Stuart S.

    2010-01-01

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

  18. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Presuming cost-effectiveness results. 436.13 Section 436... Methodology and Procedures for Life Cycle Cost Analyses § 436.13 Presuming cost-effectiveness results. (a) If the investment and other costs for an energy or water conservation measure considered for retrofit to...

  19. 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.

  20. ORIGINAL ARTICLES Cost-effectiveness analysis for priority-setting ...

    African Journals Online (AJOL)

    health outcomes and wasted resources.4-5 It was found that the cost- effectiveness of South ... Priorities for Developing Countries Project was that emergency (and even some elective) ... to control air pollutants found that in South Africa the most cost- effective ..... outdoor air pollution in South Africa in 2000. S Afr Med J ...

  1. The contribution of Japanese Soil Science Societies to scientific knowledge, education and sustainability: Good practices in the International Year of Soils 2015 towards the International Decade of Soils.

    Science.gov (United States)

    Kosaki, Takashi; Matoh, Toru; Inubushi, Kazuyuki; Sakurai, Katsutoshi

    2017-04-01

    The soil science community in Japan includes ca. 15,000 individuals from a variety of sectors, i.e. research, education, extension, business, national and local government, practitioners, non-governmental or non-profit organizations, etc., who have mostly (multi-)membership(s) in some of the academic societies. Among those societies, the Japanese Society of Soil Science and Plant Nutrition, the Japanese Society of Soil Microbiology and the Japanese Society of Pedology played a leading role in the promotion of the International Year of Soils 2015. The activities, many of which were jointly organized and executed by the above three, can be summarized as follows; Scientific symposiums/workshops not only within the societies but together with other disciplines such as geosciences, quaternary research, biogeochemistry, ecology, biosciences, geotechnology, etc. in national as well as international gatherings, Symposiums, (mobile) exhibitions, photo contests, science cafes, talk shows, field days, agricultural fairs, edutainment programs for school children, etc. for promoting the public awareness of soil and soil science, Publication of the books and booklets on the topics of soils, soil science, soil and environment (and/or food, life, human security, etc.), targeting the moderately educated public, Articles in selected newspapers, Distribution or sale of the novelty/memorial goods and items, e.g. soil globe, logo stickers, specially brewed Sake wines, etc. Translation of "Vienna Soil Declaration" of the IUSS into Japanese language and its distribution to the public, and Scientific and action proposal and its international dispatch of "The need to reinforce soil science research and the information basis to respond to both gradual and sudden changes in our environment" together with the Science Council of Japan. Scientific forums and gatherings as symposiums and workshops with other disciplines were successful and satisfied by most of the participants. Those for the

  2. ”Satoyama-Satoumi” regional management : a universal cognition and practice for green economy, ecosystem health and sustainable society in indigenous communities of the world

    OpenAIRE

    Dublin, Devon Ronald

    2015-01-01

    Satoyama concept has been advocated for an ideal model for traditional landscape, where nature and human are in harmony and sustainable. In 2010, the International Partnership for Satoyama Initiative (IPSI) was launched to revitalize the concept of Satoyama in Japan and promote it internationally but no mechanism exists in which it can be thoroughly evaluated. Because of a combination of factors, the existence of indigenous peoples can no longer be based on a hunter-gatherer tradition and req...

  3. Cost-effective analysis of PET application in NSCLC

    International Nuclear Information System (INIS)

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

    2006-01-01

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

  4. The cost-effectiveness of multi-purpose HIV and pregnancy prevention technologies in South Africa.

    Science.gov (United States)

    Quaife, Matthew; Terris-Prestholt, Fern; Eakle, Robyn; Cabrera Escobar, Maria A; Kilbourne-Brook, Maggie; Mvundura, Mercy; Meyer-Rath, Gesine; Delany-Moretlwe, Sinead; Vickerman, Peter

    2018-03-01

    averted (range: $214-$810/DALY averted among non-dominant scenarios), however, none were cost-effective among women aged 25-49 (minimum $1706/DALY averted). The cost-effectiveness of products improved with additional protection from pregnancy. Estimates were sensitive to variation in incidence assumptions, but robust to other parameters. To the best of our knowledge, this is the first study to estimate the cost-effectiveness of a range of potential MPTs; suggesting that MPTs will be cost-effective among higher incidence FSWs or young women, but not among lower incidence older women. More work is needed to make attractive MPTs available to potential users who could use them effectively. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

  5. Value of innovation in hematologic malignancies: a systematic review of published cost-effectiveness analyses.

    Science.gov (United States)

    Saret, Cayla J; Winn, Aaron N; Shah, Gunjan; Parsons, Susan K; Lin, Pei-Jung; Cohen, Joshua T; Neumann, Peter J

    2015-03-19

    We analyzed cost-effectiveness studies related to hematologic malignancies from the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org), focusing on studies of innovative therapies. Studies that met inclusion criteria were categorized by 4 cancer types (chronic myeloid leukemia, chronic lymphocytic leukemia, non-Hodgkin lymphoma, and multiple myeloma) and 9 treatment agents (interferon-α, alemtuzumab, bendamustine, bortezomib, dasatinib, imatinib, lenalidomide, rituximab alone or in combination, and thalidomide). We examined study characteristics and stratified cost-effectiveness ratios by type of cancer, treatment, funder, and year of study publication. Twenty-nine studies published in the years 1996-2012 (including 44 cost-effectiveness ratios) met inclusion criteria, 22 (76%) of which were industry funded. Most ratios fell below $50,000 per quality-adjusted life-years (QALY) (73%) and $100,000/QALY (86%). Industry-funded studies (n = 22) reported a lower median ratio ($26,000/QALY) than others (n = 7; $33,000/QALY), although the difference was not statistically significant. Published data suggest that innovative treatments for hematologic malignancies may provide reasonable value for money. © 2015 by The American Society of Hematology.

  6. Chemistry of cost effective water treatment programme in HWP (Manuguru)

    International Nuclear Information System (INIS)

    Mohapatra, C.; Laxmana Prasad, K.

    2008-01-01

    In order to develop a water treatment programme following points must be kept in mind: Effectiveness to achieve desired water quality objectives; Compliance with regulatory requirements; Cost minimization; Safety; Easy operation and protection to equipments. Heavy Water Plant (Manuguru) laboratory has developed treatment programs to treat raw water and cooling water which satisfy the above requirements and has been in use for last several years successfully without any problem. These treatment programs have been given to other plants in Heavy Water Board for implementation. This paper describes the chemistry of the treatment program and cost minimization achieved. Further these treatments have helped the plant in achieving ΦZero Discharge and indirectly reduced the production cost. The chemistry parameters are monitored regularly to ascertain the effectiveness of these treatments. The areas where significant benefits derived are raw water treatment using polyelectrolyte instead of inorganic coagulant (alum), change over of regenerant of cation exchangers from hydrochloric acid to sulfuric acid and development of in-house cooling water treatment formulation. The advantages and cost effectiveness of these treatments are discussed in detail. Further these treatments helped the plant in achieving Zero discharge and indirectly reduced production cost of heavy water. The dosage of 3 ppm of polyelectrolyte can replace 90 ppm alum at turbidity level of 300 NTU of raw water which has resulted in cost saving of Rs. 15 - 20 Lakhs in a year besides other advantages. The changeover of regenerant from HCl to H 2 SO 4 will result in cost saving of at least Rs. 1.4 Crore a year along with other advantages. The change over of proprietary formulation to in-house formulation in cooling water treatment has resulted a saving about Rs. 11 Lakhs a year. To achieve the above objectives in a sustainable way the performance results are being monitored (author)

  7. Autism Society

    Science.gov (United States)

    ... Español Improving the lives of all affected by autism. The Autism Society is the nation's leading grassroots ... more Improving the lives of all affected by autism. The Autism Society is the nation's leading grassroots ...

  8. 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.

  9. Cost-effectiveness and the socialization of health care.

    Science.gov (United States)

    Musgrove, P

    1995-01-01

    The more health care is socialized, the more cost-effectiveness is an appropriate criterion for expenditure. Utility-maximizing individuals, facing divisibility of health care purchases and declining marginal health gains, and complete information about probable health improvements, should buy health care according to its cost-effectiveness. Absent these features, individual health spending will not be cost-effective; and in any case, differences in personal utilities and risk aversion will not lead to the same ranking of health care interventions for everyone. Private insurance frees consumers from concern for cost, which undermines cost-effectiveness, but lets them emphasize effectiveness, which favors value for money. This is most important for costly and cost-effective interventions, especially for poor people. Cost-effectiveness is more appropriate and easier to achieve under second-party insurance. More complete socialization of health care, via public finance, can yield greater efficiency by making insurance compulsory. Cost-effectiveness is also more attractive when taxpayers subsidize others' care: needs (effectiveness) take precedence over wants (utility). The gain in effectiveness may be greater, and the welfare loss from Pareto non-optimality smaller, in poor countries than in rich ones.

  10. The Potential Cost-Effectiveness of Amblyopia Screening Programs

    Science.gov (United States)

    Rein, David B.; Wittenborn, John S.; Zhang, Xinzhi; Song, Michael; Saaddine, Jinan B.

    2013-01-01

    Background To estimate the incremental cost-effectiveness of amblyopia screening at preschool and kindergarten, we compared the costs and benefits of 3 amblyopia screening scenarios to no screening and to each other: (1) acuity/stereopsis (A/S) screening at kindergarten, (2) A/S screening at preschool and kindergarten, and (3) photoscreening at preschool and A/S screening at kindergarten. Methods We programmed a probabilistic microsimulation model of amblyopia natural history and response to treatment with screening costs and outcomes estimated from 2 state programs. We calculated the probability that no screening and each of the 3 interventions were most cost-effective per incremental quality-adjusted life year (QALY) gained and case avoided. Results Assuming a minimal 0.01 utility loss from monocular vision loss, no screening was most cost-effective with a willingness to pay (WTP) of less than $16,000 per QALY gained. A/S screening at kindergarten alone was most cost-effective between a WTP of $17,000 and $21,000. A/S screening at preschool and kindergarten was most cost-effective between a WTP of $22,000 and $75,000, and photoscreening at preschool and A/S screening at kindergarten was most cost-effective at a WTP greater than $75,000. Cost-effectiveness substantially improved when assuming a greater utility loss. All scenarios were cost-effective when assuming a WTP of $10,500 per case of amblyopia cured. Conclusions All 3 screening interventions evaluated are likely to be considered cost-effective relative to many other potential public health programs. The choice of screening option depends on budgetary resources and the value placed on monocular vision loss prevention by funding agencies. PMID:21877675

  11. Global cost-effectiveness of GDM screening and management

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  12. Cost effectiveness analysis of indoor radon control measures

    International Nuclear Information System (INIS)

    Fujimoto, Kenzo

    1989-01-01

    The problem of radon 222 in buildings as a contributor to radiation exposure is described. Five different control methods and the dose reductions that would result from each are analysed. The annualized cost for each control measure was evaluated and the cost effectiveness of each control measure was calculated on the basis of dollars per person-sievert dose reduction. The use of unipolar ion generators for particle removal appears to be the most cost effective and the use of ceiling fans to increase air circulation the least cost effective. 3 figs., 1 tab

  13. STATE, MARKET AND CIVIL SOCIETY AS ACTORS OF DEVELOPMENT: the Challenge of Sustainability in the 21st Century. Interview with Lecturer Heike Doering, PhD

    Directory of Open Access Journals (Sweden)

    Priscila De Nadai

    2016-01-01

    Full Text Available In this edition, professor Priscila De Nadai interviewed Heike Doering, PhD in Sociology from Cardiff University (United Kingdom, lecturer at Cardiff Business School and researcher of the Centre for Local and Regional Government Research, also from Cardiff University. In the past few years,  she has conducted research about reginal development and sustainability management, in emerging economies. One of her research projects is being developed in Espírito Santo in partnership with researchers from our State. In this interview, profesor Heike Doering will tell us about her trajectory as a researcher, about her studies and the specific research she is currently conducting in Espírito Santo.

  14. 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.

  15. 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.

  16. Cost-effectiveness of routine computed tomography in the evaluation of idiopathic unilateral vocal fold paralysis.

    Science.gov (United States)

    Hojjat, Houmehr; Svider, Peter F; Folbe, Adam J; Raza, Syed N; Carron, Michael A; Shkoukani, Mahdi A; Merati, Albert L; Mayerhoff, Ross M

    2017-02-01

    To evaluate the cost-effectiveness of routine computed tomography (CT) in individuals with unilateral vocal fold paralysis (UVFP) STUDY DESIGN: Health Economics Decision Tree Analysis METHODS: A decision tree was constructed to determine the incremental cost-effectiveness ratio (ICER) of CT imaging in UVFP patients. Univariate sensitivity analysis was utilized to calculate what the probability of having an etiology of the paralysis discovered would have to be to make CT with contrast more cost-effective than no imaging. We used two studies examining findings in UVFP patients. The decision pathways were utilizing CT neck with intravenous contrast after diagnostic laryngoscopy versus laryngoscopy alone. The probability of detecting an etiology for UVFP and associated costs were extracted to construct the decision tree. The only incorrect diagnosis was missing a mass in the no-imaging decision branch, which rendered an effectiveness of 0. The ICER of using CT was $3,306, below most acceptable willingness-to-pay (WTP) thresholds. Additionally, univariate sensitivity analysis indicated that at the WTP threshold of $30,000, obtaining CT imaging was the most cost-effective choice when the probability of having a lesion was above 1.7%. Multivariate probabilistic sensitivity analysis with Monte Carlo simulations also showed that at the WTP of $30,000, CT scanning is more cost-effective, with 99.5% certainty. Particularly in the current healthcare environment characterized by increasing consciousness of utilization defensive medicine, economic evaluations represent evidence-based findings that can be employed to facilitate appropriate decision making and enhance physician-patient communication. This economic evaluation strongly supports obtaining CT imaging in patients with newly diagnosed UVFP. 2c. Laryngoscope, 2016 127:440-444, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  17. Cost-effectiveness of community screening for glaucoma in rural India: a decision analytical model.

    Science.gov (United States)

    John, D; Parikh, R

    2018-02-01

    Studies in several countries have demonstrated the cost-effectiveness of population-based screening for glaucoma when targeted at high-risk groups such as older adults and with familial history of disease. This study conducts a cost-effective analysis of a hypothetical community screening and subsequent treatment programme in comparison to opportunistic case finding for glaucoma in rural 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 rural areas of India. A decision analytical model was built to model events, costs and treatment pathways with and without a hypothetical screening programme for glaucoma for a rural-based population aged between 40 and 69 years in India. The treatment pathway included both primary open-angle glaucoma and angle-closure disease. The data on costs of screening and treatment were provided by an administrator of a tertiary eye hospital in Eastern India. The probabilities for the screening and treatment pathway were derived from published literature and a glaucoma specialist. The glaucoma prevalence rates were adapted from the Chennai Glaucoma Study findings. An incremental cost-effectiveness ratio value of ₹7292.30 per quality-adjusted life-year was calculated for a community-screening programme for glaucoma in rural India. The community screening for glaucoma would treat an additional 2872 cases and prevent 2190 person-years of blindness over a 10-year period. Community screening for glaucoma in rural India appears to be cost-effective when judged by a ratio of willingness-to-pay thresholds as per WHO-CHOICE guidelines. For community screening to be cost-effective, adequate resources, such as trained medical personnel and equipment would need to be made available. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  18. Cost-Effectiveness Analysis of an Automated Medication System Implemented in a Danish Hospital Setting.

    Science.gov (United States)

    Risør, Bettina Wulff; Lisby, Marianne; Sørensen, Jan

    To evaluate the cost-effectiveness of an automated medication system (AMS) implemented in a Danish hospital setting. An economic evaluation was performed alongside a controlled before-and-after effectiveness study with one control ward and one intervention ward. The primary outcome measure was the number of errors in the medication administration process observed prospectively before and after implementation. To determine the difference in proportion of errors after implementation of the AMS, logistic regression was applied with the presence of error(s) as the dependent variable. Time, group, and interaction between time and group were the independent variables. The cost analysis used the hospital perspective with a short-term incremental costing approach. The total 6-month costs with and without the AMS were calculated as well as the incremental costs. The number of avoided administration errors was related to the incremental costs to obtain the cost-effectiveness ratio expressed as the cost per avoided administration error. The AMS resulted in a statistically significant reduction in the proportion of errors in the intervention ward compared with the control ward. The cost analysis showed that the AMS increased the ward's 6-month cost by €16,843. The cost-effectiveness ratio was estimated at €2.01 per avoided administration error, €2.91 per avoided procedural error, and €19.38 per avoided clinical error. The AMS was effective in reducing errors in the medication administration process at a higher overall cost. The cost-effectiveness analysis showed that the AMS was associated with affordable cost-effectiveness rates. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  19. The cost-effectiveness of intervening in low and high HIV prevalence areas in South Africa

    Directory of Open Access Journals (Sweden)

    Josue Mbonigaba

    2013-05-01

    Full Text Available This research compared the cost-effectiveness of a set of HIV/AIDS interventions in a low HIV prevalence area (LPA and in a high HIV prevalence area (HPA in South Africa. The rationale for this analysis was to assess the interaction dynamics between a specific HIV/AIDS intervention and an area of implementation and the effects of these dynamics on the cost-effectiveness of such an HIV/AIDS intervention. A pair of Markov models was evaluated for each intervention; one model for a HPA and another for an LPA and the cost-effectiveness of that intervention was compared across an LPA and a HPA. The baseline costs and health outcomes in each area were collected from the literature. To depict interaction dynamics between an HIV/AIDS intervention and an area of implementation, baseline health outcomes collected in each area, were adjusted over time based on the patterns of the projections observed in the AIDS model of the Actuarial Society of South Africa (ASSA2008. The study found that the VCT and treatment of STDs were equally cost-effective in an LPA and in a HPA while PMTCT and HAART were more cost-effective in an LPA than in a HPA. As a policy proposal, resources earmarked to non-ARV based interventions (VCT and treatment of STDs should  be equally shared across an LPA and a HPA while  more of the resources reserved for ARV-based interventions (PMTCT and HAART should go in an LPA in order to increase efficiency.

  20. Cost-effectiveness of alternative conservation strategies with application to the Pacific leatherback turtle.

    Science.gov (United States)

    Gjertsen, Heidi; Squires, Dale; Dutton, Peter H; Eguchi, Tomoharu

    2014-02-01

    Although holistic conservation addressing all sources of mortality for endangered species or stocks is the preferred conservation strategy, limited budgets require a criterion to prioritize conservation investments. We compared the cost-effectiveness of nesting site and at-sea conservation strategies for Pacific leatherback turtles (Dermochelys coriacea). We sought to determine which conservation strategy or mix of strategies would produce the largest increase in population growth rate per dollar. Alternative strategies included protection of nesters and their eggs at nesting beaches in Indonesia, gear changes, effort restrictions, and caps on turtle takes in the Hawaiian (U.S.A.) longline swordfish fishery, and temporal and area closures in the California (U.S.A.) drift gill net fishery. We used a population model with a biological metric to measure the effects of conservation alternatives. We normalized all effects by cost to prioritize those strategies with the greatest biological effect relative to its economic cost. We used Monte Carlo simulation to address uncertainty in the main variables and to calculate probability distributions for cost-effectiveness measures. Nesting beach protection was the most cost-effective means of achieving increases in leatherback populations. This result creates the possibility of noncompensatory bycatch mitigation, where high-bycatch fisheries invest in protecting nesting beaches. An example of this practice is U.S. processors of longline tuna and California drift gill net fishers that tax themselves to finance low-cost nesting site protection. Under certain conditions, fisheries interventions, such as technologies that reduce leatherback bycatch without substantially decreasing target species catch, can be cost-effective. Reducing bycatch in coastal areas where bycatch is high, particularly adjacent to nesting beaches, may be cost-effective, particularly, if fisheries in the area are small and of little commercial value.

  1. Cost-Effectiveness of Rotavirus Vaccination in France-Accounting for Indirect Protection.

    Science.gov (United States)

    Yamin, Dan; Atkins, Katherine E; Remy, Vanessa; Galvani, Alison P

    Vaccination against rotavirus has shown great potential for reducing the primary cause of severe childhood gastroenteritis. Previous economic evaluations of rotavirus vaccination in France have not modeled the potential impact of vaccines on disease burden via reduced transmission. To determine the cost-effectiveness of the introduction of pentavalent rotavirus vaccination into the French infant vaccination schedule. We developed an age-structured model of rotavirus transmission calibrated to 6 years of French gastroenteritis incidence and vaccine clinical trial data. We evaluated the cost-effectiveness of pentavalent rotavirus vaccination considering that 75% of infants would receive the three-dose vaccine course. Our model predicts that rotavirus vaccination will decrease rotavirus gastroenteritis incidence and associated clinical outcomes in vaccinated and unvaccinated individuals, delay the seasonal peak of infection, and increase the age of infection. From the societal perspective, our base-case scenario predicts that vaccination coverage would be cost-effective at €115 or €135 per vaccine course at €28,500 and €39,500/quality-adjusted life-year (QALY) gained, respectively, and suggests that almost 95% of the financial benefits will be recouped within the first 5 years following vaccination implementation. From the third-party payer perspective, incremental cost-effectiveness ratios ranged from €12,500 to €20,000/QALY, respectively. Our uncertainty analysis suggests that findings were sensitive to various assumptions including the number of hospitalizations, outpatient visits, and the extent of QALY losses per rotavirus episode. Introducing pentavalent rotavirus vaccination into the French infant vaccination schedule would significantly reduce the burden of rotavirus disease in children, and could be cost-effective under plausible conditions. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by

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

    Science.gov (United States)

    Glassman, Amanda; Cañón, Oscar; Silverman, Rachel

    2016-12-01

    In middle-income countries, vaccines against pneumococcal disease, rotavirus, and human papilloma virus are in general more costly, not necessarily cost saving, and less consistently cost-effective than earlier generation vaccines against measles, diphtheria, tetanus, and pertussis. Budget impact is also substantial; public spending on vaccines in countries adopting new vaccines is, on average, double the amount of countries that have not adopted. Policymakers must weigh the costs and benefits of the adoption decision carefully, given the low coverage of other kinds of cost-effective health and nonhealth interventions in these same settings and relatively flat overall public spending on health as a share of gross domestic product (GDP) over time. This paper considers lessons learned from recent vaccine cost-effectiveness analyses and subsequent adoption decisions in Latin America a, largely under the auspices of the Pro Vac Initiative. The paper illustrates how small methodological choices and seemingly minor technical limitations of cost-effectiveness models can have major implications for the studies' conclusions, potentially influencing countries' subsequent vaccine adoption decisions. We evaluate the ProVac models and technical outputs against the standards and framework set out by the International Decision Support Initiative Reference Case for economic evaluation and consider the practical effects of deviations from those standards. Lessons learned are discussed, including issues of appropriate comparators, GDP-based thresholds, and use of average versus incremental cost-effectiveness ratios as a convention are assessed. The article ends with recommendations for the future. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  3. Cost effectiveness of facility and home based HIV voluntary ...

    African Journals Online (AJOL)

    Cost effectiveness of facility and home based HIV voluntary counseling and ... Background: In Uganda, the main stay for provision of human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) ... AJOL African Journals Online.

  4. Cost-effectiveness and radiation risk of breast cancer screening

    International Nuclear Information System (INIS)

    Rombach, J.J.

    1987-01-01

    Base cost effectiveness risk associated with radiological screening for tuberculosis and lung tumor the Government of Netherlands advised against mass screening. However, mass screening remains an important method in the case of breast cancer

  5. Bioinformatics tools for development of fast and cost effective simple ...

    African Journals Online (AJOL)

    Bioinformatics tools for development of fast and cost effective simple sequence repeat ... comparative mapping and exploration of functional genetic diversity in the ... Already, a number of computer programs have been implemented that aim at ...

  6. A literature review of the cost-effectiveness of nuclear medicine

    International Nuclear Information System (INIS)

    Carter, J.

    1995-01-01

    Nuclear medicine is a medical speciality that uses tiny quantities of radioactivity to produce diagnostic images. It also has a role in therapy for some thyroid diseases and certain tumours. Surveys have shown that nuclear medicine procedures are used significantly less in the UK than in many other countries in Europe. One reason may be that there is inadequate information about the clinical utility of these techniques, particularly their cost-effectiveness in clinical management. To establish what evidence was currently available about the cost-effectiveness of nuclear medicine, the British Nuclear Medicine Society commissioned a worldwide literature review in diseases of the heart, kidney, lung, bone, brain, bowel and thyroid. This volume summarises the findings of the independent study and gives details of the background, clinical utility and limitations of the different nuclear medicine procedures used in the diagnosis and treatment of each disease reviewed. (author)

  7. Cost effectiveness of coronary angiography and calcium scoring using CT and stress MRI for diagnosis of coronary artery disease

    International Nuclear Information System (INIS)

    Dewey, Marc; Hamm, Bernd

    2007-01-01

    We compared the cost effectiveness of recent approaches [coronary angiography and calcium scoring using computed tomography (CT) and stress magnetic resonance imaging (MRI)] to the diagnosis of coronary artery disease (CAD) with those of the traditional diagnostic modalities [conventional angiography (CATH), exercise ECG, and stress echocardiography] using a decision tree model. For patients with a 10% to 50% pretest likelihood of coronary artery disease, non-invasive coronary angiography using CT was the most cost effective approach, with costs per correctly identified CAD patient of EUR4,435 (10% likelihood) to EUR1,469 (50% likelihood). Only for a pretest likelihood of 30% to 40% was calcium scoring using CT more cost effective than any of the traditional diagnostic modalities, while MRI was not cost effective for any pretest likelihood. At a pretest likelihood of 60%, CT coronary angiography and CATH were equally effective, while CATH was most cost effective for a pretest likelihood of at least 70%. In conclusion, up to a pretest likelihood for coronary artery disease of 50%, CT coronary angiography is the most cost-effective procedure, being superior to the other new modalities and the most commonly used traditional diagnostic modalities. With a very high likelihood for disease (above 60%), CATH is the most effective procedure from the perspective of society. (orig.)

  8. 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.

  9. Sustainable finance

    NARCIS (Netherlands)

    Boersma-de Jong, Margreet F.

    2012-01-01

    Presentation for Springschool of Strategy, University of Groningen, 10 October 2012. The role of CSR is to stimulate ethical behaviour, and as a result, mutual trust in society. Advantage of CSR for the company and the evolution of CSR. From CSR to Sustainable Finance: how does CSR influence

  10. Mass Society

    DEFF Research Database (Denmark)

    Borch, Christian

    2017-01-01

    the negative features usually ascribed by late nineteenth-century crowd psychology to spontaneous crowds, and attributes these to the entire social fabric. However, in contrast to crowd psychology, theorists of mass society often place greater emphasis on how capitalism, technological advances, or demographic......Mass society is a societal diagnosis that emphasizes – usually in a pejorative, modernity critical manner – a series of traits allegedly associated with modern society, such as the leveling of individuality, moral decay, alienation, and isolation. As such, the notion of mass society generalizes...... developments condition such negative features, and some theorists argue that mass society produces a propensity to totalitarianism. Discussions of mass society culminated in the early and mid-twentieth century....

  11. Cost-effectiveness of emergency department-initiated treatment for opioid dependence.

    Science.gov (United States)

    Busch, Susan H; Fiellin, David A; Chawarski, Marek C; Owens, Patricia H; Pantalon, Michael V; Hawk, Kathryn; Bernstein, Steven L; O'Connor, Patrick G; D'Onofrio, Gail

    2017-11-01

    In a recent randomized trial, patients with opioid dependence receiving brief intervention, emergency department (ED)-initiated buprenorphine and ongoing follow-up in primary care with buprenorphine (buprenorphine) were twice as likely to be engaged in addiction treatment compared with referral to community-based treatment (referral) or brief intervention and referral (brief intervention). Our aim was to evaluate the relative cost-effectiveness of these three methods of intervening on opioid dependence in the ED. Measured health-care use was converted to dollar values. We considered a health-care system perspective and constructed cost-effectiveness acceptability curves that indicate the probability each treatment is cost-effective under different thresholds of willingness-to-pay for outcomes studied. An urban ED in the United States. Opioid-dependent patients aged 18 years or older. Self-reported 30-day assessment data were used to construct cost-effectiveness acceptability curves for patient engagement in formal addiction treatment at 30 days and the number of days illicit opioid-free in the past week. Considering only health-care system costs, cost-effectiveness acceptability curves indicate that at all positive willingness-to-pay values, ED-initiated buprenorphine treatment was more cost-effective than brief intervention or referral. For example, at a willingness-to-pay threshold of $1000 for 30-day treatment engagement, we are 79% certain ED-initiated buprenorphine is most cost-effective compared with other studied treatments. Similar results were found for days illicit opioid-free in the past week. Results were robust to secondary analyses that included patients with missing cost data, included crime and patient time costs in the numerator, and to changes in unit price estimates. In the United States, emergency department-initiated buprenorphine intervention for patients with opioid dependence provides high value compared with referral to community

  12. The cost effectiveness of NHS physiotherapy support for occupational health (OH) services.

    Science.gov (United States)

    Phillips, Ceri J; Phillips Nee Buck, Rhiannon; Main, Chris J; Watson, Paul J; Davies, Shân; Farr, Angela; Harper, Christie; Noble, Gareth; Aylward, Mansel; Packman, Julie; Downton, Matt; Hale, Janine

    2012-02-23

    Musculoskeletal pain is detrimental to quality of life (QOL) and disruptive to activities of daily living. It also places a major economic burden on healthcare systems and wider society. In 2006, the Welsh Assembly Government (WAG) established a three tiered self-referral Occupational Health Physiotherapy Pilot Project (OHPPP) comprising: 1.) telephone advice and triage, 2.) face-to-face physiotherapy assessment and treatment if required, and 3.) workplace assessment and a return-to-work facilitation package as appropriate. This study aimed to evaluate the feasibility and cost-effectiveness of the pilot service. A pragmatic cohort study was undertaken, with all OHPPP service users between September 2008 and February 2009 being invited to participate. Participants were assessed on clinical status, yellow flags, sickness absence and work performance at baseline, after treatment and at 3 month follow up. Cost-effectiveness was evaluated from both top-down and bottom-up perspectives and cost per Quality Adjusted Life Year (cost/QALY) was calculated. The cost-effectiveness analysis assessed the increase in service cost that would be necessary before the cost-effectiveness of the service was compromised. A total of 515 patients completed questionnaires at baseline. Of these, 486 were referred for face to face assessment with a physiotherapist and were included in the analysis for the current study. 264 (54.3%) and 199 (40.9%) were retained at end of treatment and 3 month follow up respectively. An improvement was observed at follow up in all the clinical outcomes assessed, as well as a reduction in healthcare resource usage and sickness absence, and improvement in self-reported work performance. Multivariate regression indicated that baseline and current physical health were associated with work-related outcomes at follow up. The costs of the service were £194-£360 per service user depending on the method used, and the health gains contributed to a cost/QALY of £1386

  13. Planetary Society

    Science.gov (United States)

    Murdin, P.

    2000-11-01

    Carl Sagan, Bruce Murray and Louis Friedman founded the non-profit Planetary Society in 1979 to advance the exploration of the solar system and to continue the search for extraterrestrial life. The Society has its headquarters in Pasadena, California, but is international in scope, with 100 000 members worldwide, making it the largest space interest group in the world. The Society funds a var...

  14. Cost-effectiveness analysis of a multifactorial fall prevention intervention in older home care clients at risk for falling.

    Science.gov (United States)

    Isaranuwatchai, Wanrudee; Perdrizet, Johnna; Markle-Reid, Maureen; Hoch, Jeffrey S

    2017-09-01

    Falls among older adults can cause serious morbidity and pose economic burdens on society. Older age is a known risk factor for falls and age has been shown to influence the effectiveness of fall prevention programs. To our knowledge, no studies have explicitly investigated whether cost-effectiveness of a multifactorial fall prevention intervention (the intervention) is influenced by age. This economic evaluation explores: 1) the cost-effectiveness of a multifactorial fall prevention intervention compared to usual care for community-dwelling adults ≥ 75 years at risk of falling in Canada; and 2) the influence of age on the cost-effectiveness of the intervention. Net benefit regression was used to examine the cost-effectiveness of the intervention with willingness-to-pay values ranging from $0-$50,000. Effects were measured as change in the number of falls, from baseline to 6-month follow-up. Costs were measured using a societal perspective. The cost-effectiveness analysis was conducted for both the total sample and by age subgroups (75-84 and 85+ years). For the total sample, the intervention was not economically attractive. However, the intervention was cost-effective at higher willingness-to-pay (WTP) (≥ $25,000) for adults 75-84 years and at lower WTP (cost-effectiveness of the intervention depends on age and decision makers' WTP to prevent falls. Understanding the influence of age on the cost-effectiveness of an intervention may help to target resources to those who benefit most. Retrospectively registered. Clinicaltrials.gov identifier: NCT00463658 (18 April 2007).

  15. Developing adaptive capacity for responding to environmental change in the Arab Gulf States: Uncertainties to linking ecosystem conservation, sustainable development and society in authoritarian rentier economies

    Science.gov (United States)

    Spiess, Andy

    2008-12-01

    The recent assessment by the Intergovernmental Panel on Climate Change (IPCC) has emphasized that understanding the institutional context in which policies are made and implemented is critical to define sustainable development paths from a climate change perspective. Nevertheless, while the importance of social, political and cultural factors is getting more recognition in some parts of the world, little is known about the human dimensions or the contexts in which they operate in the affluent oil economies of the Arabian Peninsula. Policies that implicitly subsidize or support a wasteful and environmentally destructive use of resources are still pervasive, while noteworthy environmental improvements still face formidable political and institutional constraints to the adaptation of the necessary far reaching and multisectoral approach. The principal aim of this paper is to identify some of the major shortcomings within the special context of the Arab Gulf states' socio-cultural environment in support of appropriate development pathways. Conclusions highlight that past and current policy recommendations for mitigating environmental threats are likely to be ineffective. This is because they are based on the unverified assumption that Western-derived standards of conduct, specifically the normative concept of "good governance" and "democracy", will be adopted in non-Western politico-cultural contexts.

  16. Nanotechnology for sustainable development: retrospective and outlook

    Science.gov (United States)

    Diallo, Mamadou S.; Fromer, Neil A.; Jhon, Myung S.

    2013-11-01

    The world is facing great challenges in meeting rising demands for basic commodities (e.g., food, water and energy), finished goods (e.g., cell phones, cars and airplanes) and services (e.g., shelter, healthcare and employment) while reducing and minimizing the impact of human activities on Earth's global environment and climate. Nanotechnology has emerged as a versatile platform that could provide efficient, cost-effective and environmentally acceptable solutions to the global sustainability challenges facing society. This special issue of the Journal of Nanoparticle Research is devoted to the utilization of nanotechnology to improve or achieve sustainable development. We highlight recent advances and discuss opportunities of utilizing nanotechnology to address global challenges in (1) water purification, (2) clean energy technologies, (3) greenhouse gases management, (4) materials supply and utilization, and (5) green manufacturing and chemistry. In addition to the technical challenges listed above, we also discuss societal perspectives and provide an outlook of the role of nanotechnology in the convergence of knowledge, technology and society for achieving sustainable development.

  17. Nanotechnology for sustainable development: retrospective and outlook

    Energy Technology Data Exchange (ETDEWEB)

    Diallo, Mamadou S., E-mail: mdiallo@kaist.ac.kr [Korea Advanced Institute of Science and Technology (KAIST), Graduate School of Energy, Environment, Water and Sustainability (EEWS) (Korea, Republic of); Fromer, Neil A. [California Institute of Technology, Resnick Sustainability Institute (United States); Jhon, Myung S. [Carnegie Mellon University, Department of Chemical Engineering (United States)

    2013-11-15

    The world is facing great challenges in meeting rising demands for basic commodities (e.g., food, water and energy), finished goods (e.g., cell phones, cars and airplanes) and services (e.g., shelter, healthcare and employment) while reducing and minimizing the impact of human activities on Earth’s global environment and climate. Nanotechnology has emerged as a versatile platform that could provide efficient, cost-effective and environmentally acceptable solutions to the global sustainability challenges facing society. This special issue of the Journal of Nanoparticle Research is devoted to the utilization of nanotechnology to improve or achieve sustainable development. We highlight recent advances and discuss opportunities of utilizing nanotechnology to address global challenges in (1) water purification, (2) clean energy technologies, (3) greenhouse gases management, (4) materials supply and utilization, and (5) green manufacturing and chemistry. In addition to the technical challenges listed above, we also discuss societal perspectives and provide an outlook of the role of nanotechnology in the convergence of knowledge, technology and society for achieving sustainable development.

  18. Nanotechnology for sustainable development: retrospective and outlook

    International Nuclear Information System (INIS)

    Diallo, Mamadou S.; Fromer, Neil A.; Jhon, Myung S.

    2013-01-01

    The world is facing great challenges in meeting rising demands for basic commodities (e.g., food, water and energy), finished goods (e.g., cell phones, cars and airplanes) and services (e.g., shelter, healthcare and employment) while reducing and minimizing the impact of human activities on Earth’s global environment and climate. Nanotechnology has emerged as a versatile platform that could provide efficient, cost-effective and environmentally acceptable solutions to the global sustainability challenges facing society. This special issue of the Journal of Nanoparticle Research is devoted to the utilization of nanotechnology to improve or achieve sustainable development. We highlight recent advances and discuss opportunities of utilizing nanotechnology to address global challenges in (1) water purification, (2) clean energy technologies, (3) greenhouse gases management, (4) materials supply and utilization, and (5) green manufacturing and chemistry. In addition to the technical challenges listed above, we also discuss societal perspectives and provide an outlook of the role of nanotechnology in the convergence of knowledge, technology and society for achieving sustainable development

  19. Simple, cost effective & result oriented framework for supplier performance measurement in sports goods manufacturing industry

    Directory of Open Access Journals (Sweden)

    2011-09-01

    Full Text Available The emergences of global markets have increased competition worldwide. For the Sports Goods Manufacturing Industry which is considered to be an intensive supplier base industry with limited resources to sustain in what is already a very competitive market there is a need for the entire supply chain viz. raw material and machinery suppliers and manufacturers to measure their supplier's performance to reduce business risks and revenue losses. How to design & execute a simple, cost effective & result oriented Framework for Supplier Performance Measurement for sports goods manufacturing small - medium enterprises is the main aim of this research paper.

  20. Encouraging smokers to quit: the cost effectiveness of reimbursing the costs of smoking cessation treatment.

    Science.gov (United States)

    Kaper, Janneke; Wagena, Edwin J; van Schayck, Constant P; Severens, Johan L

    2006-01-01

    Smoking cessation should be encouraged in order to increase life expectancy and reduce smoking-related healthcare costs. Results of a randomised trial suggested that reimbursing the costs of smoking cessation treatment (SCT) may lead to an increased use of SCT and an increased number of quitters versus no reimbursement. To assess whether reimbursement for SCT is a cost-effective intervention (from the Dutch societal perspective), we calculated the incremental costs per quitter and extrapolated this outcome to incremental costs per QALY saved versus no reimbursement. In the reimbursement trial, 1266 Dutch smokers were randomly assigned to the intervention or control group using a randomised double consent design. Reimbursement for SCT was offered to the intervention group for a period of 6 months. No reimbursement was offered to the control group. Prolonged abstinence from smoking was determined 6 months after the end of the reimbursement period. The QALYs gained from quitting were calculated until 80 years of age using data from the US. Costs (year 2002 values) were determined from the societal perspective during the reimbursement period (May-November 2002). Benefits were discounted at 4% per annum. The uncertainty of the incremental cost-effectiveness ratios was estimated using non-parametric bootstrapping. Eighteen participants in the control group (2.8%) and 35 participants in the intervention group (5.5%) successfully quit smoking. The costs per participant were 291 euro and 322 euro, respectively. If society is willing to pay 1000 euro or 10,000 euro for an additional 12-month quitter, the probability that reimbursement for SCT would be cost effective was 50% or 95%, respectively. If society is willing to pay 18,000 euro for a QALY, the probability that reimbursement for SCT would be cost effective was 95%. However, the external validity of the extrapolation from quitters to QALYs is uncertain and several assumptions had to be made. Reimbursement for SCT may

  1. Transforming Society

    DEFF Research Database (Denmark)

    Enemark, Stig; Dahl Højgaard, Pia

    2017-01-01

    , was a result of transforming society from a feudal system to a capitalistic and market based economy. This story is interesting in itself - but it also provides a key to understanding the cadastral system of today. The system has evolved over time and now serves a whole range of functions in society. The paper...

  2. Cost-effectiveness analysis of treatments for premenstrual dysphoric disorder.

    Science.gov (United States)

    Rendas-Baum, Regina; Yang, Min; Gricar, Joseph; Wallenstein, Gene V

    2010-01-01

    Premenstrual syndrome (PMS) is reported to affect between 13% and 31% of women. Between 3% and 8% of women are reported to meet criteria for the more severe form of PMS, premenstrual dysphoric disorder (PMDD). Although PMDD has received increased attention in recent years, the cost effectiveness of treatments for PMDD remains unknown. To evaluate the cost effectiveness of the four medications with a US FDA-approved indication for PMDD: fluoxetine, sertraline, paroxetine and drospirenone plus ethinyl estradiol (DRSP/EE). A decision-analytic model was used to evaluate both direct costs (medication and physician visits) and clinical outcomes (treatment success, failure and discontinuation). Medication costs were based on average wholesale prices of branded products; physician visit costs were obtained from a claims database study of PMDD patients and the Agency for Healthcare Research and Quality. Clinical outcome probabilities were derived from published clinical trials in PMDD. The incremental cost-effectiveness ratio (ICER) was calculated using the difference in costs and percentage of successfully treated patients at 6 months. Deterministic and probabilistic sensitivity analyses were used to assess the impact of uncertainty in parameter estimates. Threshold values where a change in the cost-effective strategy occurred were identified using a net benefit framework. Starting therapy with DRSP/EE dominated both sertraline and paroxetine, but not fluoxetine. The estimated ICER of initiating treatment with fluoxetine relative to DRSP/EE was $US4385 per treatment success (year 2007 values). Cost-effectiveness acceptability curves revealed that for ceiling ratios>or=$US3450 per treatment success, fluoxetine had the highest probability (>or=0.37) of being the most cost-effective treatment, relative to the other options. The cost-effectiveness acceptability frontier further indicated that DRSP/EE remained the option with the highest expected net monetary benefit for

  3. 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

  4. Cost-effectiveness analysis of sandhill crane habitat management

    Science.gov (United States)

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

    2013-01-01

    Invasive species often threaten native wildlife populations and strain the budgets of agencies charged with wildlife management. We demonstrate the potential of cost-effectiveness analysis to improve the efficiency and value of efforts to enhance sandhill crane (Grus canadensis) roosting habitat. We focus on the central Platte River in Nebraska (USA), a region of international ecological importance for migrating avian species including sandhill cranes. Cost-effectiveness analysis is a valuation process designed to compare alternative actions based on the cost of achieving a pre-determined objective. We estimated costs for removal of invasive vegetation using geographic information system simulations and calculated benefits as the increase in area of sandhill crane roosting habitat. We generated cost effectiveness values for removing invasive vegetation on 7 land parcels and for the entire central Platte River to compare the cost-effectiveness of management at specific sites and for the central Platte River landscape. Median cost effectiveness values for the 7 land parcels evaluated suggest that costs for creating 1 additional hectare of sandhill crane roosting habitat totaled US $1,595. By contrast, we found that creating an additional hectare of sandhill crane roosting habitat could cost as much as US $12,010 for some areas in the central Platte River, indicating substantial cost savings can be achieved by using a cost effectiveness analysis to target specific land parcels for management. Cost-effectiveness analysis, used in conjunction with geographic information systems, can provide decision-makers with a new tool for identifying the most economically efficient allocation of resources to achieve habitat management goals.

  5. Cost effectiveness of eptifibatide in acute coronary syndromes; an economic analysis of Western European patients enrolled in the PURSUIT trial. The Platelet IIa/IIb in unstable Angina: Receptor Suppression Using Integrilin Therapy.

    Science.gov (United States)

    Brown, R E; Henderson, R A; Koster, D; Hutton, J; Simoons, M L

    2002-01-01

    To assess the direct medical costs and cost effectiveness of routine eptifibatide use amongst patients with unstable angina and myocardial infarction without persistent ST-segment elevation in the Western European subgroup of the PURSUIT trial. Health care resources were collected for the Western European PURSUIT trial patients (n=3697). Unit costs for major resources were developed within six countries using a consistent bottom-up methodology. Resource consumption from the Western European population was used to calculate the average direct medical costs per patient in the eptifibatide and placebo arms of the trial. Eptifibatide was estimated to cost 524 Euros per treatment. Long-term survival estimated from the 6-month trial survival data and combined with the cost data was used to calculate cost-effectiveness ratios. Additionally, cost per death and non-fatal myocardial infarction at 30 days was calculated. Sensitivity analyses were conducted on the discount rate and resource consumption. Cost-effectiveness ratios ranged from 9603 Euros to 18 115 Euros per year of life saved with 3% discount. Using resource consumption based on countries with low coronary arteriography rates, the cost per year of life saved was between 3329 Euros and 10 079 Euros. Using resource consumption based on high coronary arteriography rate countries, the cost per year of life saved was between 17 089 Euros and 24 099 Euros. Assuming no difference in treatment costs except for the addition of eptifibatide, the incremental cost per year of life saved was 23 818 Euros. Routine eptifibatide use was associated with a reduction in the combined end-point of death and myocardial infarction at 30 days, which was sustained at 6 months. Long-term projections indicate a modest increase in survival in eptifibatide patients. These data translate into cost-effectiveness ratios that compare favourably with other new technologies that are currently in use. Copyright 2001 The European Society of

  6. Resources available in society

    International Nuclear Information System (INIS)

    Berg, S.E.

    1997-01-01

    A decontamination operation will only be successful if cost-efficient methods are used. The cost-effectiveness depends, among many other factors, including the qualifications and training of the personnel and the capability of the equipment. The personnel must be able to handle the equipment in a professional way and should also know how to protect themselves. To fulfil these requirements they need courses in radiation protection. The equipment must be suitable for the selected countermeasure. Societies planning and preparedness for reclamation should meet realistic demands for early actions and outline a cost-effective strategy that implies reasonable use of personnel and equipment resources. Planning for early cleanup actions is different from that of long term planning with respect to the available time and quantity and quality of available information on which to base decisions. Available resources vary, of course, between the Nordic countries, but in all countries there are organisations with both knowledgeable staff and suitable equipment accessible for decontamination operations. (EG)

  7. The determinants of cost-effectiveness potential: an historical perspective on lipid-lowering therapies.

    Science.gov (United States)

    Refoios Camejo, Rodrigo; McGrath, Clare; Miraldo, Marisa; Rutten, Frans

    2013-05-01

    %, contracting from 0.36 QALYs to 0.08 QALYs, which resulted in a saving of approximately 15 % of the costs related to cardiovascular events. The price of the drug mix used in the management of high blood cholesterol varied considerably across the years: the weighted average monthly price (in year 2007 values) started at approximately £14, peaked around £26 and progressively decreased to its minimum at £6.85 in 2010. As a consequence, the maximum price allowed by current cost-effectiveness rules for a new technology achieving the clinical target was found to decrease by a minimum of 80 % between 1990 and 2010. The analysis supports the hypothesis that the potential for cost effectiveness of new therapies is dependent on factors specific to each disease area and furthermore to sub-populations within disease areas. Despite a clinical need still existing, the results suggest that no more technologies are likely to be developed in certain disease areas based on their low perceived cost-effectiveness potential. This occurs without considering the immediate and future value of the effectiveness lost, which may depend on the technical difficulty of materializing future advancements, and ignores the permanent character of such a decision. The analysis suggests that a single, static and arbitrary cost-effectiveness threshold may not be sufficient to capture the drug-development dynamics occurring at the disease level and successfully direct research to the disease areas that are most valued by society.

  8. 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

  9. Determination of Cost-Effective Energy Efficiency Measures in Buildings with the Aid of Multiple Indices

    Directory of Open Access Journals (Sweden)

    Theodoros Zachariadis

    2018-01-01

    Full Text Available Energy refurbishments of buildings can substantially contribute to economy-wide energy efficiency improvements, leading to decarbonisation and additional sustainability benefits. Prioritising the most economically promising investments is not straightforward because apart from cost-effectiveness calculations, several real-world constraints have to be taken into account. This paper describes an approach to assess the economically viable energy efficiency potential in the building sector of the Mediterranean island of Cyprus, with a combination of detailed engineering modelling, cost-effectiveness calculations and real-world considerations of budgetary, technical, behavioural and market constraints. We examine diverse cost-effectiveness indices and come up with a proposal for prioritising specific energy investments such as the installation of heat pumps, insulation of roofs, and replacement of lighting and electronic equipment—without however ignoring other measures that may be economically less favourable but can realistically be implemented in a limited number of buildings. Finally we address the governance of energy efficiency policies, focusing on weaknesses of the current regulatory environment in Cyprus, which can be generalised for many other countries facing similar dilemmas.

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

    Directory of Open Access Journals (Sweden)

    Jørgen Dejgård Jensen

    2015-06-01

    Full Text Available Inappropriate diets constitute an important health risk and an increasing environmental burden. Healthy regional diets may contribute to meeting this dual challenge. A palatable, healthy and sustainable New Nordic diet (NND based on organic products from the Nordic region has been developed. This study assesses whether a large-scale introduction of NND is a cost-effective health promotion strategy by combining an economic model for estimating the utility-maximizing composition of NND, a life cycle assessment model to assess environmental effects of the dietary change, and a health impact model to assess impacts on the disease burden. Consumer expenditure for food and beverages in the NND is about 16% higher than currently, with the largest relative difference in low-income households. Environmental loads from food consumption are 15%–25% lower, and more than 18,000 disability-adjusted life years (DALY will be saved per year in Denmark. NND exhibits a cost-effectiveness ratio of about €73,000–94,000 per DALY saved. This cost-effectiveness improves considerably, if the NND’s emphasis on organic and Nordic-origin products is relaxed.

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

    Science.gov (United States)

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

    2015-01-01

    Inappropriate diets constitute an important health risk and an increasing environmental burden. Healthy regional diets may contribute to meeting this dual challenge. A palatable, healthy and sustainable New Nordic diet (NND) based on organic products from the Nordic region has been developed. This study assesses whether a large-scale introduction of NND is a cost-effective health promotion strategy by combining an economic model for estimating the utility-maximizing composition of NND, a life cycle assessment model to assess environmental effects of the dietary change, and a health impact model to assess impacts on the disease burden. Consumer expenditure for food and beverages in the NND is about 16% higher than currently, with the largest relative difference in low-income households. Environmental loads from food consumption are 15%–25% lower, and more than 18,000 disability-adjusted life years (DALY) will be saved per year in Denmark. NND exhibits a cost-effectiveness ratio of about €73,000–94,000 per DALY saved. This cost-effectiveness improves considerably, if the NND’s emphasis on organic and Nordic-origin products is relaxed. PMID:26133129

  12. Sustainable consumption

    DEFF Research Database (Denmark)

    Prothero, Andrea; Dobscha, Susan; Freund, Jim

    2011-01-01

    This essay explores sustainable consumption and considers possible roles for marketing and consumer researchers and public policy makers in addressing the many sustainability challenges that pervade our planet. Future research approaches to this interdisciplinary topic need to be comprehensive...... and systematic and will benefit from a variety of different perspectives. There are a number of opportunities for future research, and three areas are explored in detail. First, the essay considers the inconsistency between the attitudes and behaviors of consumers with respect to sustainability; next, the agenda...... is broadened to explore the role of individual citizens in society; and finally, a macro institutional approach to fostering sustainability is explored. Each of these areas is examined in detail and possible research avenues and public policy initiatives are considered within each of these separate...

  13. Cost-effectiveness and pricing of antibacterial drugs.

    Science.gov (United States)

    Verhoef, Talitha I; Morris, Stephen

    2015-01-01

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

  14. Accounting for Cured Patients in Cost-Effectiveness Analysis.

    Science.gov (United States)

    Othus, Megan; Bansal, Aasthaa; Koepl, Lisel; Wagner, Samuel; Ramsey, Scott

    2017-04-01

    Economic evaluations often measure an intervention effect with mean overall survival (OS). Emerging types of cancer treatments offer the possibility of being "cured" in that patients can become long-term survivors whose risk of death is the same as that of a disease-free person. Describing cured and noncured patients with one shared mean value may provide a biased assessment of a therapy with a cured proportion. The purpose of this article is to explain how to incorporate the heterogeneity from cured patients into health economic evaluation. We analyzed clinical trial data from patients with advanced melanoma treated with ipilimumab (Ipi; n = 137) versus glycoprotein 100 (gp100; n = 136) with statistical methodology for mixture cure models. Both cured and noncured patients were subject to background mortality not related to cancer. When ignoring cured proportions, we found that patients treated with Ipi had an estimated mean OS that was 8 months longer than that of patients treated with gp100. Cure model analysis showed that the cured proportion drove this difference, with 21% cured on Ipi versus 6% cured on gp100. The mean OS among the noncured cohort patients was 10 and 9 months with Ipi and gp100, respectively. The mean OS among cured patients was 26 years on both arms. When ignoring cured proportions, we found that the incremental cost-effectiveness ratio (ICER) when comparing Ipi with gp100 was $324,000/quality-adjusted life-year (QALY) (95% confidence interval $254,000-$600,000). With a mixture cure model, the ICER when comparing Ipi with gp100 was $113,000/QALY (95% confidence interval $101,000-$154,000). This analysis supports using cure modeling in health economic evaluation in advanced melanoma. When a proportion of patients may be long-term survivors, using cure models may reduce bias in OS estimates and provide more accurate estimates of health economic measures, including QALYs and ICERs. Copyright © 2017 International Society for Pharmacoeconomics

  15. Cost-Effectiveness of Endoscopic Versus Microscopic Transsphenoidal Surgery for Pituitary Adenoma.

    Science.gov (United States)

    Ament, Jared D; Yang, Zhuo; Khatchadourian, Vic; Strong, Edward B; Shahlaie, Kiarash

    2018-02-01

    Endoscopic transsphenoidal surgery (ETPS) has become increasingly popular for resection of pituitary tumors, whereas microscopic transsphenoidal surgery (MTPS) also remains a commonly used approach. The economic sustainability of new techniques and technologies is rarely evaluated in the neurosurgical skull base literature. The aim of this study was to determine the cost-effectiveness of ETPS compared with MTPS. A Markov model was constructed to conduct a cost-utility analysis of ETPS versus MTPS from a single-payer health care perspective. Data were obtained from previously published outcomes studies. Costs were based on Medicare reimbursement rates, considering covariates such as complications, length of stay, and operative time. The base case adopted a 2-year follow-up period. Univariate and multivariate sensitivity analyses were conducted. On average, ETPS costs $143 less and generates 0.014 quality-adjusted life years (QALYs) compared with MTPS over 2 years. The incremental cost-effectiveness ratio (ICER) is -$10,214 per QALY, suggesting economic dominance. The QALY benefit increased to 0.105 when modeled to 10 years, suggesting that ETPS becomes even more favorable over time. ETPS appears to be cost-effective when compared with MTPS because the ICER falls below the commonly accepted $50,000 per QALY benchmark. Model limitations and assumptions affect the generalizability of the conclusion; however, ongoing efforts to improve rhinologic morbidity related to ETPS would appear to further augment the marginal cost savings and QALYs gained. Further research on the cost-effectiveness of ETPS using prospective data is warranted. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2017-06-01

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

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

    Science.gov (United States)

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

    2012-04-01

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

  18. Cost-effectiveness of a disease-specific oral nutritional support for pressure ulcer healing.

    Science.gov (United States)

    Cereda, Emanuele; Klersy, Catherine; Andreola, Manuela; Pisati, Roberto; Schols, Jos M G A; Caccialanza, Riccardo; D'Andrea, Federico

    2017-02-01

    The Oligo Element Sore Trial has shown that supplementation with a disease-specific nutritional formula enriched with arginine, zinc, and antioxidants improves pressure ulcer (PU) healing in malnourished patients compared to an isocaloric-isonitrogenous support. However, the use of such a nutritional formula needs to be supported also by a cost-effectiveness evaluation. This economic evaluation - from a local healthcare system perspective - was conducted alongside a multicenter, randomized, controlled trial following a piggy-back approach. The primary efficacy endpoint was the percentage of change in PU area at 8 weeks. The cost analysis focused on: the difference in direct medical costs of local PU care between groups and incremental cost-effectiveness ratio (ICER) of nutritional therapy related to significant study endpoints (percentage of change in PU area and ≥40% reduction in PU area at 8 weeks). Although the experimental formula was more expensive (mean difference: 39.4 Euros; P costs of local PU care (difference, -74.3 Euros; P = 0.013). Therefore, given its efficacy it proved to be a cost-effective intervention. The robustness of these results was confirmed by the sensitivity analyses. The use of a disease-specific oral nutritional formula not only results in better healing of PUs, but also reduces the costs of local PU care from a local healthcare system perspective. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  19. 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.

  20. Cost-effectiveness of indwelling pleural catheter compared with talc in malignant pleural effusion.

    Science.gov (United States)

    Olfert, Jordan A P; Penz, Erika D; Manns, Braden J; Mishra, Eleanor K; Davies, Helen E; Miller, Robert F; Luengo-Fernandez, Ramon; Gao, Song; Rahman, Najib M

    2017-05-01

    Malignant pleural effusion is associated with morbidity and mortality. A randomized controlled trial previously compared clinical outcomes and resource use with indwelling pleural catheter (IPC) and talc pleurodesis in this population. Using unpublished quality of life data, we estimate the cost-effectiveness of IPC compared with talc pleurodesis. Healthcare utilization and costs were captured during the trial. Utility weights produced by the EuroQol Group five-dimensional three-level questionnaire and survival were used to determine quality-adjusted life-years (QALYs) gained. The incremental cost-effectiveness ratio (ICER) was calculated over the 1-year trial period. Sensitivity analysis used patient survival data and modelled additional nursing time required per week for catheter drainage. Utility scores, cost and QALYs gained did not differ significantly between groups. The ICER for IPC compared with talc was favorable at $US10 870 per QALY gained. IPC was less costly with a probability exceeding 95% of being cost-effective when survival was pleural effusion in patients without history of prior pleurodesis, with consideration for patient survival, support and preferences. © 2016 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.

  1. Attributes of system testing which promote cost-effectiveness

    International Nuclear Information System (INIS)

    Martin, L.C.

    1975-01-01

    A brief overview of conventional EMP testing activity examines attributes of overall systems tests which promote cost-effectiveness. The general framework represents an EMP-oriented systems test as a portion of a planned program to design, produce, and field system elements. As such, all so-called system tests should play appropriate cost-effective roles in this program, and the objective here is to disclose such roles. The intrinsic worth of such tests depends not only upon placing proper values on the outcomes, but also upon the possible eventual consequences of not doing tests. A relative worth measure is required. Attributes of EMP system testing over the range of potential activity which encompasses research and development, production, field handling, verification, evaluation, and others are reviewed and examined. Thus, the relative worth, in a cost-effective sense, is provided by relating such attributes to the overall program objectives so that values can be placed on the outcomes for tradeoff purposes

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

    Science.gov (United States)

    Warren, C G

    1993-01-01

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

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

    CERN Document Server

    Baio, Gianluca; Heath, Anna

    2017-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-10-01

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

  5. Cost Effectiveness of a Home-Based Intervention That Helps Functionally Vulnerable Older Adults Age in Place at Home

    Directory of Open Access Journals (Sweden)

    Eric Jutkowitz

    2012-01-01

    Full Text Available Evaluating cost effectiveness of interventions for aging in place is essential for adoption in service settings. We present the cost effectiveness of Advancing Better Living for Elders (ABLE, previously shown in a randomized trial to reduce functional difficulties and mortality in 319 community-dwelling elders. ABLE involved occupational and physical therapy sessions and home modifications to address client-identified functional difficulties, performance goals, and home safety. Incremental cost-effectiveness ratio (ICER, expressed as additional cost to bring about one additional year of life, was calculated. Two models were then developed to account for potential cost differences in implementing ABLE. Probabilistic sensitivity analyses were conducted to account for variations in model parameters. By two years, there were 30 deaths (9: ABLE; 21: control. Additional costs for 1 additional year of life was $13,179 for Model 1 and $14,800 for Model 2. Investment in ABLE may be worthwhile depending on society's willingness to pay.

  6. The effectiveness and cost-effectiveness of community-based support for adolescents receiving antiretroviral treatment: an operational research study in South Africa.

    Science.gov (United States)

    Fatti, Geoffrey; Jackson, Debra; Goga, Ameena E; Shaikh, Najma; Eley, Brian; Nachega, Jean B; Grimwood, Ashraf

    2018-02-01

    Adolescents and youth receiving antiretroviral treatment (ART) in sub-Saharan Africa have high attrition and inadequate ART outcomes, and evaluations of interventions improving ART outcomes amongst adolescents are very limited. Sustainable Development Goal (SDG) target 3c is to substantially increase the health workforce in developing countries. We measured the effectiveness and cost-effectiveness of community-based support (CBS) provided by lay health workers for adolescents and youth receiving ART in South Africa. A retrospective cohort study including adolescents and youth who initiated ART at 47 facilities. Previously unemployed CBS-workers provided home-based ART-related education, psychosocial support, symptom screening for opportunistic infections and support to access government grants. Outcomes were compared between participants who received CBS plus standard clinic-based care versus participants who received standard care only. Cumulative incidences of all-cause mortality and loss to follow-up (LTFU), adherence measured using medication possession ratios (MPRs), CD4 count slope, and virological suppression were analysed using multivariable Cox, competing-risks regression, generalized estimating equations and mixed-effects models over five years of ART. An expenditure approach was used to determine the incremental cost of CBS to usual care from a provider perspective. Incremental cost-effectiveness ratios were calculated as annual cost per patient-loss (through death or LTFU) averted. Amongst 6706 participants included, 2100 (31.3%) received CBS. Participants who received CBS had reduced mortality, adjusted hazard ratio (aHR) = 0.52 (95% CI: 0.37 to 0.73; p effectiveness of CBS in reducing attrition ranged from 42.2% after one year to 35.9% after five years. Virological suppression was similar after three years, but after five years 18.8% CBS participants versus 37.2% non-CBS participants failed to achieve viral suppression, adjusted odds ratio = 0

  7. Cost-effectiveness of osteo-odonto keratoprosthesis in Singapore.

    Science.gov (United States)

    Dong, Di; Tan, Anna; Mehta, Jodhbir S; Tan, Donald; Finkelstein, Eric Andrew

    2014-01-01

    To determine the long-term cost-effectiveness of osteo-odonto keratoprosthesis (OOKP) relative to no treatment among patients with end-stage corneal and ocular surface diseases in Singapore. Cost-effectiveness analysis based on data from a retrospective cohort study. From a health system perspective, we calculated the incremental cost-effectiveness ratio of OOKP treatment relative to no treatment over a 30-year horizon, based on data from a cohort of 23 patients who underwent OOKP surgery between 2004 and 2009 at Singapore National Eye Centre. Preoperative and postoperative vision-related quality-of-life values were estimated from patients' visual outcomes and were used to calculate the gain in quality-adjusted life years (QALYs) resulting from OOKP treatment. Unsubsidized costs for surgery, consultations, examinations, medications, follow-up visits, and treatments for complications were retrieved from patients' bills to estimate the total costs associated with OOKP treatment. Sensitivity analyses were conducted to test the robustness of the model. Over a 30-year period, OOKP treatment, compared with no treatment, improved QALYs by 3.991 among patients with end-stage corneal and ocular surface diseases at an additional cost of S$67 840 (US$55 150), resulting in an incremental cost-effectiveness ratio of S$17 000/QALY (US$13 820/QALY). Based on commonly cited cost-effectiveness benchmarks, the OOKP is a cost-effective treatment for patients with end-stage corneal and ocular surface diseases. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Is individualized medicine more cost-effective? A systematic review.

    Science.gov (United States)

    Hatz, Maximilian H M; Schremser, Katharina; Rogowski, Wolf H

    2014-05-01

    Individualized medicine (IM) is a rapidly evolving field that is associated with both visions of more effective care at lower costs and fears of highly priced, low-value interventions. It is unclear which view is supported by the current evidence. Our objective was to systematically review the health economic evidence related to IM and to derive general statements on its cost-effectiveness. A literature search of MEDLINE database for English- and German-language studies was conducted. Cost-effectiveness and cost-utility studies for technologies meeting the MEDLINE medical subject headings (MeSH) definition of IM (genetically targeted interventions) were reviewed. This was followed by a standardized extraction of general study characteristics and cost-effectiveness results. Most of the 84 studies included in the synthesis were from the USA (n = 43, 51 %), cost-utility studies (n = 66, 79 %), and published since 2005 (n = 60, 71 %). The results ranged from dominant to dominated. The median value (cost-utility studies) was calculated to be rounded $US22,000 per quality-adjusted life year (QALY) gained (adjusted to $US, year 2008 values), which is equal to the rounded median cost-effectiveness in the peer-reviewed English-language literature according to a recent review. Many studies reported more than one strategy of IM with highly varying cost-effectiveness ratios. Generally, results differed according to test type, and tests for disease prognosis or screening appeared to be more favorable than tests to stratify patients by response or by risk of adverse effects. However, these results were not significant. Different definitions of IM could have been used. Quality assessment of the studies was restricted to analyzing transparency. IM neither seems to display superior cost-effectiveness than other types of medical interventions nor to be economically inferior. Instead, rather than 'whether' healthcare was individualized, the question of 'how' it was individualized was

  9. Using cost-effectiveness analyses to inform policy: the case of antiretroviral therapy in Thailand

    Directory of Open Access Journals (Sweden)

    Walt Gill

    2006-12-01

    Full Text Available Abstract Background: Much emphasis is put on providing evidence to assist policymakers in priority setting and investment decisions. Assessing the cost-effectiveness of interventions is one technique used by policymakers in their decisions around the allocation of scarce resources. However, even where such evidence is available, other considerations may also be taken into account, and even over-ride technical evidence. Antiretroviral therapy (ART is the most effective intervention to reduce HIV-related morbidity and prolong mortality. However, treatment provision in the developing world has been hindered by the high costs of services and drugs, casting doubts on its cost-effectiveness. This paper looks at Thailand's publicly-funded antiretroviral initiative which was first introduced in 1992, and explores the extent to which cost-effectiveness evidence influenced policy. Methods: This article reviews the development of the national ART programme in Thailand between 1992 and 2004. It examines the roles of cost-effectiveness information in treatment policy decisions. Qualitative approaches including document analysis and interview of key informants were employed. Results: Two significant policy shifts have been observed in government-organised ART provision. In 1996, service-based therapy for a few was replaced by a research network to support clinical assessments of antiretroviral medication in public hospitals. This decision was taken after a domestic study illustrated the unaffordable fiscal burden and inefficient use of resources in provision of ART. The numbers of treatment recipients was maintained at 2,000 per year throughout the 1990s. It was not until 2001 that a new government pledged to extend the numbers receiving the service, as part of its commitment to universal coverage. Several elements played a role in this decision: new groups of dominant actors, drug price reductions, a pro-active civil society movement, lessons from experience

  10. Cost-effectiveness of active transport for primary school children - Walking School Bus program

    Directory of Open Access Journals (Sweden)

    Swinburn Boyd

    2009-09-01

    Full Text Available Abstract Background To assess from a societal perspective the incremental cost-effectiveness of the Walking School Bus (WSB program for Australian primary school children as an obesity prevention measure. The intervention was modelled as part of the ACE-Obesity study, which evaluated, using consistent methods, thirteen interventions targeting unhealthy weight gain in Australian children and adolescents. Methods A logic pathway was used to model the effects on body mass index [BMI] and disability-adjusted life years [DALYs] of the Victorian WSB program if applied throughout Australia. Cost offsets and DALY benefits were modelled until the eligible cohort reached 100 years of age or death. The reference year was 2001. Second stage filter criteria ('equity', 'strength of evidence', 'acceptability', feasibility', sustainability' and 'side-effects' were assessed to incorporate additional factors that impact on resource allocation decisions. Results The modelled intervention reached 7,840 children aged 5 to 7 years and cost $AUD22.8M ($16.6M; $30.9M. This resulted in an incremental saving of 30 DALYs (7:104 and a net cost per DALY saved of $AUD0.76M ($0.23M; $3.32M. The evidence base was judged as 'weak' as there are no data available documenting the increase in the number of children walking due to the intervention. The high costs of the current approach may limit sustainability. Conclusion Under current modelling assumptions, the WSB program is not an effective or cost-effective measure to reduce childhood obesity. The attribution of some costs to non-obesity objectives (reduced traffic congestion and air pollution etc. is justified to emphasise the other possible benefits. The program's cost-effectiveness would be improved by more comprehensive implementation within current infrastructure arrangements. The importance of active transport to school suggests that improvements in WSB or its variants need to be developed and fully evaluated.

  11. Cost-effectiveness of active transport for primary school children - Walking School Bus program.

    Science.gov (United States)

    Moodie, Marjory; Haby, Michelle; Galvin, Leah; Swinburn, Boyd; Carter, Robert

    2009-09-14

    To assess from a societal perspective the incremental cost-effectiveness of the Walking School Bus (WSB) program for Australian primary school children as an obesity prevention measure. The intervention was modelled as part of the ACE-Obesity study, which evaluated, using consistent methods, thirteen interventions targeting unhealthy weight gain in Australian children and adolescents. A logic pathway was used to model the effects on body mass index [BMI] and disability-adjusted life years [DALYs] of the Victorian WSB program if applied throughout Australia. Cost offsets and DALY benefits were modelled until the eligible cohort reached 100 years of age or death. The reference year was 2001. Second stage filter criteria ('equity', 'strength of evidence', 'acceptability', feasibility', sustainability' and 'side-effects') were assessed to incorporate additional factors that impact on resource allocation decisions. The modelled intervention reached 7,840 children aged 5 to 7 years and cost $AUD22.8M ($16.6M; $30.9M). This resulted in an incremental saving of 30 DALYs (7:104) and a net cost per DALY saved of $AUD0.76M ($0.23M; $3.32M). The evidence base was judged as 'weak' as there are no data available documenting the increase in the number of children walking due to the intervention. The high costs of the current approach may limit sustainability. Under current modelling assumptions, the WSB program is not an effective or cost-effective measure to reduce childhood obesity. The attribution of some costs to non-obesity objectives (reduced traffic congestion and air pollution etc.) is justified to emphasise the other possible benefits. The program's cost-effectiveness would be improved by more comprehensive implementation within current infrastructure arrangements. The importance of active transport to school suggests that improvements in WSB or its variants need to be developed and fully evaluated.

  12. Cancer Care Coordinators to Improve Tamoxifen Persistence in Breast Cancer: How Heterogeneity in Baseline Prognosis Impacts on Cost-Effectiveness.

    Science.gov (United States)

    Nair, Nisha; Kvizhinadze, Giorgi; Blakely, Tony

    2016-12-01

    To assess the cost-effectiveness of a cancer care coordinator (CCC) in helping women with estrogen receptor positive (ER+) early breast cancer persist with tamoxifen for 5 years. We investigated the cost-effectiveness of a CCC across eight breast cancer subtypes, defined by progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER2) status, and local/regional spread. These subtypes range from excellent to poorer prognoses. The CCC helped in improving tamoxifen persistence by providing information, checking-in by phone, and "troubleshooting" concerns. We constructed a Markov macrosimulation model to estimate health gain (in quality-adjusted life-years or QALYs) and health system costs in New Zealand, compared with no CCC. Participants were modeled until death or till the age of 110 years. Some input parameters (e.g., the impact of a CCC on tamoxifen persistence) had sparse evidence. Therefore, we used estimates with generous uncertainty and conducted sensitivity analyses. The cost-effectiveness of a CCC for regional ER+/PR-/HER2+ breast cancer (worst prognosis) was NZ $23,400 (US $15,800) per QALY gained, compared with NZ $368,500 (US $248,800) for local ER+/PR+/HER2- breast cancer (best prognosis). Using a cost-effectiveness threshold of NZ $45,000 (US $30,400) per QALY, a CCC would be cost-effective only in the four subtypes with the worst prognoses. There is value in investigating cost-effectiveness by different subtypes within a disease. In this example of breast cancer, the poorer the prognosis, the greater the health gains from a CCC and the better the cost-effectiveness. Incorporating heterogeneity in a cost-utility analysis is important and can inform resource allocation decisions. It is also feasible to undertake in practice. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  13. A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke.

    Science.gov (United States)

    Levin, Lars-Åke; Husberg, Magnus; Sobocinski, Piotr Doliwa; Kull, Viveka Frykman; Friberg, Leif; Rosenqvist, Mårten; Davidson, Thomas

    2015-02-01

    The purpose of this study was to estimate the cost-effectiveness of two screening methods for detection of silent AF, intermittent electrocardiogram (ECG) recordings using a handheld recording device, at regular time intervals for 30 days, and short-term 24 h continuous Holter ECG, in comparison with a no-screening alternative in 75-year-old patients with a recent ischaemic stroke. The long-term (20-year) costs and effects of all alternatives were estimated with a decision analytic model combining the result of a clinical study and epidemiological data from Sweden. The structure of a cost-effectiveness analysis was used in this study. The short-term decision tree model analysed the screening procedure until the onset of anticoagulant treatment. The second part of the decision model followed a Markov design, simulating the patients' health states for 20 years. Continuous 24 h ECG recording was inferior to intermittent ECG in terms of cost-effectiveness, due to both lower sensitivity and higher costs. The base-case analysis compared intermittent ECG screening with no screening of patients with recent stroke. The implementation of the screening programme on 1000 patients resulted over a 20-year period in 11 avoided strokes and the gain of 29 life-years, or 23 quality-adjusted life years, and cost savings of €55 400. Screening of silent AF by intermittent ECG recordings in patients with a recent ischaemic stroke is a cost-effective use of health care resources saving costs and lives and improving the quality of life. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  14. Cost effectiveness of ovarian reserve testing in in vitro fertilization: a Markov decision-analytic model.

    Science.gov (United States)

    Moolenaar, Lobke M; Broekmans, Frank J M; van Disseldorp, Jeroen; Fauser, Bart C J M; Eijkemans, Marinus J C; Hompes, Peter G A; van der Veen, Fulco; Mol, Ben Willem J

    2011-10-01

    To compare the cost effectiveness of ovarian reserve testing in in vitro fertilization (IVF). A Markov decision model based on data from the literature and original patient data. Decision analytic framework. Computer-simulated cohort of subfertile women aged 20 to 45 years who are eligible for IVF. [1] No treatment, [2] up to three cycles of IVF limited to women under 41 years and no ovarian reserve testing, [3] up to three cycles of IVF with dose individualization of gonadotropins according to ovarian reserve, and [4] up to three cycles of IVF with ovarian reserve testing and exclusion of expected poor responders after the first cycle, with no treatment scenario as the reference scenario. Cumulative live birth over 1 year, total costs, and incremental cost-effectiveness ratios. The cumulative live birth was 9.0% in the no treatment scenario, 54.8% for scenario 2, 70.6% for scenario 3 and 51.9% for scenario 4. Absolute costs per woman for these scenarios were €0, €6,917, €6,678, and €5,892 for scenarios 1, 2, 3, and 4, respectively. Incremental cost-effectiveness ratios (ICER) for scenarios 2, 3, and 4 were €15,166, €10,837, and €13,743 per additional live birth. Sensitivity analysis showed the model to be robust over a wide range of values. Individualization of the follicle-stimulating hormone dose according to ovarian reserve is likely to be cost effective in women who are eligible for IVF, but this effectiveness needs to be confirmed in randomized clinical trials. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  15. Cost-effectiveness of preventive interventions to reduce alcohol consumption in Denmark.

    Directory of Open Access Journals (Sweden)

    Astrid Ledgaard Holm

    Full Text Available INTRODUCTION: Excessive alcohol consumption increases the risk of many diseases and injuries, and the Global Burden of Disease 2010 study estimated that 6% of the burden of disease in Denmark is due to alcohol consumption. Alcohol consumption thus places a considerable economic burden on society. METHODS: We analysed the cost-effectiveness of six interventions aimed at preventing alcohol abuse in the adult Danish population: 30% increased taxation, increased minimum legal drinking age, advertisement bans, limited hours of retail sales, and brief and longer individual interventions. Potential health effects were evaluated as changes in incidence, prevalence and mortality of alcohol-related diseases and injuries. Net costs were calculated as the sum of intervention costs and cost offsets related to treatment of alcohol-related outcomes, based on health care costs from Danish national registers. Cost-effectiveness was evaluated by calculating incremental cost-effectiveness ratios (ICERs for each intervention. We also created an intervention pathway to determine the optimal sequence of interventions and their combined effects. RESULTS: Three of the analysed interventions (advertising bans, limited hours of retail sales and taxation were cost-saving, and the remaining three interventions were all cost-effective. Net costs varied from € -17 million per year for advertisement ban to € 8 million for longer individual intervention. Effectiveness varied from 115 disability-adjusted life years (DALY per year for minimum legal drinking age to 2,900 DALY for advertisement ban. The total annual effect if all interventions were implemented would be 7,300 DALY, with a net cost of € -30 million. CONCLUSION: Our results show that interventions targeting the whole population were more effective than individual-focused interventions. A ban on alcohol advertising, limited hours of retail sale and increased taxation had the highest probability of being cost

  16. Cost effectiveness of FDG-PET: rapid evaluation in recurrent colorectal cancer

    International Nuclear Information System (INIS)

    Kelley, B.B.; Miles, K.A.; Keith, C.J.; Wong, D.C.; Griffiths, M.R.

    2002-01-01

    Full text: Intensive patient follow-up in assessments of the cost-effectiveness of a new imaging modality is associated with time-delays, ethical difficulties and increased costs. This study aims to evaluate the cost-effectiveness of FDG-PET in recurrent colorectal cancer using Australian data whilst avoiding intensive patient follow-up. The study population comprised patients with recurrent colorectal under consideration for resection of apparently isolated hepatic metastasis in whom demonstration of extra-hepatic tumour would preclude surgery. The results of FDG-PET in a consecutive series of 75 such patients referred to the Wesley PET centre were used to determine the range of possible values for disease prevalence and specificity, assuming the value for PET sensitivity as reported in the federal government's PET review. These values, along with the diagnostic accuracy of CT and Australian costs for procedures (PET = $ 1200), were entered into decision trees modelling a diagnostic strategy comprising CT only and an alternative strategy where patients without extra-hepatic tumour on CT also undergo FDG-PET. The cost per patient, accuracy and Incremental Cost-Accuracy Ratio (ICAR) were determined for each strategy. The PET strategy is cheaper for all possible values of disease prevalence and PET specificity ($306-328/patient) and is more cost-effective for values of disease prevalence above 0.18 or PET specificity above 0.86. At a typical disease prevalence of 0.3 (PET specificity 0.92), the ICAR for the PET strategy is $9700 versus $11,200 for CT. PET remains cost saving even if the best reported values for sensitivity of CT and worse values for PET are used, FDG-PET for recurrent colorectal cancer in Australia would be cost-saving and most probably cost-effective. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  17. Cost-effectiveness of screening for abdominal aortic aneurysm in the Netherlands and Norway.

    Science.gov (United States)

    Spronk, S; van Kempen, B J H; Boll, A P M; Jørgensen, J J; Hunink, M G M; Kristiansen, I S

    2011-11-01

    The aim of this study was to determine the cost-effectiveness of ultrasound screening for abdominal aortic aneurysm (AAA) in men aged 65 years, for both the Netherlands and Norway. A Markov model was developed to simulate life expectancy, quality-adjusted life-years, net health benefits, lifetime costs and incremental cost-effectiveness ratios for both screening and no screening for AAA. The best available evidence was retrieved from the literature and combined with primary data from the two countries separately, and analysed from a national perspective. A threshold willingness-to-pay (WTP) of €20,000 and €62,500 was used for data from the Netherlands and Norway respectively. The additional costs of the screening strategy compared with no screening were €421 (95 per cent confidence interval 33 to 806) per person in the Netherlands, and the additional life-years were 0·097 (-0·180 to 0·365), representing €4340 per life-year. For Norway, the values were €562 (59 to 1078), 0·057 (-0·135 to 0·253) life-years and €9860 per life-year respectively. In Norway the results were sensitive to a decrease in the prevalence of AAA in 65-year-old men to 1 per cent, or lower. Probabilistic sensitivity analyses indicated that AAA screening has a 70 per cent probability of being cost-effective in the Netherlands with a WTP threshold of €20,000, and 70 per cent in Norway with a threshold of €62,500. Using this model, screening for AAA in 65-year-old men would be highly cost-effective in both the Netherlands and Norway. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  18. 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

  19. Cost-effectiveness of preventive interventions to reduce alcohol consumption in Denmark.

    Science.gov (United States)

    Holm, Astrid Ledgaard; Veerman, Lennert; Cobiac, Linda; Ekholm, Ola; Diderichsen, Finn

    2014-01-01

    Excessive alcohol consumption increases the risk of many diseases and injuries, and the Global Burden of Disease 2010 study estimated that 6% of the burden of disease in Denmark is due to alcohol consumption. Alcohol consumption thus places a considerable economic burden on society. We analysed the cost-effectiveness of six interventions aimed at preventing alcohol abuse in the adult Danish population: 30% increased taxation, increased minimum legal drinking age, advertisement bans, limited hours of retail sales, and brief and longer individual interventions. Potential health effects were evaluated as changes in incidence, prevalence and mortality of alcohol-related diseases and injuries. Net costs were calculated as the sum of intervention costs and cost offsets related to treatment of alcohol-related outcomes, based on health care costs from Danish national registers. Cost-effectiveness was evaluated by calculating incremental cost-effectiveness ratios (ICERs) for each intervention. We also created an intervention pathway to determine the optimal sequence of interventions and their combined effects. Three of the analysed interventions (advertising bans, limited hours of retail sales and taxation) were cost-saving, and the remaining three interventions were all cost-effective. Net costs varied from € -17 million per year for advertisement ban to € 8 million for longer individual intervention. Effectiveness varied from 115 disability-adjusted life years (DALY) per year for minimum legal drinking age to 2,900 DALY for advertisement ban. The total annual effect if all interventions were implemented would be 7,300 DALY, with a net cost of € -30 million. Our results show that interventions targeting the whole population were more effective than individual-focused interventions. A ban on alcohol advertising, limited hours of retail sale and increased taxation had the highest probability of being cost-saving and should thus be first priority for implementation.

  20. Adaptive pacing, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Paul McCrone

    Full Text Available The PACE trial compared the effectiveness of adding adaptive pacing therapy (APT, cognitive behaviour therapy (CBT, or graded exercise therapy (GET, to specialist medical care (SMC for patients with chronic fatigue syndrome. This paper reports the relative cost-effectiveness of these treatments in terms of quality adjusted life years (QALYs and improvements in fatigue and physical function.Resource use was measured and costs calculated. Healthcare and societal costs (healthcare plus lost production and unpaid informal care were combined with QALYs gained, and changes in fatigue and disability; incremental cost-effectiveness ratios (ICERs were computed.SMC patients had significantly lower healthcare costs than those receiving APT, CBT and GET. If society is willing to value a QALY at £30,000 there is a 62.7% likelihood that CBT is the most cost-effective therapy, a 26.8% likelihood that GET is most cost effective, 2.6% that APT is most cost-effective and 7.9% that SMC alone is most cost-effective. Compared to SMC alone, the incremental healthcare cost per QALY was £18,374 for CBT, £23,615 for GET and £55,235 for APT. From a societal perspective CBT has a 59.5% likelihood of being the most cost-effective, GET 34.8%, APT 0.2% and SMC alone 5.5%. CBT and GET dominated SMC, while APT had a cost per QALY of £127,047. ICERs using reductions in fatigue and disability as outcomes largely mirrored these findings.Comparing the four treatments using a health care perspective, CBT had the greatest probability of being the most cost-effective followed by GET. APT had a lower probability of being the most cost-effective option than SMC alone. The relative cost-effectiveness was even greater from a societal perspective as additional cost savings due to reduced need for informal care were likely.

  1. Skeletal traction and intramedullary nailing cost-effectiveness

    African Journals Online (AJOL)

    In the operative group 24 patients had union with one delayed union while in the traction group 12 patients had union, 9 with mal union and 4 delayed union. Conclusion: Intramedullary nailing is more cost-effective than skeletal traction. It met the dominant strategy, because it was significantly less costly than skeletal ...

  2. Cost Effectiveness of Premium Versus Regular Gasoline in MCPS Buses.

    Science.gov (United States)

    Baacke, Clifford M.; Frankel, Steven M.

    The primary question posed in this study is whether premium or regular gasoline is more cost effective for the Montgomery County Public School (MCPS) bus fleet, as a whole, when miles-per-gallon, cost-per-gallon, and repair costs associated with mileage are considered. On average, both miles-per-gallon, and repair costs-per-mile favor premium…

  3. 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...

  4. Pressure relieving support surfaces (PRESSURE) trial: cost effectiveness analysis.

    Science.gov (United States)

    Iglesias, Cynthia; Nixon, Jane; Cranny, Gillian; Nelson, E Andrea; Hawkins, Kim; Phillips, Angela; Torgerson, David; Mason, Su; Cullum, Nicky

    2006-06-17

    To assess the cost effectiveness of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers in patients admitted to hospital. Cost effectiveness analysis carried out alongside the pressure relieving support surfaces (PRESSURE) trial; a multicentre UK based pragmatic randomised controlled trial. 11 hospitals in six UK NHS trusts. Intention to treat population comprising 1971 participants. Kaplan Meier estimates of restricted mean time to development of pressure ulcers and total costs for treatment in hospital. Alternating pressure mattresses were associated with lower overall costs (283.6 pounds sterling per patient on average, 95% confidence interval--377.59 pounds sterling to 976.79 pounds sterling) mainly due to reduced length of stay in hospital, and greater benefits (a delay in time to ulceration of 10.64 days on average,--24.40 to 3.09). The differences in health benefits and total costs for hospital stay between alternating pressure mattresses and alternating pressure overlays were not statistically significant; however, a cost effectiveness acceptability curve indicated that on average alternating pressure mattresses compared with alternating pressure overlays were associated with an 80% probability of being cost saving. Alternating pressure mattresses for the prevention of pressure ulcers are more likely to be cost effective and are more acceptable to patients than alternating pressure overlays.

  5. Cost-effectiveness of in vitro fertilization and embryo transfer

    NARCIS (Netherlands)

    Mol, B. W.; Bonsel, G. J.; Collins, J. A.; Wiegerinck, M. A.; van der Veen, F.; Bossuyt, P. M.

    2000-01-01

    OBJECTIVE: Economic analyses in reproductive medicine often fail to take into account the chances of treatment-independent conception. We compared the cost-effectiveness of several realistic strategies involving IVF using no treatment as the reference strategy. DESIGN: A decision tree was

  6. 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.

  7. Construction of cost effective homebuilt spin coater for coating ...

    African Journals Online (AJOL)

    We report the construction of a cost effective and low power consumption spin coater from a direct current (DC) brushless motor. The DC mechanical component is widdely available in the central processing unit (CPU) cooler. This set up permits simple operation where the DC voltage can be controlled manually in order to ...

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

    African Journals Online (AJOL)

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

  9. Chain Risk Model for quantifying cost effectiveness of phytosanitary measures

    NARCIS (Netherlands)

    Benninga, J.; Hennen, W.H.G.J.; Schans, van de J.

    2010-01-01

    A Chain Risk Model (CRM) was developed for a cost effective assessment of phytosanitary measures. The CRM model can be applied to phytosanitary assessments of all agricultural product chains. In CRM, stages are connected by product volume flows with which pest infections can be spread from one stage

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  11. A cost-effective Geographic Information Systems for Transportation ...

    African Journals Online (AJOL)

    A cost-effective Geographic Information Systems for Transportation (GIS-T) application for traffic congestion analyses in the Developing World. ... The PDF file you selected should load here if your Web browser has a PDF reader plug-in installed (for example, a recent version of Adobe Acrobat Reader). If you would like ...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-12-21

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

  13. The Cost-Effectiveness of Raising Teacher Quality

    Science.gov (United States)

    Yeh, Stuart S.

    2009-01-01

    Econometric studies suggest that student achievement may be improved if high-performing teachers are substituted for low-performing teachers. Drawing upon a recent study linking teacher performance on licensure exams with gains in student achievement, an analysis was conducted to determine the cost-effectiveness of requiring teacher applicants to…

  14. A Cost-Effectiveness Analysis of Early Literacy Interventions

    Science.gov (United States)

    Simon, Jessica

    2011-01-01

    Success in early literacy activities is associated with improved educational outcomes, including reduced dropout risk, in-grade retention, and special education referrals. When considering programs that will work for a particular school and context; cost-effectiveness analysis may provide useful information for decision makers. The study…

  15. Cost-Effective Mass Production of Mono Bucket Foundations

    DEFF Research Database (Denmark)

    Gres, Szymon; Nielsen, Søren Andreas; Fejerskov, Morten

    2015-01-01

    for innovative and cost-effective design of Mono Bucket foundations. Established approach merges wind and wave load models, soil/structure interaction topics, structural optimization and installation/fabrication aspects, into software package with ability to perform optimal design of the individual foundations...

  16. Cost effectiveness studies of environmental technologies: Volume 1

    International Nuclear Information System (INIS)

    Silva, E.M.; Booth, S.R.

    1994-02-01

    This paper examines cost effectiveness studies of environmental technologies including the following: (1) In Situ Air Stripping, (2) Surface Towed Ordinance Locator System, (3) Ditch Witch Horizontal Boring Technology, (4) Direct Sampling Ion Trap Mass Spectrometer, (5) In Situ Vitrification, (6) Site Characterization and Analysis Penetrometer System, (7) In Situ Bioremediation, and (8) SEAMIST Membrane System Technology

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

    African Journals Online (AJOL)

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

  18. Cost-effectiveness of hip protectors in frail institutionalized elderly

    NARCIS (Netherlands)

    van Schoor, N.M.; de Bruyne, M.C.; van der Roer, N.; Lommerse, E.; van Tulder, M.; Bouter, L.M.; Lips, P.T.A.M.

    2004-01-01

    A randomized controlled trial was performed to examine the cost-effectiveness of external hip protectors in the prevention of hip fractures. Since the hip protectors were not effective in preventing hip fractures in our study, the main objective became to examine whether the use of hip protectors

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

    Science.gov (United States)

    Young, Andrea

    2015-01-01

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

  20. 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 ...

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

    DEFF Research Database (Denmark)

    Gerke, Oke; Hermansson, Ronnie; Hess, Søren

    2015-01-01

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

  2. Cost-Effectiveness Analysis of Unsafe Abortion and Alternative First ...

    African Journals Online (AJOL)

    To explore the policy implications of increasing access to safe abortion in Nigeria and Ghana, we developed a computer-based decision analytic model which simulates induced abortion and its potential complications in a cohort of women, and comparatively assessed the cost-effectiveness of unsafe abortion and three ...

  3. Design of cost effective antennas for instrumentation radars

    CSIR Research Space (South Africa)

    Botha, L

    2012-09-01

    Full Text Available The cost of antennas for instrumentation radars are determined by the development cost. By re-use of the reflector system cost effective antennas can be designed. The factors governing the design of such antennas are described here....

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

    African Journals Online (AJOL)

    USER

    Keywords: Mobile clinics; Staic clinic; Family planning; Cost-effectiveness. Résumé. Des analyses ... d'offrir plus de méthodes de longue durée d'action peut influer sur une décision politique entre ces options. Cliniques ... nurse and a driver9.

  5. Cost-effectiveness of controlling Salmonella in the pork chain

    NARCIS (Netherlands)

    Gaag, van der M.A.; Saatkamp, H.W.; Backus, G.B.C.; Beek, van P.; Huirne, R.B.M.

    2004-01-01

    Pork is one of the sources of food-borne salmonellosis in humans. In this paper, the cost-effectiveness of different control scenarios against Salmonella in the stages finishing, transport, lairage and slaughtering is explored. A stochastic simulation model was used for the epidemiological analysis

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

    Directory of Open Access Journals (Sweden)

    Chung SH

    2018-03-01

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

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    This study compared the cost-effectiveness of telemonitoring with standard monitoring for patients with diabetic foot ulcers. The economic evaluation was nested within a pragmatic randomised controlled trial. A total of 374 patients were randomised to either telemonitoring or standard monitoring...

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

    Science.gov (United States)

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

    2009-10-01

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

  9. Protocol for cost effective detection of cassava mosaic virus ...

    African Journals Online (AJOL)

    Early detection of cassava mosaic disease (CMD) is an extremely important step in containing the spread of the disease in Africa. Many nucleic acid based detection tools have been developed for CMD diagnosis but although these methods are specific and sensitive for their target DNA, they are not fast, cost effective, can't ...

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

    Science.gov (United States)

    Persad, Govind

    2015-01-01

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

  11. Cost-effectiveness of infant pneumococcal vaccination in the Netherlands

    NARCIS (Netherlands)

    Vemer, P.; Postma, M.J.

    2013-01-01

    Objectives: The Dutch National Immunization Program offers the 10-valent pneumococcal conjugate vaccine (PCV10). Also licensed for use in the infant population is the 13-valent PCV (PCV13). To update cost-effectiveness (CE) estimates of PCV13 over PCV10, using current epidemiological and economic

  12. Cost-effectiveness of periconceptional supplementation of folic acid

    NARCIS (Netherlands)

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

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

  13. Cost-effectiveness of rotavirus vaccination in Turkey

    Directory of Open Access Journals (Sweden)

    Tulin Koksal

    2017-10-01

    Conclusion: At a cost per vaccine course of US$31.5 for monovalent and US$38 for pentavalent vaccine, routine RV vaccination could be potentially cost effective and also cost saving in Turkey. National RV vaccinations will play a significant role in preventing RV infections.

  14. Systemic cost-effectiveness analysis of food hazard reduction

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  15. Cost-effectiveness analysis of the introduction of rotavirus vaccine in Iran.

    Science.gov (United States)

    Javanbakht, Mehdi; Moradi-Lakeh, Maziar; Yaghoubi, Mohsen; Esteghamati, Abdoulreza; Mansour Ghanaie, Roxana; Mahmoudi, Sussan; Shamshiri, Ahmad-Reza; Zahraei, Seyed Mohsen; Baxter, Louise; Shakerian, Sareh; Chaudhri, Irtaza; Fleming, Jessica A; Munier, Aline; Baradaran, Hamid R

    2015-05-07

    Although the mortality from diarrheal diseases has been decreasing dramatically in Iran, it still represents an important proportion of disease burden in children Rotavirus vaccines are among the most effective strategies against diarrheal diseases in specific epidemiological conditions. This study aimed to evaluate the cost-effectiveness of the introduction of rotavirus vaccine (3 doses of pentavalent RotaTeq (RV5)) in Iran, from the viewpoints of Iran's health system and society. The TRIVAC decision support model was used to calculate total incremental costs, life years (LYs) gained, and disability-adjusted life years (DALYs) averted due to the vaccination program. Necessary input data were collected from the most valid accessible sources as well as a systematic review and meta-analysis on epidemiological studies. We used WHO guidelines to estimate vaccination cost. An annual discount rate of 3% was considered for both health gain and costs. A deterministic sensitivity analysis was performed for testing the robustness of the models results. Our results indicated that total DALYs potentially lost due to rotavirus diarrhea within 10 years would be 138,161, of which 76,591 could be prevented by rotavirus vaccine. The total vaccination cost for 10 cohorts was estimated to be US$ 499.91 million. Also, US$ 470.61 million would be saved because of preventing outpatient visits and inpatient admissions (cost-saving from the society perspective). We estimated a cost per DALY averted of US$ 2868 for RV5 vaccination, which corresponds to a highly cost-effective strategy from the government perspective. In the sensitivity analysis, all scenarios tested were still cost-saving or highly cost-effective from the society perspective, except in the least favorable scenario and low vaccine efficacy and disease incidence scenario. Based on the findings, introduction of rotavirus vaccine is a highly cost-effective strategy from the government perspective. Introducing the vaccine to

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

    Directory of Open Access Journals (Sweden)

    Vos Theo

    2011-05-01

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

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

    Science.gov (United States)

    Phanthunane, Pudtan; Vos, Theo; Whiteford, Harvey; Bertram, Melanie

    2011-05-13

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

  18. Simulation of the cost-effectiveness of malaria vaccines

    Directory of Open Access Journals (Sweden)

    Tediosi Fabrizio

    2009-06-01

    Full Text Available Abstract Background A wide range of possible malaria vaccines is being considered and there is a need to identify which vaccines should be prioritized for clinical development. An important element of the information needed for this prioritization is a prediction of the cost-effectiveness of potential vaccines in the transmission settings in which they are likely to be deployed. This analysis needs to consider a range of delivery modalities to ensure that clinical development plans can be aligned with the most appropriate deployment strategies. Methods The simulations are based on a previously published individual-based stochastic model for the natural history and epidemiology of Plasmodium falciparum malaria. Three different vaccine types: pre-erythrocytic vaccines (PEV, blood stage vaccines (BSV, mosquito-stage transmission-blocking vaccines (MSTBV, and combinations of these, are considered each delivered via a range of delivery modalities (Expanded Programme of Immunization – EPI-, EPI with booster, and mass vaccination combined with EPI. The cost-effectiveness ratios presented are calculated for four health outcomes, for assumed vaccine prices of US$ 2 or US$ 10 per dose, projected over a 10-year period. Results The simulations suggest that PEV will be more cost-effective in low transmission settings, while BSV at higher transmission settings. Combinations of BSV and PEV are more efficient than PEV, especially in moderate to high transmission settings, while compared to BSV they are more cost-effective in moderate to low transmission settings. Combinations of MSTBV and PEV or PEV and BSV improve the effectiveness and the cost-effectiveness compared to PEV and BSV alone only when applied with EPI and mass vaccinations. Adding booster doses to the EPI is unlikely to be a cost-effective alternative to delivering vaccines via the EPI for any vaccine, while mass vaccination improves effectiveness, especially in low transmission settings, and is

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

    Science.gov (United States)

    2011-01-01

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

  20. Cost-effectiveness of rotavirus vaccination in Albania.

    Science.gov (United States)

    Ahmeti, Albana; Preza, Iria; Simaku, Artan; Nelaj, Erida; Clark, Andrew David; Felix Garcia, Ana Gabriela; Lara, Carlos; Hoestlandt, Céline; Blau, Julia; Bino, Silvia

    2015-05-07

    Rotavirus vaccines have been introduced in several European countries but can represent a considerable cost, particularly for countries that do not qualify for any external financial support. This study aimed to evaluate the cost-effectiveness of introducing rotavirus vaccination into Albania's national immunization program and to inform national decision-making by improving national capacity to conduct economic evaluations of new vaccines. The TRIVAC model was used to assess vaccine impact and cost-effectiveness. The model estimated health and economic outcomes attributed to 10 successive vaccinated birth cohorts (2013-2022) from a government and societal perspective. Epidemiological and economic data used in the model were based on national cost studies, and surveillance data, as well as estimates from the scientific literature. Cost-effectiveness was estimated for both the monovalent (RV1) and pentavalent vaccines (RV5). A multivariate scenario analysis (SA) was performed to evaluate the uncertainty around the incremental cost-effectiveness ratios (ICERs). With 3% discounting of costs and health benefits over the period 2013-2022, rotavirus vaccination in Albania could avert 51,172 outpatient visits, 14,200 hospitalizations, 27 deaths, 950 disability-adjusted life-years (DALYs), and gain 801 life-years. When both vaccines were compared to no vaccination, the discounted cost per DALY averted was US$ 2008 for RV1 and US$ 5047 for RV5 from a government perspective. From the societal perspective the values were US$ 517 and US$ 3556, respectively. From both the perspectives, the introduction of rotavirus vaccine to the Albanian immunization schedule is either cost-effective or highly cost-effective for a range of plausible scenarios. In most scenarios, including the base-case scenario, the discounted cost per DALY averted was less than three times the gross domestic product (GDP) per capita. However, rotavirus vaccination was not cost-effective when rotavirus cases

  1. Cost-effectiveness of emergency contraception options over 1 year.

    Science.gov (United States)

    Bellows, Brandon K; Tak, Casey R; Sanders, Jessica N; Turok, David K; Schwarz, Eleanor B

    2018-05-01

    The copper intrauterine device is the most effective form of emergency contraception and can also provide long-term contraception. The levonorgestrel intrauterine device has also been studied in combination with oral levonorgestrel for women seeking emergency contraception. However, intrauterine devices have higher up-front costs than oral methods, such as ulipristal acetate and levonorgestrel. Health care payers and decision makers (eg, health care insurers, government programs) with financial constraints must determine if the increased effectiveness of intrauterine device emergency contraception methods are worth the additional costs. We sought to compare the cost-effectiveness of 4 emergency contraception strategies-ulipristal acetate, oral levonorgestrel, copper intrauterine device, and oral levonorgestrel plus same-day levonorgestrel intrauterine device-over 1 year from a US payer perspective. Costs (2017 US dollars) and pregnancies were estimated over 1 year using a Markov model of 1000 women seeking emergency contraception. Every 28-day cycle, the model estimated the predicted number of pregnancy outcomes (ie, live birth, ectopic pregnancy, spontaneous abortion, or induced abortion) resulting from emergency contraception failure and subsequent contraception use. Model inputs were derived from published literature and national sources. An emergency contraception strategy was considered cost-effective if the incremental cost-effectiveness ratio (ie, the cost to prevent 1 additional pregnancy) was less than the weighted average cost of pregnancy outcomes in the United States ($5167). The incremental cost-effectiveness ratios and probability of being the most cost-effective emergency contraception strategy were calculated from 1000 probabilistic model iterations. One-way sensitivity analyses were used to examine uncertainty in the cost of emergency contraception, subsequent contraception, and pregnancy outcomes as well as the model probabilities. In 1000 women

  2. Society and education

    DEFF Research Database (Denmark)

    Moutsios, Stavros

    in Europe. Elaborating on the Castoriadian ontology, the book delves into the magma of social imaginary significations that characterise and associate pivotal epochs of the continent’s history, Classical Greece and Modernity, and exemplifies their incarnation in educational systems and in the formation...... countries. Nevertheless, as Moutsios suggests, the European tradition, notwithstanding its ideological usage by much of social sciences, contains an indissoluble critical and self-reflective dimension, which needs to be sustained and advanced in education and its cross-cultural comparison, perhaps, more......'Society and Education: An Outline of Comparison' explores the relation of society to education in Europe, as well as its comparative perspective towards overseas societies and their institutions. It is an enquiry into the social-historical institution of education and cross-cultural studies...

  3. Network Society

    DEFF Research Database (Denmark)

    Clausen, Lars; Tække, Jesper

    2017-01-01

    the five strands of theory on the network society. Each theoretical position has its specific implications for acting toward strategic goals. In its entirety, the five perspectives give a thorough understanding of the conditions for successful strategic communication in the 21st century....

  4. Network Society

    DEFF Research Database (Denmark)

    Clausen, Lars; Tække, Jesper

    2018-01-01

    the five strands of theory on the network society. Each theoretical position has its specific implications for acting toward strategic goals. In its entirety, the five perspectives give a thorough understanding of the conditions for successful strategic communication in the 21st century....

  5. Cost-effectiveness of interventions to promote physical activity: a modelling study.

    Directory of Open Access Journals (Sweden)

    Linda J Cobiac

    2009-07-01

    Full Text Available BACKGROUND: Physical inactivity is a key risk factor for chronic disease, but a growing number of people are not achieving the recommended levels of physical activity necessary for good health. Australians are no exception; despite Australia's image as a sporting nation, with success at the elite level, the majority of Australians do not get enough physical activity. There are many options for intervention, from individually tailored advice, such as counselling from a general practitioner, to population-wide approaches, such as mass media campaigns, but the most cost-effective mix of interventions is unknown. In this study we evaluate the cost-effectiveness of interventions to promote physical activity. METHODS AND FINDINGS: From evidence of intervention efficacy in the physical activity literature and evaluation of the health sector costs of intervention and disease treatment, we model the cost impacts and health outcomes of six physical activity interventions, over the lifetime of the Australian population. We then determine cost-effectiveness of each intervention against current practice for physical activity intervention in Australia and derive the optimal pathway for implementation. Based on current evidence of intervention effectiveness, the intervention programs that encourage use of pedometers (Dominant and mass media-based community campaigns (Dominant are the most cost-effective strategies to implement and are very likely to be cost-saving. The internet-based intervention program (AUS$3,000/DALY, the GP physical activity prescription program (AUS$12,000/DALY, and the program to encourage more active transport (AUS$20,000/DALY, although less likely to be cost-saving, have a high probability of being under a AUS$50,000 per DALY threshold. GP referral to an exercise physiologist (AUS$79,000/DALY is the least cost-effective option if high time and travel costs for patients in screening and consulting an exercise physiologist are considered

  6. A Systematic Review of the Cost-Effectiveness of Biologics for Ulcerative Colitis.

    Science.gov (United States)

    Stawowczyk, Ewa; Kawalec, Paweł

    2018-04-01

    Ulcerative colitis (UC) is a chronic autoimmune inflammation of the colon. The condition significantly decreases quality of life and generates a substantial economic burden for healthcare payers, patients and the society in which they live. Some patients require chronic pharmacotherapy, and access to novel biologic drugs might be crucial for long-term remission. The analyses of cost-effectiveness for biologic drugs are necessary to assess their efficiency and provide the best available drugs to patients. Our aim was to collect and assess the quality of economic analyses carried out for biologic agents used in the treatment of UC, as well as to summarize evidence on the drivers of cost-effectiveness and evaluate the transferability and generalizability of conclusions. A systematic database review was conducted using MEDLINE (via PubMed), EMBASE, Cost-Effectiveness Analysis Registry and CRD0. Both authors independently reviewed the identified articles to determine their eligibility for final review. Hand searching of references in collected papers was also performed to find any relevant articles. The reporting quality of economic analyses included was evaluated by two reviewers using the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement checklist. We reviewed the sensitivity analyses in cost-effectiveness analyses to identify the variables that may have changed the conclusions of the study. Key drivers of cost-effectiveness were selected by identifying uncertain parameters that caused the highest change of the results of the analyses compared with base-case results. Of the 576 identified records, 87 were excluded as duplicates and 16 studies were included in the final review; evaluations for Canada, the UK and Poland were mostly performed. The majority of the evaluations revealed were performed for infliximab (approximately 75% of total volume); however, some

  7. The imperative for systems thinking to promote access to medicines, efficient delivery, and cost-effectiveness when implementing health financing reforms: a qualitative study.

    Science.gov (United States)

    Achoki, Tom; Lesego, Abaleng

    2017-03-21

    Health systems across Africa are faced with a multitude of competing priorities amidst pressing resource constraints. Expansion of health insurance coverage offers promise in the quest for sustainable healthcare financing for many of the health systems in the region. However, the broader policy implications of expanding health insurance coverage have not been fully investigated and contextualized to many African health systems. We interviewed 37 key informants drawn from public, private and civil society organizations involved in health service delivery in Botswana. The objective was to determine the potential health system impacts that would result from expanding the health insurance scheme covering public sector employees. Study participants were selected through purposeful sampling, stakeholder mapping, and snowballing. We thematically synthesized their views, focusing on the key health system areas of access to medicines, efficiency and cost-effectiveness, as intermediate milestones towards universal health coverage. Participants suggested that expansion of health insurance would be characterized by increased financial resources for health and catalyze an upsurge in utilization of health services particularly among those with health insurance cover. As a result, the health system, particularly within the private sector, would be expected to see higher demand for medicines and other health technologies. However, majority of the respondents cautioned that, realizing the full benefits of improved population health, equitable distribution and financial risk protection, would be wholly dependent on having sound policies, regulations and functional accountability systems in place. It was recommended that, health system stewards should embrace efficient and cost-effective delivery, in order to make progress towards universal health coverage. Despite the prospects of increasing financial resources available for health service delivery, expansion of health insurance

  8. Engineering Sustainability: A Technical Approach to Sustainability

    OpenAIRE

    Rosen, Marc A.

    2012-01-01

    Sustainability is a critically important goal for human activity and development. Sustainability in the area of engineering is of great importance to any plans for overall sustainability given 1) the pervasiveness of engineering activities in societies, 2) their importance in economic development and living standards, and 3) the significant impacts that engineering processes and systems have had, and continue to have, on the environment. Many factors that need to be considered and appropriate...

  9. Agroecology and Sustainable Agriculture

    Directory of Open Access Journals (Sweden)

    Fabio Caporali

    Full Text Available In the framework of the 16th National Meeting of the Italian Ecological Society (“Global Change, Ecological Diversity and Sustainability”, University of Tuscia, Viterbo, 19-22 September 2006, a symposium was devoted to “Agroecology and Sustainable Development”. A major goal of this symposium was to contribute to keeping the dialogue among the experts of the various disciplines alive. Sustainability of agriculture is a challenge for society world wide. Universities and society as a whole have a responsibility in re-examining current perception of nature, of the world and of human society in the light of natural resources depletion, increasing pollution and social inequalities. The urgency to address sustainability issues is increasingly being reflected in the manner in which institutions of higher education around the world are giving priority to the teaching, research and practice of sustainability. The University of Tuscia is involved in international initiatives concerning teaching and research in Agroecology and Sustainable Agriculture.

  10. Cost-effectiveness of pneumococcal conjugate vaccination in Croatia.

    Science.gov (United States)

    Vučina, V Višekruna; Filipović, S Kurečić; Kožnjak, N; Stamenić, V; Clark, A D; Mounaud, B; Blau, J; Hoestlandt, C; Kaić, B

    2015-05-07

    Pneumococcus is a known cause of meningitis, pneumonia, sepsis, and acute otitis media in children and adults globally. Two new vaccines for children have the potential to prevent illness, disability, and death, but these vaccines are expensive. The Croatian Ministry of Health has considered introducing the vaccine in the past, but requires economic evidence to ensure that the limited funds available for health care will be used in the most effective way. Croatia appointed a multidisciplinary team of experts to evaluate the cost-effectiveness of introducing pneumococcal conjugate vaccination (PCV) into the national routine child immunization program. Both 10-valent and 13-valent PCV (PCV10 and PCV13) were compared to a scenario assuming no vaccination. The TRIVAC decision-support model was used to estimate cost-effectiveness over the period 2014-2033. We used national evidence on demographics, pneumococcal disease incidence and mortality, the age distribution of disease in children, health service utilization, vaccine coverage, vaccine timeliness, and serotype coverage. Vaccine effectiveness was based on evidence from the scientific literature. Detailed health care costs were not available from the Croatian Institute for Health Insurance at the time of the analysis so assumptions and World Health Organization (WHO) estimates for Croatia were used. We assumed a three-dose primary vaccination schedule, and an initial price of US$ 30 per dose for PCV10 and US$ 35 per dose for PCV13. We ran univariate sensitivity analyses and multivariate scenario analyses. Either vaccine is estimated to prevent approximately 100 hospital admissions and one death each year in children younger than five in Croatia. Compared to no vaccine, the discounted cost-effectiveness of either vaccine is estimated to be around US$ 69,000-77,000 per disability-adjusted life-years (DALYs) averted over the period 2014-2033 (from the government or societal perspective). Only two alternative scenarios

  11. Sustainable Welfare in Low Energy Societies

    DEFF Research Database (Denmark)

    Nørgaard, Jørgen

    1996-01-01

    The chapter presents some general basic concepts which are useful in analyzing future options for saving energy and thereby mitigate the environmental problems. Three factors are suggested as determinants of the energy demand, namely the population, the level of energy services (material welfare)...

  12. Sustainability or profitability?

    Energy Technology Data Exchange (ETDEWEB)

    Khennas, Smail; Doig, Alsion [Intermediate Technology, Bourton on Dunsmore, Rugby (United Kingdom)

    1999-10-01

    For small rural communities off-grid, micro-hydro power is often the most cost-effective means of providing electricity. Whether the electricity should be provided without cost to the beneficiaries or whether it should be paid for are the points under discussion. Details of cost and technology of schemes in both Nepal and Sri Lanka show that micro hydro can be sustainable in small isolated communities. (UK)

  13. 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

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

    Science.gov (United States)

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

    2017-02-01

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

  15. Cost-effectiveness of a central venous catheter care bundle.

    Directory of Open Access Journals (Sweden)

    Kate A Halton

    Full Text Available BACKGROUND: A bundled approach to central venous catheter care is currently being promoted as an effective way of preventing catheter-related bloodstream infection (CR-BSI. Consumables used in the bundled approach are relatively inexpensive which may lead to the conclusion that the bundle is cost-effective. However, this fails to consider the nontrivial costs of the monitoring and education activities required to implement the bundle, or that alternative strategies are available to prevent CR-BSI. We evaluated the cost-effectiveness of a bundle to prevent CR-BSI in Australian intensive care patients. METHODS AND FINDINGS: A Markov decision model was used to evaluate the cost-effectiveness of the bundle relative to remaining with current practice (a non-bundled approach to catheter care and uncoated catheters, or use of antimicrobial catheters. We assumed the bundle reduced relative risk of CR-BSI to 0.34. Given uncertainty about the cost of the bundle, threshold analyses were used to determine the maximum cost at which the bundle remained cost-effective relative to the other approaches to infection control. Sensitivity analyses explored how this threshold alters under different assumptions about the economic value placed on bed-days and health benefits gained by preventing infection. If clinicians are prepared to use antimicrobial catheters, the bundle is cost-effective if national 18-month implementation costs are below $1.1 million. If antimicrobial catheters are not an option the bundle must cost less than $4.3 million. If decision makers are only interested in obtaining cash-savings for the unit, and place no economic value on either the bed-days or the health benefits gained through preventing infection, these cost thresholds are reduced by two-thirds. CONCLUSIONS: A catheter care bundle has the potential to be cost-effective in the Australian intensive care setting. Rather than anticipating cash-savings from this intervention, decision

  16. Cost-effectiveness of lurasidone vs quetiapine extended-release (XR) in patients with bipolar depression.

    Science.gov (United States)

    Rajagopalan, Krithika; Meyer, Kellie; O'Day, Ken; Denno, Melissa; Loebel, Antony

    2015-01-01

    Bipolar disorder imposes a high economic burden on patients and society. Lurasidone and quetiapine extended-release (XR) are atypical antipsychotic agents indicated for monotherapy treatment of bipolar depression. Lurasidone is also indicated as adjunctive therapy with lithium or valproate for depressive episodes associated with bipolar disorder. The objective of this analysis was to estimate the cost-effectiveness of lurasidone and quetiapine XR in patients with bipolar depression. A cost-effectiveness model was developed to compare lurasidone to quetiapine XR. The model was based on a US third-party payer perspective over a 3-month time horizon. The effectiveness measure in the model was the percentage of patients achieving remission (Montgomery-Åsberg Depression Rating Scale [MADRS] total score ≤12 by weeks 6-8). The comparison of remission rates was made through an adjusted indirect treatment comparison of lurasidone and quetiapine XR pivotal trials using placebo as the common comparator. Resource utilization for remission vs no remission was estimated from published expert panel data, and resource costs were obtained from a retrospective database study of bipolar I depression patients. Drug costs were estimated using the mean dose from clinical trials and wholesale acquisition costs. Over the 3-month model time period, lurasidone and quetiapine XR patients, respectively, had similar mean numbers of emergency department visits (0.48 vs 0.50), inpatient days (2.1 vs 2.2), and office visits (9.3 vs 9.6). More lurasidone than quetiapine XR patients achieved remission (52.0% vs 43.2%) with slightly higher total costs ($4982 vs $4676), resulting in an incremental cost-effectiveness ratio of $3474 per remission. The probabilistic sensitivity analysis showed lurasidone had an 86% probability of being cost-effective compared to quetiapine XR at a willingness-to-pay threshold of $10,000 per remission. Lurasidone may be a cost-effective option when compared to

  17. 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

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

    Science.gov (United States)

    John, Denny; Parikh, Rajul

    2017-07-01

    ), the introduction of a community screening programme for glaucoma for the 40-69 years age group is likely to be relatively cost-effective if implemented in the urban areas of India. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  19. Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa.

    Directory of Open Access Journals (Sweden)

    Muhammad Hamza

    2016-03-01

    Full Text Available Snakebite poisoning is a significant medical problem in agricultural societies in Sub Saharan Africa. Antivenom (AV is the standard treatment, and we assessed the cost-effectiveness of making it available in 16 countries in West Africa.We determined the cost-effectiveness of AV based on a decision-tree model from a public payer perspective. Specific AVs included in the model were Antivipmyn, FAV Afrique, EchiTab-G and EchiTab-Plus. We derived inputs from the literature which included: type of snakes causing bites (carpet viper (Echis species/non-carpet viper, AV effectiveness against death, mortality without AV, probability of Early Adverse Reactions (EAR, likelihood of death from EAR, average age at envenomation in years, anticipated remaining life span and likelihood of amputation. Costs incurred by the victims include: costs of confirming and evaluating envenomation, AV acquisition, routine care, AV transportation logistics, hospital admission and related transportation costs, management of AV EAR compared to the alternative of free snakebite care with ineffective or no AV. Incremental Cost Effectiveness Ratios (ICERs were assessed as the cost per death averted and the cost per Disability-Adjusted-Life-Years (DALY averted. Probabilistic Sensitivity Analyses (PSA using Monte Carlo simulations were used to obtain 95% Confidence Intervals of ICERs.The cost/death averted for the 16 countries of interest ranged from $1,997 in Guinea Bissau to $6,205 for Liberia and Sierra Leone. The cost/DALY averted ranged from $83 (95% Confidence Interval: $36-$240 for Benin Republic to $281 ($159-457 for Sierra-Leone. In all cases, the base-case cost/DALY averted estimate fell below the commonly accepted threshold of one time per capita GDP, suggesting that AV is highly cost-effective for the treatment of snakebite in all 16 WA countries. The findings were consistent even with variations of inputs in 1-way sensitivity analyses. In addition, the PSA showed that

  20. An empiric estimate of the value of life: updating the renal dialysis cost-effectiveness standard.

    Science.gov (United States)

    Lee, Chris P; Chertow, Glenn M; Zenios, Stefanos A

    2009-01-01

    Proposals to make decisions about coverage of new technology by comparing the technology's incremental cost-effectiveness with the traditional benchmark of dialysis imply that the incremental cost-effectiveness ratio of dialysis is seen a proxy for the value of a statistical year of life. The frequently used ratio for dialysis has, however, not been updated to reflect more recently available data on dialysis. We developed a computer simulation model for the end-stage renal disease population and compared cost, life expectancy, and quality adjusted life expectancy of current dialysis practice relative to three less costly alternatives and to no dialysis. We estimated incremental cost-effectiveness ratios for these alternatives relative to the next least costly alternative and no dialysis and analyzed the population distribution of the ratios. Model parameters and costs were estimated using data from the Medicare population and a large integrated health-care delivery system between 1996 and 2003. The sensitivity of results to model assumptions was tested using 38 scenarios of one-way sensitivity analysis, where parameters informing the cost, utility, mortality and morbidity, etc. components of the model were by perturbed +/-50%. The incremental cost-effectiveness ratio of dialysis of current practice relative to the next least costly alternative is on average $129,090 per quality-adjusted life-year (QALY) ($61,294 per year), but its distribution within the population is wide; the interquartile range is $71,890 per QALY, while the 1st and 99th percentiles are $65,496 and $488,360 per QALY, respectively. Higher incremental cost-effectiveness ratios were associated with older age and more comorbid conditions. Sensitivity to model parameters was comparatively small, with most of the scenarios leading to a change of less than 10% in the ratio. The value of a statistical year of life implied by dialysis practice currently averages $129,090 per QALY ($61,294 per year), but

  1. A cost-effect analysis of an intervention against radon in homes

    Directory of Open Access Journals (Sweden)

    Hein Stigum

    2009-10-01

    Full Text Available Background  Key words  : Radon exposure, lung cancer, cost-effect analysis, attributable risk, models-mathematical: Radon is a radioactive gas that may leak into buildings from the ground. Radon exposure is a risk factor for lung cancer. An intervention against radon exposure in homes may consist of locating homes with high radon exposure (above 200 Bq m-3 and improving these, and of protecting future houses. The purpose of this paper is to calculate the costs and the effects of this intervention. Methods: We performed a cost-effect analysis from the perspective of the society, followed by an uncertainty and sensitivity analysis. The distribution of radon levels in Norwegian homes is lognormal with mean=74.5 Bq/m3, and 7.6% above 200 Bq/m3. Results: The preventable attributable fraction of radon on lung cancer was 3.8% (95% uncertainty interval: 0.6%, 8.3%. In cumulative present values the intervention would cost $238 (145, 310 million and save 892 (133, 1981 lives, each life saved costs $0.27 (0.09, 0.9 million. The cost-effect ratio was sensitive to the radon risk, the radon exposure distribution, and the latency period of lung cancer. Together these three parameters explained 90% of the variation in the cost-effect ratio. Conclusions: Reducing the radon concentration in present and future homes to below 200 Bq/m3 will cost $0.27 (0.09, 0.9 million per life saved. The uncertainty in the estimated cost per life is large, mainly due to uncertainty in the risk of lung cancer from radon. Based on estimates from road construction, the Norwegian society has been willing to pay $1 million to save a life. We therefore conclude that the intervention against radon in homes is justifiable. The willingness to pay is also larger that the upper uncertainty limit of the cost per life. Our conclusion is therefore robust against the uncertainties in the parameters.

  2. Above Bonneville passage and propagation cost effectiveness analysis

    International Nuclear Information System (INIS)

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

    1993-05-01

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

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

    Science.gov (United States)

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

    2009-01-01

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

  4. In search of cost-effective, reliable software

    International Nuclear Information System (INIS)

    Naser, J.A.; Bhatt, S.C.

    1992-01-01

    Considerable effort is ongoing to utilize the strengths of digital technology to upgrade and add functionality to existing systems and to develop solutions to problems in the nuclear industry. Acceptance of digital solutions requires verification and validation activities to ensure the reliability and acceptance of these solutions. EPRI has an ongoing effort to develop a methodology for verification and validation of digital control systems. Also, a joint project between the NRC and EPRI is developing a methodology for expert system verification and validation. To obtain a wider acceptance of digital system solutions and hence the utilization of verification and validation techniques, cost effective methods for design, development and verification and validation are needed. EPRI is leading an effort to develop methods for cost effective verification and validation for all types of software

  5. Above Bonneville Passage and Propagation Cost Effectiveness Analysis.

    Energy Technology Data Exchange (ETDEWEB)

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

    1993-05-01

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

  6. Privacy Enforcement in a Cost-Effective Smart Grid

    DEFF Research Database (Denmark)

    Mikkelsen, Søren Aagaard

    In this technical report we present the current state of the research conducted during the first part of the PhD period. The PhD thesis “Privacy Enforcement in a Cost-Effective Smart Grid” focuses on ensuring privacy when generating market for energy service providers that develop web services...... for the residential domain in the envisaged smart grid. The PhD project is funded and associated to the EU project “Energy Demand Aware Open Services for Smart Grid Intelligent Automation” (Smart HG) and therefore introduces the project on a system-level. Based on this, we present some of the integration, security...... and privacy challenges that emerge when designing a system architecture and infrastructure. The resulting architecture is a consumer-centric and agent-based design and uses open Internet-based communication protocols for enabling interoperability while being cost-effective. Finally, the PhD report present...

  7. 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

  8. Cost-effectiveness of root caries preventive treatments.

    Science.gov (United States)

    Schwendicke, Falk; Göstemeyer, Gerd

    2017-01-01

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

  9. Cost-Effectiveness of a Clinical Childhood Obesity Intervention.

    Science.gov (United States)

    Sharifi, Mona; Franz, Calvin; Horan, Christine M; Giles, Catherine M; Long, Michael W; Ward, Zachary J; Resch, Stephen C; Marshall, Richard; Gortmaker, Steven L; Taveras, Elsie M

    2017-11-01

    To estimate the cost-effectiveness and population impact of the national implementation of the Study of Technology to Accelerate Research (STAR) intervention for childhood obesity. In the STAR cluster-randomized trial, 6- to 12-year-old children with obesity seen at pediatric practices with electronic health record (EHR)-based decision support for primary care providers and self-guided behavior-change support for parents had significantly smaller increases in BMI than children who received usual care. We used a microsimulation model of a national implementation of STAR from 2015 to 2025 among all pediatric primary care providers in the United States with fully functional EHRs to estimate cost, impact on obesity prevalence, and cost-effectiveness. The expected population reach of a 10-year national implementation is ∼2 million children, with intervention costs of $119 per child and $237 per BMI unit reduced. At 10 years, assuming maintenance of effect, the intervention is expected to avert 43 000 cases and 226 000 life-years with obesity at a net cost of $4085 per case and $774 per life-year with obesity averted. Limiting implementation to large practices and using higher estimates of EHR adoption improved both cost-effectiveness and reach, whereas decreasing the maintenance of the intervention's effect worsened the former. A childhood obesity intervention with electronic decision support for clinicians and self-guided behavior-change support for parents may be more cost-effective than previous clinical interventions. Effective and efficient interventions that target children with obesity are necessary and could work in synergy with population-level prevention strategies to accelerate progress in reducing obesity prevalence. Copyright © 2017 by the American Academy of Pediatrics.

  10. Cost-effectiveness of rotavirus vaccination in Kenya and Uganda.

    Science.gov (United States)

    Sigei, Charles; Odaga, John; Mvundura, Mercy; Madrid, Yvette; Clark, Andrew David

    2015-05-07

    Rotavirus vaccines have the potential to prevent a substantial amount of life-threatening gastroenteritis in young African children. This paper presents the results of prospective cost-effectiveness analyses for rotavirus vaccine introduction for Kenya and Uganda. In each country, a national consultant worked with a national technical working group to identify appropriate data and validate study results. Secondary data on demographics, disease burden, health utilization, and costs were used to populate the TRIVAC cost-effectiveness model. The baseline analysis assumed an initial vaccine price of $0.20 per dose, corresponding to Gavi, the Vaccine Alliance stipulated copay for low-income countries. The incremental cost-effectiveness of a 2-dose rotavirus vaccination schedule was evaluated for 20 successive birth cohorts from the government perspective in both countries, and from the societal perspective in Uganda. Between 2014 and 2033, rotavirus vaccination can avert approximately 60,935 and 216,454 undiscounted deaths and hospital admissions respectively in children under 5 years in Kenya. In Uganda, the respective number of undiscounted deaths and hospital admission averted is 70,236 and 329,779 between 2016 and 2035. Over the 20-year period, the discounted vaccine program costs are around US$ 80 million in Kenya and US$ 60 million in Uganda. Discounted government health service costs avoided are US$ 30 million in Kenya and US$ 10 million in Uganda (or US$ 18 million including household costs). The cost per disability-adjusted life-year (DALY) averted from a government perspective is US$ 38 in Kenya and US$ 34 in Uganda (US$ 29 from a societal perspective). Rotavirus vaccine introduction is highly cost-effective in both countries in a range of plausible 'what-if' scenarios. The involvement of national experts improves the quality of data used, is likely to increase acceptability of the results in decision-making, and can contribute to strengthened national

  11. COST EFFECTIVE AND HIGH RESOLUTION SUBSURFACE CHARACTERIZATION USING HYDRAULIC TOMOGRAPHY

    Science.gov (United States)

    2017-08-01

    objective of this project is to provide the DoD and its remediation contractors with the HT technology for delineating the spatial distribution of...STATEMENT Approved for public release; distribution is unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Hydraulic Tomography ( HT ) is a high-resolution...performance of subsurface remedial actions at environmental sites. The good technical performance and cost-effectiveness of HT have been demonstrated in

  12. Invisible Cost Effective Mechanics for Anterior Space Closure.

    Science.gov (United States)

    Jumle, Aatish Vinod; Bagrecha, Saurabh; Gharat, Ninad; Misal, Abhijit; Toshniwal, N G

    2015-01-01

    The shifting paradigm towards invisible orthodontic treatment and also awareness in patients has allured their focus towards the most esthetic treatment approach. Also the lingual treatment is proved successful and is very well accepted by the patients. The problem that persist is its high expenses, which is not affordable by all patients. This article is a effort to treat a simple Class I malocclusion with anterior spacing using a simple, esthetic, Cost effective approach with acceptable results when esthetics plays a priority role.

  13. A Cost-effectiveness Analysis of Early vs Late Tracheostomy.

    Science.gov (United States)

    Liu, C Carrie; Rudmik, Luke

    2016-10-01

    The timing of tracheostomy in critically ill patients requiring mechanical ventilation is controversial. An important consideration that is currently missing in the literature is an evaluation of the economic impact of an early tracheostomy strategy vs a late tracheostomy strategy. To evaluate the cost-effectiveness of the early tracheostomy strategy vs the late tracheostomy strategy. This economic analysis was performed using a decision tree model with a 90-day time horizon. The economic perspective was that of the US health care third-party payer. The primary outcome was the incremental cost per tracheostomy avoided. Probabilities were obtained from meta-analyses of randomized clinical trials. Costs were obtained from the published literature and the Healthcare Cost and Utilization Project database. A multivariate probabilistic sensitivity analysis was performed to account for uncertainty surrounding mean values used in the reference case. The reference case demonstrated that the cost of the late tracheostomy strategy was $45 943.81 for 0.36 of effectiveness. The cost of the early tracheostomy strategy was $31 979.12 for 0.19 of effectiveness. The incremental cost-effectiveness ratio for the late tracheostomy strategy compared with the early tracheostomy strategy was $82 145.24 per tracheostomy avoided. With a willingness-to-pay threshold of $50 000, the early tracheostomy strategy is cost-effective with 56% certainty. The adaptation of an early vs a late tracheostomy strategy depends on the priorities of the decision-maker. Up to a willingness-to-pay threshold of $80 000 per tracheostomy avoided, the early tracheostomy strategy has a higher probability of being the more cost-effective intervention.

  14. Emission Control Cost-Effectiveness of Alternative-Fuel Vehicles

    OpenAIRE

    Wang, Quanlu; Sperling, Daniel; Olmstead, Janis

    1993-01-01

    Although various legislation and regulations have been adopted to promote the use of alternative-fuel vehicles for curbing urban air pollution problems, there is a lack of systematic comparisons of emission control cost-effectiveness among various alternative-fuel vehicle types. In this paper, life-cycle emission reductions and life-cycle costs were estimated for passenger cars fueled with methanol, ethanol, liquified petroleum gas, compressed natural gas, and electricity. Vehicle emission es...

  15. Cost effectiveness methodology for evaluating Korean international communication system alternatives.

    OpenAIRE

    Hwang, Tae Kyun.

    1987-01-01

    Approved for public release; distribution in unlimited. Cost and Effectiveness models are developed by using of cost-effectiveness technique for fiber optic cable and satellite communication media. The models are applied to the Korean international communication problem. Alternative selection is required since the two medias different in cost and effectiveness. The major difficulties encountered were data gathering and measuring the effectiveness of the Korean international ...

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

    Science.gov (United States)

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

    2017-02-15

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

  17. 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.

  18. 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.

  19. Comparison of Strategies and Incidence Thresholds for Vi Conjugate Vaccines Against Typhoid Fever: A Cost-effectiveness Modeling Study.

    Science.gov (United States)

    Lo, Nathan C; Gupta, Ribhav; Stanaway, Jeffrey D; Garrett, Denise O; Bogoch, Isaac I; Luby, Stephen P; Andrews, Jason R

    2018-02-12

    Typhoid fever remains a major public health problem globally. While new Vi conjugate vaccines hold promise for averting disease, the optimal programmatic delivery remains unclear. We aimed to identify the strategies and associated epidemiologic conditions under which Vi conjugate vaccines would be cost-effective. We developed a dynamic, age-structured transmission and cost-effectiveness model that simulated multiple vaccination strategies with a typhoid Vi conjugate vaccine from a societal perspective. We simulated 10-year vaccination programs with (1) routine immunization of infants (aged typhoid fever and defined strategies as highly cost-effective by using the definition of a low-income country (defined as a country with a gross domestic product of $1045 per capita). We defined incidence as the true number of clinically symptomatic people in the population per year. Vi conjugate typhoid vaccines were highly cost-effective when administered by routine immunization activities through the EPI in settings with an annual incidence of >50 cases/100000 (95% uncertainty interval, 40-75 cases) and when administered through the EPI plus a catch-up campaign in settings with an annual incidence of >130 cases/100000 (95% uncertainty interval, 50-395 cases). The incidence threshold was sensitive to the typhoid-related case-fatality rate, carrier contribution to transmission, vaccine characteristics, and country-specific economic threshold for cost-effectiveness. Typhoid Vi conjugate vaccines would be highly cost-effective in low-income countries in settings of moderate typhoid incidence (50 cases/100000 annually). These results were sensitive to case-fatality rates, underscoring the need to consider factors contributing to typhoid mortality (eg, healthcare access and antimicrobial resistance) in the global vaccination strategy. © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America.

  20. Value for Money in H1N1 Influenza: A Systematic Review of the Cost-Effectiveness of Pandemic Interventions.

    Science.gov (United States)

    Pasquini-Descomps, Hélène; Brender, Nathalie; Maradan, David

    2017-06-01

    The 2009 A/H1N1 influenza pandemic generated additional data and triggered new studies that opened debate over the optimal strategy for handling a pandemic. The lessons-learned documents from the World Health Organization show the need for a cost estimation of the pandemic response during the risk-assessment phase. Several years after the crisis, what conclusions can we draw from this field of research? The main objective of this article was to provide an analysis of the studies that present cost-effectiveness or cost-benefit analyses for A/H1N1 pandemic interventions since 2009 and to identify which measures seem most cost-effective. We reviewed 18 academic articles that provide cost-effectiveness or cost-benefit analyses for A/H1N1 pandemic interventions since 2009. Our review converts the studies' results into a cost-utility measure (cost per disability-adjusted life-year or quality-adjusted life-year) and presents the contexts of severity and fatality. The existing studies suggest that hospital quarantine, vaccination, and usage of the antiviral stockpile are highly cost-effective, even for mild pandemics. However, school closures, antiviral treatments, and social distancing may not qualify as efficient measures, for a virus like 2009's H1N1 and a willingness-to-pay threshold of $45,000 per disability-adjusted life-year. Such interventions may become cost-effective for severe crises. This study helps to shed light on the cost-utility of various interventions, and may support decision making, among other criteria, for future pandemics. Nonetheless, one should consider these results carefully, considering these may not apply to a specific crisis or country, and a dedicated cost-effectiveness assessment should be conducted at the time. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  1. Decision tree analysis to assess the cost-effectiveness of yttrium microspheres for treatment of hepatic metastases from colorectal cancer

    International Nuclear Information System (INIS)

    Kelley, B.B.; Walker, G.D.; Miles, K.A.

    2002-01-01

    Full text: The aim is to determine the cost-effectiveness of yttrium microsphere treatment of hepatic metastases from colorectal cancer, with and without FDG-PET for detection of extra-hepatic disease. A decision tree was created comparing two strategies for yttrium treatment with chemotherapy, one incorporating PET in addition to CT in the pre-treatment work-up, to a strategy of chemotherapy alone. The sensitivity and specificity of PET and CT were obtained from the Federal Government PET review. Imaging costs were obtained from the Medicare benefits schedule with an additional capital component added for PET (final cost $1200). The cost of yttrium treatment was determined by patient-tracking. Previously published reports indicated a mean gain in life-expectancy from treatment of 0.52 years. Patients with extra-hepatic metastases were assumed to receive no survival benefit. Cost effectiveness was expressed as incremental cost per life-year gained (ICER). Sensitivity analysis determined the effect of prior probability of extra-hepatic disease on cost-savings and cost-effectiveness. The cost of yttrium treatment including angiography, particle perfusion studies and bed-stays, was $10530. A baseline value for prior probability of extra-hepatic disease of 0.35 gave ICERs of $26,378 and $25,271 for the no-PET and PET strategies respectively. The PET strategy was less expensive if the prior probability of extra-hepatic metastases was greater than 0.16 and more cost-effective if above 0.28. Yttrium microsphere treatment is less cost-effective than other interventions for colon cancer but comparable to other accepted health interventions. Incorporating PET into the pre-treatment assessment is likely to save costs and improve cost-effectiveness. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  2. Optimizing the position and use of omalizumab for severe persistent allergic asthma using cost-effectiveness analysis.

    Science.gov (United States)

    Faria, Rita; McKenna, Claire; Palmer, Stephen

    2014-12-01

    There has been some controversy on whether the costs of omalizumab outweigh its benefits for severe persistent allergic asthma. This study aimed to resolve the uncertainties and limitations of previous analyses and establish the cost-effectiveness of omalizumab under the list price and Patient Access Scheme (PAS) discounted price for the UK National Health Service. A decision-analytic model was developed to evaluate the long-term cost-effectiveness of omalizumab under the perspective of the National Health Service. Outcomes were expressed as quality-adjusted life-years (QALYs). Patient subgroups were defined post hoc on the basis of data collected in clinical trials: previous hospitalization, on maintenance oral corticosteroids, and three or more previous exacerbations. The incremental cost-effectiveness ratio varied from £30,109 to £57,557 per QALY gained depending on the population considered using the PAS price; incremental cost-effectiveness ratios were over a third higher using the list price. Omalizumab is likely to be cost-effective at the threshold of £30,000 per QALY gained in the severe subgroups if the improvement in health-related quality of life from omalizumab is mapped from an asthma-specific measure to the EuroQol five-dimensional questionnaire (vs. the EuroQol five-dimensional questionnaire directly collected from patients) or asthma mortality refers to death after hospitalization from asthma (vs. asthma-mortality risk in the community). Although the cost-effectiveness of omalizumab is more favorable under the PAS price, it represents good value for money only in severe subgroups and under optimistic assumptions regarding asthma mortality and improvement in health-related quality of life. For these reasons, omalizumab should be carefully targeted to ensure value for money. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  3. Cost-Effectiveness of Nicotine Patches for Smoking Cessation in Pregnancy: A Placebo Randomized Controlled Trial (SNAP).

    Science.gov (United States)

    Essex, Holly N; Parrott, Steve; Wu, Qi; Li, Jinshuo; Cooper, Sue; Coleman, Tim

    2015-06-01

    Smoking during pregnancy is the most important, preventable cause of adverse pregnancy outcomes including miscarriage, premature birth, and low birth weight with huge financial costs to the National Health Service. However, there are very few published economic evaluations of smoking cessation interventions in pregnancy and previous studies are predominantly U.S.-based and do not present incremental cost-effectiveness ratios (ICER). A number of studies have demonstrated cost-effectiveness of nicotine replacement therapy (NRT) in the general population, but this has yet to be tested among pregnant smokers. A cost-effectiveness analysis was undertaken alongside the smoking, nicotine, and pregnancy trial to compare NRT patches plus behavioral support to behavioral support alone, for pregnant women who smoked. At delivery, biochemically verified quit rates were slightly higher at 9.4% in the NRT group compared to 7.6% in the control group (odds ratio = 1.26, 95% CI = 0.82-1.96), at an increased cost of around £90 per participant. Higher costs in the NRT group were mainly attributable to the cost of NRT patches (mean = £46.07). The incremental cost-effectiveness ratio associated with NRT was £4,926 per quitter and a sensitivity analysis including only singleton births yielded an ICER of £4,156 per quitter. However, wide confidence intervals indicated a high level of uncertainty. Without a specific willingness to pay threshold, and due to high levels of statistical uncertainty, it is hard to determine the cost-effectiveness of NRT in this population. Furthermore, future research should address compliance issues, as these may dilute any potential effects of NRT, thus reducing the cost-effectiveness. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. Cost-effectiveness analysis evaluating fidaxomicin versus oral vancomycin for the treatment of Clostridium difficile infection in the United States.

    Science.gov (United States)

    Stranges, Paul M; Hutton, David W; Collins, Curtis D

    2013-01-01

    Fidaxomicin is a novel treatment for Clostridium difficile infections (CDIs). This new treatment, however, is associated with a higher acquisition cost compared with alternatives. The objective of this study was to evaluate the cost-effectiveness of fidaxomicin or oral vancomycin for the treatment of CDIs. We performed a cost-utility analysis comparing fidaxomicin with oral vancomycin for the treatment of CDIs in the United States by creating a decision analytic model from the third-party payer perspective. The incremental cost-effectiveness ratio with fidaxomicin compared with oral vancomycin was $67,576/quality-adjusted life-year. A probabilistic Monte Carlo sensitivity analysis showed that fidaxomicin had an 80.2% chance of being cost-effective at a willingness-to-pay threshold of $100,000/quality-adjusted life-year. Fidaxomicin remained cost-effective under all fluctuations of both fidaxomicin and oral vancomycin costs. The decision analytic model was sensitive to variations in clinical cure and recurrence rates. Secondary analyses revealed that fidaxomicin was cost-effective in patients receiving concominant antimicrobials, in patients with mild to moderate CDIs, and when compared with oral metronidazole in patients with mild to moderate disease. Fidaxomicin was dominated by oral vancomycin if CDI was caused by the NAP1/Bl/027 Clostridium difficile strain and was dominant in institutions that did not compound oral vancomycin. Results of our model showed that fidaxomicin may be a more cost-effective option for the treatment of CDIs when compared with oral vancomycin under most scenarios tested. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  5. 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.

  6. A Cost-Effectiveness Analysis Model for Evaluating and Planning Secondary Vocational Programs

    Science.gov (United States)

    Kim, Jin Eun

    1977-01-01

    This paper conceptualizes a cost-effectiveness analysis and describes a cost-effectiveness analysis model for secondary vocational programs. It generates three kinds of cost-effectiveness measures: program effectiveness, cost efficiency, and cost-effectiveness and/or performance ratio. (Author)

  7. Cost-Effectiveness of Secondary Screening Modalities for Hypertension

    Science.gov (United States)

    Wang, Y. Claire; Koval, Alisa M.; Nakamura, Miyabi; Newman, Jonathan D.; Schwartz, Joseph E.; Stone, Patricia W.

    2014-01-01

    Background Clinic-based blood pressure (CBP) has been the default approach for diagnosing hypertension, but patients may be misclassified due to masked hypertension (false negative) or “white coat” hypertension (false positive). The incorporation of other diagnostic modalities, such as home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), holds promise to improve diagnostic accuracy and subsequent treatment decisions. Method We reviewed the literature on the costs and cost-effectiveness of adding HBPM and ABPM into routine blood pressure screening in adults. We excluded letters, editorials, and studies of pregnant and/or pre-eclamptic patients, children, and patients with specific conditions (e.g. diabetes). Results We identified 14 original, English language studies that included cost outcomes and compared two or more modalities. ABPM was found to be cost-saving for diagnostic confirmation following an elevated CBP in 6 studies. Three of 4 studies found that adding HBPM to an elevated CBP was also cost-effective. Conclusion Existing evidence supports the cost-effectiveness of incorporating HBPM or ABPM following an initial CBP-based diagnosis of hypertension. Future research should focus on their implementation in clinical practice, long-term economic values, and potential roles in identifying masked hypertension. PMID:23263535

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

    Science.gov (United States)

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

    2015-11-16

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

  9. Cost-effective conservation planning: lessons from economics.

    Science.gov (United States)

    Duke, Joshua M; Dundas, Steven J; Messer, Kent D

    2013-08-15

    Economists advocate that the billions of public dollars spent on conservation be allocated to achieve the largest possible social benefit. This is "cost-effective conservation"-a process that incorporates both monetized benefits and costs. Though controversial, cost-effective conservation is poorly understood and rarely implemented by planners. Drawing from the largest publicly financed conservation programs in the United States, this paper seeks to improve the communication from economists to planners and to overcome resistance to cost-effective conservation. Fifteen practical lessons are distilled, including the negative implications of limiting selection with political constraints, using nonmonetized benefit measures or benefit indices, ignoring development risk, using incomplete cost measures, employing cost measures sequentially, and using benefit indices to capture costs. The paper highlights interrelationships between benefits and complications such as capitalization and intertemporal planning. The paper concludes by identifying the challenges at the research frontier, including incentive problems associated with adverse selection, additionality, and slippage. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Cost-effectiveness of secondary screening modalities for hypertension.

    Science.gov (United States)

    Wang, Y Claire; Koval, Alisa M; Nakamura, Miyabi; Newman, Jonathan D; Schwartz, Joseph E; Stone, Patricia W

    2013-02-01

    Clinic-based blood pressure (CBP) has been the default approach for the diagnosis of hypertension, but patients may be misclassified because of masked hypertension (false negative) or 'white coat' hypertension (false positive). The incorporation of other diagnostic modalities, such as home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), holds promise to improve diagnostic accuracy and subsequent treatment decisions. We reviewed the literature on the costs and cost-effectiveness of adding HBPM and ABPM to routine blood pressure screening in adults. We excluded letters, editorials, and studies of pregnant and/or pre-eclamptic patients, children, and patients with specific conditions (e.g. diabetes). We identified 14 original, English language studies that included cost outcomes and compared two or more modalities. ABPM was found to be cost saving for diagnostic confirmation following an elevated CBP in six studies. Three of four studies found that adding HBPM to an elevated CBP was also cost-effective. Existing evidence supports the cost-effectiveness of incorporating HBPM or ABPM after an initial CBP-based diagnosis of hypertension. Future research should focus on their implementation in clinical practice, long-term economic values, and potential roles in identifying masked hypertension.

  11. The Canadian Government perspective on cost-effective regulation

    Energy Technology Data Exchange (ETDEWEB)

    Martin, J K; Iwankow, C [Treasury Board of Canada Secretariat, Ottawa, ON (Canada)

    1997-12-31

    Fiscal constraint, globalization of markets, and accelerated technological change have resulted in a new focus on the cost-effectiveness of government activities and, in turn, on methods of policy evaluation. An exploration of regulatory problems, and the use of regulation as a public policy instrument, reveals a commonalty of experience in all industrialized countries. This paper provides a brief synopsis of the Government of Canada`s perspective on cost-effective regulation. To understand cost-effective regulation, this paper examines the principles of regulatory reform which underlie the current strategy of the federal government (collaborative decision-making mechanisms., methods of clear policy evaluation, and well defined lines of accountability). It discusses the nature of, and rationale for, government regulation, the reasons for regulatory reform in the economy, and the principal aims of Canadian regulatory reform and regulatory policy assessment. It does so by specifically addressing the role of cost-benefit analysis in the process of regulatory assessment - a method which involves systematically identifying, and quantifying where possible, the social benefits and costs associated with alternative public policy actions - with a particular focus on regulation which affects the Canadian nuclear industry. (author). 51 refs.

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

    Science.gov (United States)

    Chung, Shao-Hsi; Cheng, Kuo-Chih

    2018-01-01

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

  13. Cost-effectiveness analysis of optimal strategy for tumor treatment

    International Nuclear Information System (INIS)

    Pang, Liuyong; Zhao, Zhong; Song, Xinyu

    2016-01-01

    We propose and analyze an antitumor model with combined immunotherapy and chemotherapy. Firstly, we explore the treatment effects of single immunotherapy and single chemotherapy, respectively. Results indicate that neither immunotherapy nor chemotherapy alone are adequate to cure a tumor. Hence, we apply optimal theory to investigate how the combination of immunotherapy and chemotherapy should be implemented, for a certain time period, in order to reduce the number of tumor cells, while minimizing the implementation cost of the treatment strategy. Secondly, we establish the existence of the optimality system and use Pontryagin’s Maximum Principle to characterize the optimal levels of the two treatment measures. Furthermore, we calculate the incremental cost-effectiveness ratios to analyze the cost-effectiveness of all possible combinations of the two treatment measures. Finally, numerical results show that the combination of immunotherapy and chemotherapy is the most cost-effective strategy for tumor treatment, and able to eliminate the entire tumor with size 4.470 × 10"8 in a year.

  14. Cost-effectiveness of barium enemas performed by radiographers

    International Nuclear Information System (INIS)

    Brown, Lorraine; Desai, Sharad

    2002-01-01

    AIM: To assess the cost-effectiveness of barium enemas performed by radiographers compared to those performed by consultant radiologists. METHOD: Prospective study of 200 barium enemas carried out by a senior radiographer and a consultant radiologist. The sample was a consecutive sample of adult out-patients over a 3-month period, with no exclusion. The length of time of the enema and the numbers and grades of staff involved in the procedure were recorded. This was translated into staffing costs using the appropriate pay scales. RESULTS: The barium enemas performed by the superintendent radiographer were more cost-effective than those performed by the consultant radiologist (1406 pounds for 100 radiographer-performed barium enemas compared to 1787 pounds for 100 carried out by the consultant radiologist). CONCLUSION: In terms of staffing costs, radiographers performing barium enemas not only liberates radiologist time, it is also a cost-effective method of providing an out-patient barium enema service. Brown, L. and Desai, S. (2002)

  15. The Canadian Government perspective on cost-effective regulation

    International Nuclear Information System (INIS)

    Martin, J.K.; Iwankow, C.

    1996-01-01

    Fiscal constraint, globalization of markets, and accelerated technological change have resulted in a new focus on the cost-effectiveness of government activities and, in turn, on methods of policy evaluation. An exploration of regulatory problems, and the use of regulation as a public policy instrument, reveals a commonalty of experience in all industrialized countries. This paper provides a brief synopsis of the Government of Canada's perspective on cost-effective regulation. To understand cost-effective regulation, this paper examines the principles of regulatory reform which underlie the current strategy of the federal government (collaborative decision-making mechanisms., methods of clear policy evaluation, and well defined lines of accountability). It discusses the nature of, and rationale for, government regulation, the reasons for regulatory reform in the economy, and the principal aims of Canadian regulatory reform and regulatory policy assessment. It does so by specifically addressing the role of cost-benefit analysis in the process of regulatory assessment - a method which involves systematically identifying, and quantifying where possible, the social benefits and costs associated with alternative public policy actions - with a particular focus on regulation which affects the Canadian nuclear industry. (author). 51 refs

  16. Cost-effectiveness of open versus arthroscopic rotator cuff repair.

    Science.gov (United States)

    Adla, Deepthi N; Rowsell, Mark; Pandey, Radhakant

    2010-03-01

    Economic evaluation of surgical procedures is necessary in view of more expensive newer techniques emerging in an increasingly cost-conscious health care environment. This study compares the cost-effectiveness of open rotator cuff repair with arthroscopic repair for moderately size tears. This was a prospective study of 30 consecutive patients, of whom 15 had an arthroscopic repair and 15 had an open procedure. Clinical effectiveness was assessed using Oxford and Constant shoulder scores. Costs were estimated from departmental and hospital financial data. At last follow-up, no difference Oxford and Constant shoulder scores was noted between the 2 methods of repair. There was no significant difference between the groups in the cost of time in the operating theater, inpatient time, amount of postoperative analgesia, number of postoperative outpatient visits, physiotherapy costs, and time off work. The incremental cost of each arthroscopic rotator cuff repair was pound675 ($1248.75) more than the open procedure. This was mainly in the area of direct health care costs, instrumentation in particular. Health care policy makers are increasingly demanding evidence of cost-effectiveness of a procedure. This study showed both methods of repair provide equivalent clinical results. Open cuff repair is more cost-effective than arthroscopic repair and is likely to have lower cost-utility ratio. In addition, the tariff for the arthroscopic procedure in some health care systems is same as open repair. Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  17. Cost effectiveness of detritiating water with resin columns

    International Nuclear Information System (INIS)

    Drake, R.H.; Williams, D.S.

    1997-10-01

    There are technologies in use for cleaning up concentrated tritiated process water. These are not cost effective for tritiated water with low concentrations of tritium. There are currently no cost-effective technologies for cleaning up low-tritium-concentration tritiated water, such as most tritiated groundwater, spent fuel storage basin water, or underground storage tank water. Resin removal of tritium from tritiated water at low concentrations (near the order of magnitude of drinking water standard maximums) is being tested on TA-SO (Los Alamos National Laboratory's Liquid Radioactive Waste Treatment Facility) waste streams. There are good theoretical and test indications that this may be a technologically effective means of removing tritium from tritiated water. Because of likely engineering design similarity, it is reasonable to anticipate that a resin column system's costs will be similar to some common commercial water treatment systems. Thus, the potential cost effectiveness of a resin treatment system offers hope for treating tritiated water at affordable costs. The TA-50 resin treatment cost projection of $18 per 1,000 gallons is within the same order of magnitude as cost data for typical commercial groundwater cleanup projects. The prospective Los Alamos National Laboratory (LANL) resin treatment system at $18 per 1,000 gallons appears to have a likely cost advantage of at least an order of magnitude over the competing, developmental, water detritiation technologies

  18. Determinants of Change in the Cost-effectiveness Threshold.

    Science.gov (United States)

    Paulden, Mike; O'Mahony, James; McCabe, Christopher

    2017-02-01

    The cost-effectiveness threshold in health care systems with a constrained budget should be determined by the cost-effectiveness of displacing health care services to fund new interventions. Using comparative statics, we review some potential determinants of the threshold, including the budget for health care, the demand for existing health care interventions, the technical efficiency of existing interventions, and the development of new health technologies. We consider the anticipated direction of impact that would affect the threshold following a change in each of these determinants. Where the health care system is technically efficient, an increase in the health care budget unambiguously raises the threshold, whereas an increase in the demand for existing, non-marginal health interventions unambiguously lowers the threshold. Improvements in the technical efficiency of existing interventions may raise or lower the threshold, depending on the cause of the improvement in efficiency, whether the intervention is already funded, and, if so, whether it is marginal. New technologies may also raise or lower the threshold, depending on whether the new technology is a substitute for an existing technology and, again, whether the existing technology is marginal. Our analysis permits health economists and decision makers to assess if and in what direction the threshold may change over time. This matters, as threshold changes impact the cost-effectiveness of interventions that require decisions now but have costs and effects that fall in future periods.

  19. 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

  20. A cost-effective evaluation of biomass district heating in rural communities

    International Nuclear Information System (INIS)

    Hendricks, Aaron M.; Wagner, John E.; Volk, Timothy A.; Newman, David H.; Brown, Tristan R.

    2016-01-01

    Highlights: • Develop a cost-effective model using secondary data examining delivering heat through Biomass District Heating (BDH). • Eight of ten rural villages studied could cost-effectively deliver heat through BDH below the 2013 price of heating oil. • 80% of the annual cost of BDH was attributable to capital expenses. • Erratic fuel oil prices substantially impact future feasibility. • Village level feasibility is highly-influenced by the presence of large heat demanders. - Abstract: The economic feasibility of Biomass District Heating (BDH) networks in rural villages is largely unknown. A cost-effective evaluation tool is developed to examine the feasibility of BDH in rural communities using secondary data sources. The approach is unique in that it accounts for all the major capital expenses: energy center, distribution network, and energy transfer stations, as well as biomass procurement. BDH would deliver heat below #2 fuel oil in eight of the ten rural study villages examined, saving nearly $500,000 per year in heating expenses while demanding less than 5% of the forest residues sustainably available regionally. Capital costs comprised over 80% of total costs, illuminating the importance of reaching a sufficient heat density. Reducing capital costs by 1% lowers total cost by $93,000 per year. Extending capital payment period length five years or lowering interest rates has the next highest influence decreasing delivered heat price 0.49% and 0.35% for each 1% change, respectively. This highlights that specific building heat is a strong determinant of feasibility given the relative influence of high-demanding users on the overall village heat-density. Finally, we use a stochastic analysis projecting future #2 fuel oil prices, incorporating historical variability, to determine the probability of future BDH feasibility. Although future oil prices drop below the BDH feasibility threshold, the villages retain a 22–53% probability of feasibility after

  1. Cost-effectiveness of human papillomavirus vaccination for adolescent girls in Punjab state: Implications for India's universal immunization program.

    Science.gov (United States)

    Prinja, Shankar; Bahuguna, Pankaj; Faujdar, Dharmjeet Singh; Jyani, Gaurav; Srinivasan, Radhika; Ghoshal, Sushmita; Suri, Vanita; Singh, Mini P; Kumar, Rajesh

    2017-09-01

    Introduction of human papillomavirus (HPV) vaccination for adolescent girls is being considered in the Punjab state of India. However, evidence regarding cost-effectiveness is sought by policy makers when making this decision. The current study was undertaken to evaluate the incremental cost per quality-adjusted life-years (QALYs) gained with introduction of the HPV vaccine compared with a no-vaccination scenario. A static progression model, using a combination of decision tree and Markov models, was populated using epidemiological, cost, coverage, and effectiveness data to determine the cost-effectiveness of HPV vaccination. Using a societal perspective, lifetime costs and consequences (in terms of QALYs) among a cohort of 11-year-old adolescent girls in Punjab state were modeled in 2 alternate scenarios with and without vaccination. All costs and consequences were discounted at a rate of 3%. Although immunizing 1 year's cohort of 11-year-old girls in Punjab state costs Indian National Rupees (INR) 135 million (US dollars [USD] 2.08 million and International dollars [Int$] 6.25 million) on an absolute basis, its net cost after accounting for treatment savings is INR 38 million (USD 0.58 million and Int$ 1.76 million). Incremental cost per QALY gained for HPV vaccination was found to be INR 73 (USD 1.12 and Int$ 3.38). Given all the data uncertainties, there is a 90% probability for the vaccination strategy to be cost-effective in Punjab state at a willingness-to-pay threshold of INR 10,000, which is less than one-tenth of the per capita gross domestic product. HPV vaccination appears to be a very cost-effective strategy for Punjab state, and is likely to be cost-effective for other Indian states. Cancer 2017;123:3253-60. © 2017 American Cancer Society. © 2017 American Cancer Society.

  2. Cryptozoology Society

    Science.gov (United States)

    Richman, Barbara T.

    Reports of Loch Ness monsters, Bigfoot, and the Yeti spring u p from time to time, sparking scientific controversy about the veracity of these observations. Now an organization has been established to help cull, analyze, and disseminate information on the alleged creatures. The International Society of Cryptozoology, formed at a January meeting at the U.S. National Museum of Natural History of the Smithsonian Institution, will serve as the focal point for the investigation, analysis, publication, and discussion of animals of unexpected form or size or of unexpected occurrences in time or space.

  3. A cost-effectiveness analysis of shipboard telemedicine.

    Science.gov (United States)

    Stoloff, P H; Garcia, F E; Thomason, J E; Shia, D S

    1998-01-01

    The U.S. Navy is considering the installation of telemedicine equipment on more than 300 ships. Besides improving the quality of care, benefits would arise from avoiding medical evacuations (MEDEVACs) and returning patients to work more quickly. Because telemedicine has not yet been fully implemented by the Navy, we relied on projections of anticipated savings and costs, rather than actual expenditures, to determine cost-effectiveness. To determine the demand for telemedicine and the cost-effectiveness of various technologies (telephone and fax, e-mail and Internet, video teleconferencing (VTC), teleradiology, and diagnostic instruments), as well as their bandwidth requirements. A panel of Navy medical experts with telemedicine experience reviewed a representative sample of patient visits collected over a 1-year period and estimated the man-day savings and quality-of-care enhancements that might have occurred had telemedicine technologies been available. The savings from potentially avoiding MEDEVACs was estimated from a survey of ships' medical staff. These sample estimates were then projected to the medical workload of the entire fleet. Off-the-shelf telemedicine equipment prices were combined with installation, maintenance, training, and communication costs to obtain the lifecycle costs of the technology. If telemedicine were available to the fleet, ship medical staffs would initiate nearly 19, 000 consults in a year-7% of all patient visits. Telemedicine would enhance quality of care in two-thirds of these consults. Seventeen percent of the MEDEVACs would be preventable with telemedicine (representing 155,000 travel miles), with a savings of $4400 per MEDEVAC. If the ship's communication capabilities were available, e-mail and Internet and telephone and fax would be cost-effective on all ships (including small ships and submarines). Video teleconferencing would be cost-effective on large ships (aircraft carriers and amphibious) only. Teleradiology would be cost-effective

  4. Cost-effectiveness of hepatitis A vaccination in Indonesia

    Science.gov (United States)

    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

  5. 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

  6. An Alternative Methodological Approach for Cost-Effectiveness Analysis and Decision Making in Genomic Medicine.

    Science.gov (United States)

    Fragoulakis, Vasilios; Mitropoulou, Christina; van Schaik, Ron H; Maniadakis, Nikolaos; Patrinos, George P

    2016-05-01

    Genomic Medicine aims to improve therapeutic interventions and diagnostics, the quality of life of patients, but also to rationalize healthcare costs. To reach this goal, careful assessment and identification of evidence gaps for public health genomics priorities are required so that a more efficient healthcare environment is created. Here, we propose a public health genomics-driven approach to adjust the classical healthcare decision making process with an alternative methodological approach of cost-effectiveness analysis, which is particularly helpful for genomic medicine interventions. By combining classical cost-effectiveness analysis with budget constraints, social preferences, and patient ethics, we demonstrate the application of this model, the Genome Economics Model (GEM), based on a previously reported genome-guided intervention from a developing country environment. The model and the attendant rationale provide a practical guide by which all major healthcare stakeholders could ensure the sustainability of funding for genome-guided interventions, their adoption and coverage by health insurance funds, and prioritization of Genomic Medicine research, development, and innovation, given the restriction of budgets, particularly in developing countries and low-income healthcare settings in developed countries. The implications of the GEM for the policy makers interested in Genomic Medicine and new health technology and innovation assessment are also discussed.

  7. The cost effectiveness of NHS physiotherapy support for occupational health (OH services

    Directory of Open Access Journals (Sweden)

    Phillips Ceri J

    2012-02-01

    Full Text Available Abstract Background Musculoskeletal pain is detrimental to quality of life (QOL and disruptive to activities of daily living. It also places a major economic burden on healthcare systems and wider society. In 2006, the Welsh Assembly Government (WAG established a three tiered self-referral Occupational Health Physiotherapy Pilot Project (OHPPP comprising: 1. telephone advice and triage, 2. face-to-face physiotherapy assessment and treatment if required, and 3. workplace assessment and a return-to-work facilitation package as appropriate. This study aimed to evaluate the feasibility and cost-effectiveness of the pilot service. Methods A pragmatic cohort study was undertaken, with all OHPPP service users between September 2008 and February 2009 being invited to participate. Participants were assessed on clinical status, yellow flags, sickness absence and work performance at baseline, after treatment and at 3 month follow up. Cost-effectiveness was evaluated from both top-down and bottom-up perspectives and cost per Quality Adjusted Life Year (cost/QALY was calculated. The cost-effectiveness analysis assessed the increase in service cost that would be necessary before the cost-effectiveness of the service was compromised. Results A total of 515 patients completed questionnaires at baseline. Of these, 486 were referred for face to face assessment with a physiotherapist and were included in the analysis for the current study. 264 (54.3% and 199 (40.9% were retained at end of treatment and 3 month follow up respectively. An improvement was observed at follow up in all the clinical outcomes assessed, as well as a reduction in healthcare resource usage and sickness absence, and improvement in self-reported work performance. Multivariate regression indicated that baseline and current physical health were associated with work-related outcomes at follow up. The costs of the service were £194-£360 per service user depending on the method used, and the

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

    Science.gov (United States)

    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.

  9. Are labour-intensive efforts to prevent pressure ulcers cost-effective?

    Science.gov (United States)

    Mathiesen, Anne Sofie Mølbak; Nørgaard, Kamilla; Andersen, Marie Frederikke Bruun; Møller, Klaus Meyer; Ehlers, Lars Holger

    2013-10-01

    Pressure ulcers are a major problem in Danish healthcare with a prevalence of 13-43% among hospitalized patients. The associated costs to the Danish Health Care Sector are estimated to be €174.5 million annually. In 2010, The Danish Society for Patient Safety introduced the Pressure Ulcer Bundle (PUB) in order to reduce hospital-acquired pressure ulcers by a minimum of 50% in five hospitals. The PUB consists of evidence-based preventive initiatives implemented by ward staff using the Model for Improvement. To investigate the cost-effectiveness of labour-intensive efforts to reduce pressure ulcers in the Danish Health Care Sector, comparing the PUB with standard care. A decision analytic model was constructed to assess the costs and consequences of hospital-acquired pressure ulcers during an average hospital admission in Denmark. The model inputs were based on a systematic review of clinical efficacy data combined with local cost and effectiveness data from the Thy-Mors Hospital, Denmark. A probabilistic sensitivity analysis (PSA) was conducted to assess the uncertainty. Prevention of hospital-acquired pressure ulcers by implementing labour-intensive effects according to the PUB was cost-saving and resulted in an improved effect compared to standard care. The incremental cost of the PUB was -€38.62. The incremental effects were a reduction of 9.3% prevented pressure ulcers and 0.47% prevented deaths. The PSAs confirmed the incremental cost-effectiveness ratio (ICER)'s dominance for both prevented pressure ulcers and saved lives with the PUB. This study shows that labour-intensive efforts to reduce pressure ulcers on hospital wards can be cost-effective and lead to savings in total costs of hospital and social care. The data included in the study regarding costs and effects of the PUB in Denmark were based on preliminary findings from a pilot study at Thy-Mors Hospital and literature.

  10. 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.

  11. Are financial incentives cost-effective to support smoking cessation during pregnancy?

    Science.gov (United States)

    Boyd, Kathleen A; Briggs, Andrew H; Bauld, Linda; Sinclair, Lesley; Tappin, David

    2016-02-01

    To investigate the cost-effectiveness of up to £400 worth of financial incentives for smoking cessation in pregnancy as an adjunct to routine health care. Cost-effectiveness analysis based on a Phase II randomized controlled trial (RCT) and a cost-utility analysis using a life-time Markov model. The RCT was undertaken in Glasgow, Scotland. The economic analysis was undertaken from the UK National Health Service (NHS) perspective. A total of 612 pregnant women randomized to receive usual cessation support plus or minus financial incentives of up to £400 vouchers (US $609), contingent upon smoking cessation. Comparison of usual support and incentive interventions in terms of cotinine-validated quitters, quality-adjusted life years (QALYs) and direct costs to the NHS. The incremental cost per quitter at 34-38 weeks pregnant was £1127 ($1716).This is similar to the standard look-up value derived from Stapleton & West's published ICER tables, £1390 per quitter, by looking up the Cessation in Pregnancy Incentives Trial (CIPT) incremental cost (£157) and incremental 6-month quit outcome (0.14). The life-time model resulted in an incremental cost of £17 [95% confidence interval (CI) = -£93, £107] and a gain of 0.04 QALYs (95% CI = -0.058, 0.145), giving an ICER of £482/QALY ($734/QALY). Probabilistic sensitivity analysis indicates uncertainty in these results, particularly regarding relapse after birth. The expected value of perfect information was £30 million (at a willingness to pay of £30 000/QALY), so given current uncertainty, additional research is potentially worthwhile. Financial incentives for smoking cessation in pregnancy are highly cost-effective, with an incremental cost per quality-adjusted life years of £482, which is well below recommended decision thresholds. © 2015 Society for the Study of Addiction.

  12. Cost-effectiveness of motivational intervention with significant others for patients with alcohol misuse.

    Science.gov (United States)

    Shepard, Donald S; Lwin, Aung K; Barnett, Nancy P; Mastroleo, Nadine; Colby, Suzanne M; Gwaltney, Chad; Monti, Peter M

    2016-05-01

    To estimate the incremental cost, cost-effectiveness and benefit-cost ratio of incorporating a significant other (SO) into motivational intervention for alcohol misuse. We obtained economic data from the one year with the intervention in full operation for patients in a recent randomized trial. The underlying trial took place at a major urban hospital in the United States. The trial randomized 406 (68.7% male) eligible hazardous drinkers (196 during the economic study) admitted to the emergency department or trauma unit. The motivational interview condition consisted of one in-person session featuring personalized normative feedback. The significant other motivational interview condition comprised one joint session with the participant and SO in which the SO's perspective and support were elicited. We ascertained activities across 445 representative time segments through work sampling (including staff idle time), calculated the incremental cost in per patient of incorporating an SO, expressed the results in 2014 US$, incorporated quality and mortality effects from a closely related trial and derived the cost per quality-adjusted life-year (QALY) gained. From a health system perspective, the incremental cost per patient of adding an SO was $341.09 [95% confidence interval (CI) = $244.44-437.74]. The incremental cost per year per hazardous drinker averted was $3623 (CI = $1777-22,709), the cost per QALY gained $32,200 (CI = $15,800-201,700), and the benefit-cost ratio was 4.73 (95% CI = 0.7-9.66). If adding an SO into the intervention strategy were concentrated during the hours with highest risk or in a trauma unit, it would become even more cost-beneficial. Using criteria established by the World Health Organization (cost-effectiveness below the country's gross domestic product per capita), incorporating a significant other into a patient's motivational intervention for alcohol misuse is highly cost-effective. © 2015 Society for the Study of Addiction.

  13. Sustaining The Quality Of The All Volunteer Force: A Cost Effective Approach

    Science.gov (United States)

    2016-05-26

    new norm, youth unemployment, veteran family members, sex , age, and race. Generally, propensity in the US is higher for men than women, decreases with...troubled inner cities. He envisioned inner city kids from broken homes, finding stability, a taste of...towards kids joining their local Army JROTC programs to learn more about the Army on channels where airtime is much less expensive. This would replace an

  14. Cost-effective DWDM ROADM design for flexible sustainable optical metro–access networks

    OpenAIRE

    Sarmiento Hernández, Samael; Altabas, Jose Antonio; Izquierdo, David; Garces, Ignacio; Spadaro, Salvatore; Lázaro Villa, José Antonio

    2017-01-01

    © 2017 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes,creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works Architectural changes are required for the underlying networks to support the expected Internet data traffic vol...

  15. Investment Success in Public Health: An Analysis of the Cost-Effectiveness and Cost-Benefit of the Global Programme to Eliminate Lymphatic Filariasis.

    Science.gov (United States)

    Turner, Hugo C; Bettis, Alison A; Chu, Brian K; McFarland, Deborah A; Hooper, Pamela J; Mante, Sunny D; Fitzpatrick, Christopher; Bradley, Mark H

    2017-03-15

    It has been estimated that $154 million per year will be required during 2015-2020 to continue the Global Programme to Eliminate Lymphatic Filariasis (GPELF). In light of this, it is important to understand the program's current value. Here, we evaluate the cost-effectiveness and cost-benefit of the preventive chemotherapy that was provided under the GPELF between 2000 and 2014. In addition, we also investigate the potential cost-effectiveness of hydrocele surgery. Our economic evaluation of preventive chemotherapy was based on previously published health and economic impact estimates (between 2000 and 2014). The delivery costs of treatment were estimated using a model developed by the World Health Organization. We also developed a model to investigate the number of disability-adjusted life years (DALYs) averted by a hydrocelectomy and identified the cost threshold under which it would be considered cost-effective. The projected cost-effectiveness and cost-benefit of preventive chemotherapy were very promising, and this was robust over a wide range of costs and assumptions. When the economic value of the donated drugs was not included, the GPELF would be classed as highly cost-effective. We projected that a typical hydrocelectomy would be classed as highly cost-effective if the surgery cost less than $66 and cost-effective if less than $398 (based on the World Bank's cost-effectiveness thresholds for low income countries). Both the preventive chemotherapy and hydrocele surgeries provided under the GPELF are incredibly cost-effective and offer a very good investment in public health. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

  16. Using cost-effectiveness analysis to support research and development portfolio prioritization for product innovations in measles vaccination.

    Science.gov (United States)

    Garrison, Louis P; Bauch, Chris T; Bresnahan, Brian W; Hazlet, Tom K; Kadiyala, Srikanth; Veenstra, David L

    2011-07-01

    Several potential measles vaccine innovations are in development to address the shortcomings of the current vaccine. Funders need to prioritize their scarce research and development resources. This article demonstrates the usefulness of cost-effectiveness analysis to support these decisions. This study had 4 major components: (1) identifying potential innovations, (2) developing transmission models to assess mortality and morbidity impacts, (3) estimating the unit cost impacts, and (4) assessing aggregate cost-effectiveness in United Nations Children's Fund countries through 2049. Four promising technologies were evaluated: aerosol delivery, needle-free injection, inhalable dry powder, and early administration DNA vaccine. They are projected to have a small absolute impact in terms of reducing the number of measles cases in most scenarios because of already improving vaccine coverage. Three are projected to reduce unit cost per dose by $0.024 to $0.170 and would improve overall cost-effectiveness. Each will require additional investments to reach the market. Over the next 40 years, the aggregate cost savings could be substantial, ranging from $98.4 million to $689.4 million. Cost-effectiveness analysis can help to inform research and development portfolio prioritization decisions. Three new measles vaccination technologies under development hold promise to be cost-saving from a global perspective over the long-term, even after considering additional investment costs. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

  17. Cost-Effectiveness of Implantable Pulmonary Artery Pressure Monitoring in Chronic Heart Failure.

    Science.gov (United States)

    Sandhu, Alexander T; Goldhaber-Fiebert, Jeremy D; Owens, Douglas K; Turakhia, Mintu P; Kaiser, Daniel W; Heidenreich, Paul A

    2016-05-01

    This study aimed to evaluate the cost-effectiveness of the CardioMEMS (CardioMEMS Heart Failure System, St Jude Medical Inc, Atlanta, Georgia) device in patients with chronic heart failure. The CardioMEMS device, an implantable pulmonary artery pressure monitor, was shown to reduce hospitalizations for heart failure and improve quality of life in the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients) trial. We developed a Markov model to determine the hospitalization, survival, quality of life, cost, and incremental cost-effectiveness ratio of CardioMEMS implantation compared with usual care among a CHAMPION trial cohort of patients with heart failure. We obtained event rates and utilities from published trial data; we used costs from literature estimates and Medicare reimbursement data. We performed subgroup analyses of preserved and reduced ejection fraction and an exploratory analysis in a lower-risk cohort on the basis of the CHARM (Candesartan in Heart failure: Reduction in Mortality and Morbidity) trials. CardioMEMS reduced lifetime hospitalizations (2.18 vs. 3.12), increased quality-adjusted life-years (QALYs) (2.74 vs. 2.46), and increased costs ($176,648 vs. $156,569), thus yielding a cost of $71,462 per QALY gained and $48,054 per life-year gained. The cost per QALY gained was $82,301 in patients with reduced ejection fraction and $47,768 in those with preserved ejection fraction. In the lower-risk CHARM cohort, the device would need to reduce hospitalizations for heart failure by 41% to cost cost-effectiveness was most sensitive to the device's durability. In populations similar to that of the CHAMPION trial, the CardioMEMS device is cost-effective if the trial effectiveness is sustained over long periods. Post-marketing surveillance data on durability will further clarify its value. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights

  18. Cost-Effectiveness of Pazopanib Versus Sunitinib for Renal Cancer in the United States.

    Science.gov (United States)

    Benedict, Agnes; Ramaswamy, Krishnan; Sandin, Rickard

    2015-09-01

    We write to comment on a recently published study by Delea et al. in the January 2015 issue of JMCP that evaluated the cost-effectiveness (CE) of sunitinib (SU) versus pazopanib (PAZ) as first-line treatment for metastatic renal cell carcinoma (mRCC) from a U.S. third-party payer perspective.1 This analysis was based on COMPARZ and PISCES, clinical trials that compared SU and PAZ2,3 and led the authors to conclude that PAZ is cost-effective (in fact, dominant, according to the base-case results) compared with SU. Such assessment of economic value is clearly important for deciding between therapies to ensure fair access; therefore, we welcome a comparative evaluation of SU and PAZ. However, we believe that some of the key assumptions and inputs used in the model by Delea et al. render their results and conclusions invalid.  Best practice requires that results from a health economic model should reflect the most likely outcomes based on sound methodology and robust evidence for its inputs, as recommended by the International Society of Pharmacoeconomics and Outcomes Research (ISPOR).4 Here, we focus on 2 key areas (utilities and survival modeling) where, in our view, the analysis by Delea et al. falls short of this standard, and a third area (treatment costs) where the basis for the data derived is unclear.

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

    International Nuclear Information System (INIS)

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

    1984-01-01

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

  20. Cost-effectiveness of identifying aortoiliac and femoropopliteal arterial disease with angiography or duplex scanning

    International Nuclear Information System (INIS)

    Coffi, S.B.; Ubbink, D.Th.; Dijkgraaf, M.G.W.; Reekers, J.A.; Legemate, D.A.

    2008-01-01

    Objectives: Cost-effectiveness analysis of three diagnostic imaging strategies for the assessment of aortoiliac and femoropopliteal arteries in patients with peripheral arterial occlusive disease. The strategies were: angiography as the reference strategy, duplex scanning (DS) plus supplementary angiography (S1) and DS plus confirmative angiography (S2). Design, materials and methods: A decision model was built with sensitivity and specificity data from literature, supplemented with prospective hospital cost data in Euro ( Euro ). The probability of correctly identifying the status of a lesion was taken as the primary outcome. We compared strategies by assessing the extra costs per additional correctly identified case. Results: Assuming no false positive or false negative results, angiography is the most effective strategy if the prevalence of significant obstructive lesions in the aortoiliac and femoropopliteal tract exceeds 70%, or if the sensitivity of duplex scanning is lower than 83%. In case of lower prevalence, strategy S1 becomes equally or even more effective than angiography. At a prevalence of 75%, performing angiography costs Euro 8443 per extra correctly identified case compared with strategy S1. Conclusions: In most situations angiography is more effective than diagnostic strategy S1. However, if society is unwilling to pay more than Euro 8443 for knowing a patient's disease status, diagnostic strategy S1 is a cost-effective alternative to angiography, especially at lower prevalence values

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

    International Nuclear Information System (INIS)

    Coe, Richard P.

    2003-01-01

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

  2. On the censored cost-effectiveness analysis using copula information

    Directory of Open Access Journals (Sweden)

    Charles Fontaine

    2017-02-01

    Full Text Available Abstract Background Information and theory beyond copula concepts are essential to understand the dependence relationship between several marginal covariates distributions. In a therapeutic trial data scheme, most of the time, censoring occurs. That could lead to a biased interpretation of the dependence relationship between marginal distributions. Furthermore, it could result in a biased inference of the joint probability distribution function. A particular case is the cost-effectiveness analysis (CEA, which has shown its utility in many medico-economic studies and where censoring often occurs. Methods This paper discusses a copula-based modeling of the joint density and an estimation method of the costs, and quality adjusted life years (QALY in a cost-effectiveness analysis in case of censoring. This method is not based on any linearity assumption on the inferred variables, but on a punctual estimation obtained from the marginal distributions together with their dependence link. Results Our results show that the proposed methodology keeps only the bias resulting statistical inference and don’t have anymore a bias based on a unverified linearity assumption. An acupuncture study for chronic headache in primary care was used to show the applicability of the method and the obtained ICER keeps in the confidence interval of the standard regression methodology. Conclusion For the cost-effectiveness literature, such a technique without any linearity assumption is a progress since it does not need the specification of a global linear regression model. Hence, the estimation of the a marginal distributions for each therapeutic arm, the concordance measures between these populations and the right copulas families is now sufficient to process to the whole CEA.

  3. Cost-effectiveness of minimally invasive sacroiliac joint fusion

    Science.gov (United States)

    Cher, Daniel J; Frasco, Melissa A; Arnold, Renée JG; Polly, David W

    2016-01-01

    Background Sacroiliac joint (SIJ) disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. Objective To determine the cost-effectiveness of minimally invasive SIJ fusion. Methods Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. Results SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs) at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER) <$26,000/QALY. Probabilistic analyses showed a high degree of certainty that the maximum ICER for SIJ fusion was less than commonly selected thresholds for acceptability (mean ICER =$13,687, 95% confidence interval $5,162–$28,085). SIJ fusion provided potential cost savings per QALY gained compared to non-surgical treatment after a treatment horizon of greater than 13 years. Conclusion Compared to traditional non-surgical treatments, SIJ fusion is a cost-effective, and, in the long term, cost-saving strategy for the treatment of SIJ dysfunction due to degenerative sacroiliitis or SIJ disruption. PMID:26719717

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

    Science.gov (United States)

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

    2011-11-08

    The cost-effectiveness of introducing infant rotavirus vaccination in Armenia in 2012 using Rotarix(R) was evaluated using a multiple birth cohort model. The model considered the cost and health implications of hospitalisations, primary health care consultations and episodes not leading to medical care in children under five years old. Rotavirus vaccination is expected to cost the Ministry of Health $220,000 in 2012, rising to $830,000 in 2016 following termination of GAVI co-financing, then declining to $260,000 in 2025 due to vaccine price maturity. It may reduce health care costs by $34,000 in the first year, rising to $180,000 by 2019. By 2025, vaccination may be close to cost saving to the Ministry of Health if the vaccine purchase price declines as expected. Once coverage has reached high levels, vaccination may prevent 25,000 cases, 3000 primary care consultations, 1000 hospitalisations and 8 deaths per birth cohort vaccinated. The cost per disability-adjusted life year (DALY) saved is estimated to be about $650 from the perspective of the Ministry of Health, $850 including costs accrued to both the Ministry and to GAVI, $820 from a societal perspective excluding indirect costs and $44 from a societal perspective including indirect costs. Since the gross domestic product per capita of Armenia in 2008 was $3800, rotavirus vaccination is likely to be regarded as "very cost-effective" from a WHO standpoint. Vaccination may still be "very cost-effective" if less favourable assumptions are used regarding vaccine price and disease incidence, as long as DALYs are not age-weighted. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. 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.

  6. 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.

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

    Science.gov (United States)

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

    2013-01-01

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

  8. Cost-effectiveness of pharmacotherapy to reduce obesity.

    Directory of Open Access Journals (Sweden)

    J Lennert Veerman

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

  9. Cost-effective analysis of unilateral vestibular weakness investigation.

    Science.gov (United States)

    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.

  10. Marketing societal: uma contribuição para o crescimento sustentável das organizações SOCIETY MARKETING: A CONTRIBUTION FOR THE PROGRESS SUSTAINABLE OF THE ORGANIZATIONS

    Directory of Open Access Journals (Sweden)

    Edson Coutinho Silva

    2011-04-01

    Full Text Available Today the necessity of the organizations in to add the sustainable development, or at least to reduce the impacts caused in the development of its productive process unquestionable. The action accomplishment is vital for the organizations that its parcel of contribution evidences for with the social environment. The strategies of Marketing in the organizations looking for to develop actions directed to the satisfaction of its customers, creating new desires in the existing necessities already and taking care of them with the biggest level of possible quality in all the processes. However, this has not been the sufficient, the customers have demanded more, they want organizations compromised to the social welfare of the society. With the incited competition in the market, the organizations search differentials essential that they guarantee its competitive advantage on the too much organizations. The administration has on tool that brings benefits to all the involved ones in the process, which is the Society Marketing, where the organization invests in the social, looking for a return of overcomes for the organization.Hoje é indiscutível a necessidade de as organizações incorporarem o desenvolvimento sustentável ou, pelo menos, minimizarem os impactos causados no desenvolvimento de seu processo produtivo. É vital, para as organizações, a realização de ações que evidenciem a sua parcela de contribuição para com o meio social. Diante disso, as estratégias de marketing nas organizações vêm procurando desenvolver ações voltadas à satisfação de seus clientes, despertando novos desejos nas necessidades já existentes e atendendo-os com o maior nível de qualidade possível em todos os processos. Entretanto, isto não tem sido o suficiente, pois os consumidores têm exigido mais: querem organizações comprometidas com o bem-estar social da sociedade. Com a acirrada concorrência no mercado, as organizações buscam diferenciais

  11. Design of a cost-effective laser spot tracker

    Science.gov (United States)

    Artan, Göktuǧ Gencehan; Sari, Hüseyin

    2017-05-01

    One of the most important aspects of guided systems is detection. The most convenient detection in the sense of precision can be achieved with a laser spot tracker. This study deals with a military grade, high performance and cost-effective laser spot tracker for a guided system. The aim is to develop a high field of view system that will detect a laser spot from a distance of 3 kilometers in which the target is designated from 3 kilometers with a laser. The study basically consists of the system design, modeling, producing and the conducting performance tests of the whole system.

  12. Preoperative localization of parathyroid adenomas is cost-effective

    International Nuclear Information System (INIS)

    Wilson, M.A.; Mack, E.; Rowe, B.; Perlman, S.B.

    1986-01-01

    The preoperative localization of parathyroid adenomas is cost-effective because it reduces anesthesia and surgery times. The technique is sensitive in single and double adenomas (90%), and some surgeons have modified their operative technique because of its introduction. The practical experience of one surgeon is presented, with similar patient subsets (n = 22) compared before and after use of a localization scan was instituted. The average operative time fell by 94%, from 2 hours 35 minutes to 1 hour 19 minutes. The reduction in operative time was possible because the surgeon did not seek to identify the remaining normal parathyroids when the scanned lesion was excised and proved to be the adenoma

  13. Operating dedicated data centers – is it cost-effective?

    International Nuclear Information System (INIS)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2014-06-01

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

  15. Cost-effectiveness in fall prevention for older women

    OpenAIRE

    Hektoen, Liv F.; Aas, Eline; Lurås, Hilde

    2009-01-01

    Artikkelen beskriver en studie hvor hensikten var å estimere kostnadseffekten av fallforebygging for hjemmeboende eldre kvinner i Norge. The aim of this study was to estimate the cost-effectiveness of implementing an exercise-based fall prevention programme for home-dwelling women in the 80-year age group in Norway. Methods: the impact of the home-based individual exercise programme on the number of falls is based on a New Zealand study. On the basis of the cost estimates and the estimate...

  16. Cost effective tools for soil organic carbon monitoring

    Science.gov (United States)

    Shepherd, Keith; Aynekulu, Ermias

    2013-04-01

    There is increasing demand for data on soil properties at fine spatial resolution to support management and planning decisions. Measurement of soil organic carbon has attracted much interest because (i) soil organic carbon is widely cited as a useful indicator of soil condition and (ii) of the importance of soil carbon in the global carbon cycle and climate mitigation strategies. However in considering soil measurement designs there has been insufficient attention given to careful analysis of the specific decisions that the measurements are meant to support and on what measurements have high information value for decision-making. As a result, much measurement effort may be wasted or focused on the wrong variables. A cost-effective measurement is one that reduces risk in decisions and does not cost more than the societal returns to additional evidence. A key uncertainty in measuring soil carbon as a soil condition indicator is what constitutes a good or bad level of carbon on a given soil. A measure of soil organic carbon concentration may have limited value for informing management decisions without the additional information required to interpret it, and so expending further efforts on improving measurements to increase precision may then have no value to improving the decision. Measuring soil carbon stock changes for carbon trading purposes requires high levels of measurement precision but there is still large uncertainty on whether the costs of measurement exceed the benefits. Since the largest cost component in soil monitoring is often travel to the field and physically sampling soils, it is generally cost-effective to meet multiple objectives by analysing a number of properties on a soil sample. Diffuse reflectance infrared spectroscopy is playing a key role in allowing multiple soil properties to be determined rapidly and at low cost. The method provides estimation of multiple soil properties (e.g. soil carbon, texture and mineralogy) in one measurement

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

    Science.gov (United States)

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

    2014-01-01

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

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

    International Nuclear Information System (INIS)

    Baum, J.W.

    1986-01-01

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

  19. The cost - effective solar energy applications in Canada

    International Nuclear Information System (INIS)

    Pape, A.

    1999-01-01

    This paper outlines several cost-effective solar energy application in Canada, and estimates the GHG emission reduction potential for each. The applications include: (1) passive solar building design; (2) solar water heating applications; (3) solar photovoltaics for remote power; and (4) solar assisted space heating and cooling in industrial buildings. Each technology is briefly profiled in terms of functionality, cost characteristics, energy production characteristics and potential emission reduction benefits. Real-life examples of each application are also included. Finally, the paper concludes on the potential role of solar energy in the reduction of Canadian GHG emissions. (author)

  20. A compact cost-effective beamline for a PET Cyclotron

    International Nuclear Information System (INIS)

    Dehnel, M.P.; Jackle, P.; Roeder, M.; Stewart, T.; Theroux, J.; Brasile, J.P.; Sirot, P.; Buckley, K.R.; Bedue, M.

    2007-01-01

    Most commercial PET Cyclotrons have targets mounted on or near the main cyclotron vacuum chamber. There is often little or no system capability for centering or focusing the extracted beam on target to achieve maximum production. This paper describes the ion-optics, design and development of a compact cost-effective beamline comprised of low activation and radiation resistant materials. The beamline, complete with suitable diagnostic devices, permits the extracted proton beam to be centered (X-Y steering magnet), and focused (quadrupole doublet) on target eliminating unnecessary beamspill and ensuring high production

  1. Cost-effectiveness of minimally invasive sacroiliac joint fusion

    Directory of Open Access Journals (Sweden)

    Cher DJ

    2015-12-01

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

  2. Cost-effectiveness in the mitigation of green house gases

    International Nuclear Information System (INIS)

    Rey, Francisco Carlos

    2009-01-01

    This paper analyzes the cost-effectiveness in the mitigation of green house gases from solar, eolic and nuclear energy sources, concluding that nuclear is, not doubt, the mos efficient. On the other hand, nuclear is the unique source that can be installed without limit in magnitude and in the proximity of the demand, and is for all these reasons that several environmental referents in the world have changed their perception on this source and defend it as the unique actual alternative to fight against the emission of green house gases. (author) [es

  3. Cost effective treatment for wet FGD scrubber bleedoff

    Energy Technology Data Exchange (ETDEWEB)

    Janecek, K.F. [EIMCO Process Equipment Company, Salt Lake City, UT (United States); Kim, J.Y. [Samkook Corporation, Seoul (Korea, Democratic People`s Republic of)

    1994-12-31

    The dewatering of scrubber bleedoff gypsum is a thoroughly proven technology, whether for production of wallboard grade gypsum or environmentally responsible land fill. Careful review of the technology options will show which one is the most effective for the specific plant site. Likewise, a recipe for wastewater treatment for heavy metals removal can be found that will meet local regulatory limits. EIMCO has worldwide experience in FGD gypsum sludge dewatering and wastewater treatment. Contacting EIMCO can be the most important step toward a practical cost effective system for handling FGD scrubber bleed slurries.

  4. Cost Effective Polymer Solar Cells Research and Education

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-10-13

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

  5. 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

  6. Handbook of sustainable engineering

    CERN Document Server

    Lee, Kun-Mo

    2013-01-01

    "The efficient utilization of energy, sustainable use of natural resources, and large-scale adoption of sustainable technologies is the key to a sustainable future. The Handbook of Sustainable Engineering provides tools that will help us achieve these goals". Nobel Prize Winner Dr. R.K. Pauchauri, Chairman, UN Intergovernmental Panel on Climate Change As global society confronts the challenges of diminishing resources, ecological degradation, and climate change, engineers play a crucial role designing and building technologies and products that fulfil our needs for utility and sustainability. The Handbook of Sustainable Engineering equips readers with the context and the best practices derived from both academic research and practical examples of successful implementations of sustainable technical solutions. The handbook’s content revolves around the two themes, new ways of thinking and new business models, including sustainable production, products, service systems and consumption while addressing key asse...

  7. Cost-Effectiveness of Four Parenting Programs and Bibliotherapy for Parents of Children with Conduct Problems.

    Science.gov (United States)

    Sampaio, Filipa; Enebrink, Pia; Mihalopoulos, Cathrine; Feldman, Inna

    2016-12-01

    "recovered and improved" and of intervention completers held Cope as the cheapest alternative. Exclusion of parents' time and training costs did not change the cost-effectiveness results. The time horizon for this evaluation is very short. This study also had a limited costing perspective. Results may be interpreted with caution when considering decision-making about value for money. The inclusion of a multi-attribute utility instrument sensitive to domains of quality-of-life impacted by CP in children would be valuable so that pragmatic value for money estimations can be made. Further studies are needed with longer follow-up periods to ascertain on the sustainability of the effects, and fuller economic evaluations and economic modeling to provide insights on longer-term cost-effectiveness. These results also raise the need to investigate the cost-effectiveness of the provision of these interventions as a "stepped care" approach. The results suggest the delivery of different programs according to budget constraints and the outcome desired. In the absence of a WTP threshold, bibliotherapy could be a cheap and effective option to initially target CP within a limited budget, whereas Comet could be offered to achieve greater effects based on decision-makers' willingness to make larger investments. In its turn, Cope could be offered when targeting broader outcomes, such as symptom improvement, rather than clinical caseness.

  8. Cost-effectiveness evaluation of escitalopram in major depressive disorder in Italy

    Directory of Open Access Journals (Sweden)

    Mencacci C

    2013-02-01

    escitalopram strategy gained 0.011 QALYs more than citalopram, 0.008 more than paroxetine, and around 0.007 more than sertraline. Monte Carlo simulations indicated that ICER values for escitalopram were centered around €1100 and €4400 per QALY compared with paroxetine and sertraline, respectively. Although there is no official cost-effectiveness threshold in Italy, the value of €25,000 per QALY could be acceptable. All ICER values retrieved in all analyses were lower than this threshold.Conclusion: The findings from this cost-effectiveness analysis indicate that escitalopram could be accepted as a cost-effective strategy for the Lombardy region health service compared with the other SSRIs studied. The present assessment is based on ICER values resulting from this analysis, which are lower than the thresholds proposed by health care authorities in other European Union countries. These benefits are driven by the effectiveness of escitalopram, which result in an improved health-related quality of life, a higher probability of sustained remission, and better utilization of health care resources. The study results are robust and in line with other pharmacoeconomic analyses comparing escitalopram with other SSRIs.Keywords: CEA, depression, escitalopram, Lombardy, ICER, SSRI

  9. Botulinum Toxin Therapy: Is Syringe Type Related to Cost-Effectiveness?

    Science.gov (United States)

    Foglietti, Mark Anthony; Wright, Lauren; Foglietti-Fostyk, Alanna

    2018-03-01

    Clostridium botulinum toxin is effective through cleaving presynaptic proteins at the neuromuscular junction, which prevents the release of acetylcholine and inhibits muscle contraction. Several serotypes of botulinum toxin (BT) exist; however, only 2 types have been approved by the US Food and Drug Administration for commercial and medical use, A and B. Both types of BT must be administered intramuscularly with a syringe, but the type of syringe is the injector's preference. Which syringe type is most efficient in minimizing product waste and most cost-effective for the patient and provider? We performed a single-center, open-label, analytical study using BT therapy and 2 types of syringes for analytics of cost-effectiveness. OnabotulinumtoxinA was the neuromodulator used in this report. Vials (100 U) of BT A were each reconstituted with 2.5 mL of 0.9% sodium chloride, for a final concentration of 4 U/0.1 mL. High-dead-space syringes are compared with low-dead-space syringes: 1-mL tuberculin (TB) luer slip syringe with detachable 25-gauge needle and 1-mL ultrafine insulin syringe with an attached 31-gauge needle, respectively. After each syringe was evacuated, the TB syringe was noted to contain 0.05 mL of the remaining product in the hub. Providers are discarding approximately 2 U of BT per TB syringe product injection. If the physician uses 30 syringes per day, 3 days a week, for 1 year, it equals to a lost revenue of approximately $155,500 per year. To individualize the cost-effective analysis, average quantity of syringes used per patient and overall patient volume must be considered, with corresponding adjustment of cost and units discarded. The American Society of Plastic Surgeons reported that the use of neuromodulators has increased by approximately 797% from 2000 to 2016. During that period, the price of neuromodulators has also increased by approximately 85%. Considering these statistics, the type of syringe used for BT neuromodular injection is a

  10. Is cost-effective healthcare compatible with publicly financed academic medical centres?

    Science.gov (United States)

    Chia, Whay Kuang; Toh, Han Chong

    2013-01-01

    Probably more than any country, Singapore has made significant investment into the biomedical enterprise as a proportion of its economy and size. This focus recently witnessed a shift towards a greater emphasis on translational and clinical development. Key to the realisation of this strategy will be Academic Medical Centres (AMCs), as a principal tool to developing and applying useful products for the market and further improving health outcomes. Here, we explore the principal value proposition of the AMC to Singapore society and its healthcare system. We question if the values inherent within academic medicine--that of inquiry, innovation, pedagogy and clinical exceptionalism--can be compatible with the seemingly paradoxical mandate of providing cost-effective or rationed healthcare.

  11. Monitor Sustainable Netherlands 2011

    International Nuclear Information System (INIS)

    2011-09-01

    The Monitor provides an image of the sustainability of the Dutch society. It shows which areas are successful and what the 'concerns for tomorrow' are from the point of view of sustainability. An analysis is conducted of how the Netherlands are doing in the fields of climate change, biodiversity, health, knowledge, graying and social cohesion. These and many other topics are discussed in this monitor by means of a number of sustainability indicators and detail analyses [mk]. [nl

  12. Monitor Sustainable Netherlands 2009

    International Nuclear Information System (INIS)

    2009-02-01

    The Monitor provides an image of the sustainability of the Dutch society. It shows which areas are successful and what the 'concerns for tomorrow' are from the point of view of sustainability. An analysis is conducted of how the Netherlands are doing in the fields of climate change, biodiversity, health, knowledge, graying and social cohesion. These and many other topics are discussed in this monitor by means of a number of sustainability indicators and detail analyses [mk] [nl

  13. Stay@Work : Participatory Ergonomics to prevent low back and neck pain among workers : Design of a randomised controlled trial to evaluate the (cost-)effectiveness

    NARCIS (Netherlands)

    Driessen, M.T.; Anema, J.R.; Proper, K.I.; Bongers, P.M.; Beek, A.J.van der

    2008-01-01

    Background. Low back pain (LBP) and neck pain (NP) are a major public health problem with considerable costs for individuals, companies and society. Therefore, prevention is imperative. The Stay@Work study investigates the (cost-)effectiveness of Participatory Ergonomics (PE) to prevent LBP and NP

  14. Stay@Work: Participatory Ergonomics to prevent low back and neck pain among workers: design of a randomised controlled trial to evaluate the (cost-)effectiveness

    NARCIS (Netherlands)

    Driessen, M.T.; Anema, J.R.; Proper, K.I.; Bongers, P.M.; van der Beek, A.J.

    2008-01-01

    Background. Low back pain (LBP) and neck pain (NP) are a major public health problem with considerable costs for individuals, companies and society. Therefore, prevention is imperative. The Stay@Work study investigates the (cost-)effectiveness of Participatory Ergonomics (PE) to prevent LBP and NP

  15. Cost-effectiveness criteria for marine oil spill preventive measures

    International Nuclear Information System (INIS)

    Vanem, Erik; Endresen, Oyvind; Skjong, Rolf

    2008-01-01

    Oil tanker accidents resulting in large quantities of oil spills and severe pollution have occurred in the past, leading to major public attention and an international focus on finding solutions for minimising the risks related to such events. This paper proposes a novel approach for evaluating measures for prevention and control of marine oil spills, based on considerations of oil spill risk and cost effectiveness. A cost model that incorporates all costs of a shipping accident has been established and oil tanker spill accidents have been further elaborated as a special case of such accidents. Utilising this model, novel implementation criteria, in terms of the Cost of Averting a Tonne of oil Spilt (CATS), for risk control options aiming at mitigating the environmental risk of accidental oil spills, are proposed. The paper presents a review of previous studies on the costs associated with oil spills from shipping, which is a function of many factors such as location of spill, spill amount, type of oil, etc. However, ships are designed for global trade, transporting different oil qualities. Therefore, globally applicable criteria must average over most of these factors, and the spill amount is the remaining factor that will be used to measure cost effectiveness against. A weighted, global average cleanup cost of USD 16,000/tonne of oil spilt has been calculated, considering the distribution of oil tanker traffic densities. Finally, the criteria are compared with some existing regulations for oil spill prevention, response and compensation (OPA 90)

  16. 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

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

    Science.gov (United States)

    White, S B; Fane, S A

    2002-01-01

    This paper describes recent experience with integrated resource planning (IRP) and the application of least cost planning (LCP) for the evaluation of demand management strategies in urban water. Two Australian case studies, Sydney and Northern New South Wales (NSW) are used in illustration. LCP can determine the most cost effective means of providing water services or alternatively the cheapest forms of water conservation. LCP contrasts to a traditional approach of evaluation which looks only at means of increasing supply. Detailed investigation of water usage, known as end-use analysis, is required for LCP. End-use analys