Measuring the value of process improvement initiatives in a preoperative assessment center using time-driven activity-based costing.

Science.gov (United States)

French, Katy E; Albright, Heidi W; Frenzel, John C; Incalcaterra, James R; Rubio, Augustin C; Jones, Jessica F; Feeley, Thomas W

2013-12-01

The value and impact of process improvement initiatives are difficult to quantify. We describe the use of time-driven activity-based costing (TDABC) in a clinical setting to quantify the value of process improvements in terms of cost, time and personnel resources. Difficulty in identifying and measuring the cost savings of process improvement initiatives in a Preoperative Assessment Center (PAC). Use TDABC to measure the value of process improvement initiatives that reduce the costs of performing a preoperative assessment while maintaining the quality of the assessment. Apply the principles of TDABC in a PAC to measure the value, from baseline, of two phases of performance improvement initiatives and determine the impact of each implementation in terms of cost, time and efficiency. Through two rounds of performance improvements, we quantified an overall reduction in time spent by patient and personnel of 33% that resulted in a 46% reduction in the costs of providing care in the center. The performance improvements resulted in a 17% decrease in the total number of full time equivalents (FTE's) needed to staff the center and a 19% increase in the numbers of patients assessed in the center. Quality of care, as assessed by the rate of cancellations on the day of surgery, was not adversely impacted by the process improvements. © 2013 Published by Elsevier Inc.

Investing in breastfeeding - the world breastfeeding costing initiative.

Science.gov (United States)

Holla-Bhar, Radha; Iellamo, Alessandro; Gupta, Arun; Smith, Julie P; Dadhich, Jai Prakash

2015-01-01

Despite scientific evidence substantiating the importance of breastfeeding in child survival and development and its economic benefits, assessments show gaps in many countries' implementation of the 2003 WHO and UNICEF Global Strategy for Infant and Young Child Feeding (Global Strategy). Optimal breastfeeding is a particular example: initiation of breastfeeding within the first hour of birth, exclusive breastfeeding for the first six months; and continued breastfeeding for two years or more, together with safe, adequate, appropriate, responsive complementary feeding starting in the sixth month. While the understanding of "optimal" may vary among countries, there is a need for governments to facilitate an enabling environment for women to achieve optimal breastfeeding. Lack of financial resources for key programs is a major impediment, making economic perspectives important for implementation. Globally, while achieving optimal breastfeeding could prevent more than 800,000 under five deaths annually, in 2013, US$58 billion was spent on commercial baby food including milk formula. Support for improved breastfeeding is inadequately prioritized by policy and practice internationally. The World Breastfeeding Costing Initiative (WBCi) launched in 2013, attempts to determine the financial investment that is necessary to implement the Global Strategy, and to introduce a tool to estimate the costs for individual countries. The article presents detailed cost estimates for implementing the Global Strategy, and outlines the WBCi Financial Planning Tool. Estimates use demographic data from UNICEF's State of the World's Children 2013. The WBCi takes a programmatic approach to scaling up interventions, including policy and planning, health and nutrition care systems, community services and mother support, media promotion, maternity protection, WHO International Code of Marketing of Breastmilk Substitutes implementation, monitoring and research, for optimal breastfeeding practices

Full-field initialized decadal predictions with the MPI earth system model: an initial shock in the North Atlantic

Science.gov (United States)

Kröger, Jürgen; Pohlmann, Holger; Sienz, Frank; Marotzke, Jochem; Baehr, Johanna; Köhl, Armin; Modali, Kameswarrao; Polkova, Iuliia; Stammer, Detlef; Vamborg, Freja S. E.; Müller, Wolfgang A.

2017-12-01

Our decadal climate prediction system, which is based on the Max-Planck-Institute Earth System Model, is initialized from a coupled assimilation run that utilizes nudging to selected state parameters from reanalyses. We apply full-field nudging in the atmosphere and either full-field or anomaly nudging in the ocean. Full fields from two different ocean reanalyses are considered. This comparison of initialization strategies focuses on the North Atlantic Subpolar Gyre (SPG) region, where the transition from anomaly to full-field nudging reveals large differences in prediction skill for sea surface temperature and ocean heat content (OHC). We show that nudging of temperature and salinity in the ocean modifies OHC and also induces changes in mass and heat transports associated with the ocean flow. In the SPG region, the assimilated OHC signal resembles well OHC from observations, regardless of using full fields or anomalies. The resulting ocean transport, on the other hand, reveals considerable differences between full-field and anomaly nudging. In all assimilation runs, ocean heat transport together with net heat exchange at the surface does not correspond to OHC tendencies, the SPG heat budget is not closed. Discrepancies in the budget in the cases of full-field nudging exceed those in the case of anomaly nudging by a factor of 2-3. The nudging-induced changes in ocean transport continue to be present in the free running hindcasts for up to 5 years, a clear expression of memory in our coupled system. In hindcast mode, on annual to inter-annual scales, ocean heat transport is the dominant driver of SPG OHC. Thus, we ascribe a significant reduction in OHC prediction skill when using full-field instead of anomaly initialization to an initialization shock resulting from the poor initialization of the ocean flow.

Initiating antiretroviral therapy for HIV at a patient's first clinic visit: a cost-effectiveness analysis of the rapid initiation of treatment randomized controlled trial.

Science.gov (United States)

Long, Lawrence C; Maskew, Mhairi; Brennan, Alana T; Mongwenyana, Constance; Nyoni, Cynthia; Malete, Given; Sanne, Ian; Fox, Matthew P; Rosen, Sydney

2017-07-17

Determine the cost and cost-effectiveness of single-visit (same-day) antiretroviral treatment (ART) initiation compared to standard of care initiation. Cost-effectiveness analysis of individually randomized (1 : 1) pragmatic trial of single-visit initiation, which increased viral suppression at 10 months by 26% [relative risk (95% confidence interval) 1.26 (1.05-1.50)]. Primary health clinic in Johannesburg, South Africa. HIV positive, adult, nonpregnant patients not yet on ART or known to be eligible who presented at the clinic 8 May 2013 to 29 August 2014. Same-day ART initiation using point-of-care laboratory instruments and accelerated clinic procedures to allow treatment-eligible patients to receive antiretroviral medications at the same visit as testing HIV positive or having an eligible CD4 cell count. Comparison was to standard of care ART initiation, which typically required three to five additional clinic visits. Average cost per patient enrolled and per patient achieving the primary outcome of initiated 90 days or less and suppressed 10 months or less, and production cost per patient achieving primary outcome (all costs per primary outcome patients). The average cost per patient enrolled, per patient achieving the primary outcome, and production cost were $319, $487, and $738 in the standard arm and $451, $505, and $707 in the rapid arm. Same-day treatment initiation was more effective than standard initiation, more expensive per patient enrolled, and less expensive to produce a patient achieving the primary outcome. Omitting point-of-care laboratory tests at initiation and focusing on high-volume clinics have the potential to reduce costs substantially and should be evaluated in routine settings.

Integrating tuberculosis and HIV services for people living with HIV: Costs of the Zambian ProTEST Initiative

Directory of Open Access Journals (Sweden)

Kayawe Ignatius

2008-01-01

Full Text Available Abstract Background In the face of the dual TB/HIV epidemic, the ProTEST Initiative was one of the first to demonstrate the feasibility of providing collaborative TB/HIV care for people living with HIV (PLWH in poor settings. The ProTEST Initiative facilitated collaboration between service providers. Voluntary counselling and testing (VCT acted as the entry point for services including TB screening and preventive therapy, clinical treatment for HIV-related disease, and home-based care (HBC, and a hospice. This paper estimates the costs of the ProTEST Initiative in two sites in urban Zambia, prior to the introduction of anti-retroviral therapy. Methods Annual financial and economic providers costs and output measures were collected in 2000–2001. Estimates are made of total costs for each component and average costs per: person reached by ProTEST; VCT pre-test counselled, tested and completed; isoniazid preventive therapy started and completed; clinic visit; HBC patient; and hospice admission and bednight. Results Annual core ProTEST costs were (in 2007 US dollars $84,213 in Chawama and $31,053 in Matero. The cost of coordination was 4%–5% of total site costs ($1–$6 per person reached. The largest cost component in Chawama was voluntary counselling and testing (56% and the clinic in Matero (50%, where VCT clients had higher HIV-prevalences and more advanced HIV. Average costs were lower for all components in the larger site. The cost per HBC patient was $149, and per hospice bednight was $24. Conclusion This study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive. The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV.

Economics of tobacco control research initiative: Operating costs for ...

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

Economics of tobacco control research initiative: Operating costs for capacity building ... (but misinformed) beliefs about the economic benefits of the tobacco industry ... Nutrition, health policy, and ethics in the age of public-private partnerships.

Production costs and operative margins in electric energy generation from biogas. Full-scale case studies in Italy.

Science.gov (United States)

Riva, C; Schievano, A; D'Imporzano, G; Adani, F

2014-08-01

The purpose of this study was to observe the economic sustainability of three different biogas full scale plants, fed with different organic matrices: energy crops (EC), manure, agro-industrial (Plants B and C) and organic fraction of municipal solid waste (OFMSW) (Plant A). The plants were observed for one year and total annual biomass feeding, biomass composition and biomass cost (€ Mg(-1)), initial investment cost and plant electric power production were registered. The unit costs of biogas and electric energy (€ Sm(-3)biogas, € kWh(-1)EE) were differently distributed, depending on the type of feed and plant. Plant A showed high management/maintenance cost for OFMSW treatment (0.155 € Sm(-3)biogas, 45% of total cost), Plant B suffered high cost for EC supply (0.130 € Sm(-3)biogas, 49% of total cost) and Plant C showed higher impact on the total costs because of the depreciation charge (0.146 € Sm(-3)biogas, 41% of total costs). The breakeven point for the tariff of electric energy, calculated for the different cases, resulted in the range 120-170 € MWh(-1)EE, depending on fed materials and plant scale. EC had great impact on biomass supply costs and should be reduced, in favor of organic waste and residues; plant scale still heavily influences the production costs. The EU States should drive incentives in dependence of these factors, to further develop this still promising sector. Copyright © 2014 Elsevier Ltd. All rights reserved.

Costs and cost-effectiveness of full implementation of a biennial faecal occult blood test screening program for bowel cancer in Australia.

Science.gov (United States)

Pignone, Michael P; Flitcroft, Kathy L; Howard, Kirsten; Trevena, Lyndal J; Salkeld, Glenn P; St John, D James B

2011-02-21

To examine the costs and cost-effectiveness of full implementation of biennial bowel cancer screening for Australian residents aged 50-74 years. Identification of existing economic models from 1993 to 2010 through searches of PubMed and economic analysis databases, and by seeking expert advice; and additional modelling to determine the costs and cost-effectiveness of full implementation of biennial faecal occult blood test screening for the five million adults in Australia aged 50-74 years. Estimated number of deaths from bowel cancer prevented, costs, and cost-effectiveness (cost per life-year gained [LYG]) of biennial bowel cancer screening. We identified six relevant economic analyses, all of which found colorectal cancer (CRC) screening to be very cost-effective, with costs per LYG under $55,000 per year in 2010 Australian dollars. Based on our additional modelling, we conservatively estimate that full implementation of biennial screening for people aged 50-74 years would have gross costs of $150 million, reduce CRC mortality by 15%-25%, prevent 300-500 deaths from bowel cancer, and save 3600-6000 life-years annually, for an undiscounted cost per LYG of $25,000-$41,667, compared with no screening, and not taking cost savings as a result of treatment into consideration. The additional expenditure required, after accounting for reductions in CRC incidence, savings in CRC treatment costs, and existing ad-hoc colonoscopy use, is likely to be less than $50 million annually. Full implementation of biennial faecal occult blood test screening in Australia can reduce bowel cancer mortality, and is an efficient use of health resources that would require modest additional government investment.

Variability in the Initial Costs of Care and One-Year Outcomes of Observation Services

Directory of Open Access Journals (Sweden)

Abbass, Ibrahim

2015-05-01

Full Text Available Introduction: The use of observation units (OUs following emergency departments (ED visits as a model of care has increased exponentially in the last decade. About one-third of U.S. hospitals now have OUs within their facilities. While their use is associated with lower costs and comparable level of care compared to inpatient units, there is a wide variation in OUs characteristics and operational procedures. The objective of this research was to explore the variability in the initial costs of care of placing patients with non-specific chest pain in observation units (OUs and the one-year outcomes. Methods: The author retrospectively investigated medical insurance claims of 22,962 privately insured patients (2009-2011 admitted to 41 OUs. Outcomes included the one-year chest pain/cardiovascular related costs and primary and secondary outcomes. Primary outcomes included myocardial infarction, congestive heart failure, stroke or cardiac arrest, while secondary outcomes included revascularization procedures, ED revisits for angina pectoris or chest pain and hospitalization due to cardiovascular diseases. The author aggregated the adjusted costs and prevalence rates of outcomes for patients over OUs, and computed the weighted coefficients of variation (WCV to compare variations across OUs. Results: There was minimal variability in the initial costs of care (WCV=2.2%, while the author noticed greater variability in the outcomes. Greater variability were associated with the adjusted cardiovascular-related costs of medical services (WCV=17.6% followed by the adjusted prevalence odds ratio of patients experiencing primary outcomes (WCV=16.3% and secondary outcomes (WCV=10%. Conclusion: Higher variability in the outcomes suggests the need for more standardization of the observation services for chest pain patients. [West J Emerg Med. 2015;16(3:395–400.

Comparison Between Individually and Group-Based Insulin Pump Initiation by Time-Driven Activity-Based Costing.

Science.gov (United States)

Ridderstråle, Martin

2017-07-01

Depending on available resources, competencies, and pedagogic preference, initiation of insulin pump therapy can be performed on either an individual or a group basis. Here we compared the two models with respect to resources used. Time-driven activity-based costing (TDABC) was used to compare initiating insulin pump treatment in groups (GT) to individual treatment (IT). Activities and cost drivers were identified, timed, or estimated at location. Medical quality and patient satisfaction were assumed to be noninferior and were not measured. GT was about 30% less time-consuming and 17% less cost driving per patient and activity compared to IT. As a batch driver (16 patients in one group) GT produced an upward jigsaw-shaped accumulative cost curve compared to the incremental increase incurred by IT. Taking the alternate cost for those not attending into account, and realizing the cost of opportunity gained, suggested that GT was cost neutral already when 5 of 16 patients attended, and that a second group could be initiated at no additional cost as the attendance rate reached 15:1. We found TDABC to be effective in comparing treatment alternatives, improving cost control and decision making. Everything else being equal, if the setup is available, our data suggest that initiating insulin pump treatment in groups is far more cost effective than on an individual basis and that TDABC may be used to find the balance point.

Assessing the full costs of electricity

International Nuclear Information System (INIS)

Keppler, Jan Horst

2016-01-01

For decades, economists, energy specialists and policy-makers have been satisfied with assessing the comparative costs of electricity generation on the basis of discounted average costs over the lifetime and the total output of a generating plant. As a standardised form of cost-benefit accounting (CBA), these levelised costs of electricity (LCOE) indicate the required expenditures in terms of capital, fuel, and operations and management (O and M), adjusted for their incidence in time or the different technology options per unit of output (i.e. a MWh of electricity). This straightforward, transparent and comparatively simple metric worked well in a context of regulated markets where generators were centrally dispatched according to system requirements, tariffs were set by regulators and load factors could be predicted with confidence. In order to satisfy a given demand for electricity, the technology with the lowest LCOE was usually chosen, thus minimising the costs of the electricity system. Nuclear energy thus competed with hydro, where available, and coal and gas on the basis of their respective capital, labour and fuel costs at the level of the individual plant. (author)

Tax shift : eliminating subsidies and moving to full cost electricity pricing

International Nuclear Information System (INIS)

Gibbons, J.

2008-01-01

In order to ensure that Ontario's service needs are met at the lowest possible total cost, energy conservation and small-scale distributed generation options must be able to compete with large scale-centralized generation and transmission options on a level playing field. This report discussed how electricity is priced in Ontario. The report described the policies that subsidize coal and nuclear generation and promote excessive consumption of grid-supplied electricity. The report also presented an analysis of the impact of these subsidies and policies on Ontario's electricity consumption, electricity productivity, standard of living and air pollutant emissions. It described a practical strategy whereby these subsidies can be eliminated by recycling or shifting the monies currently spent on subsidies in a way that creates an incentive to reduce electricity consumption. It also described how full cost pricing could lead to a net financial benefit for residential customers as well as an adaptation strategy for businesses that would ensure that they remain competitive. Finally the report identified ten major subsidies that artificially reduce the cost of electricity in Ontario. These included below-market water royalty rates; corporate income tax revenue subsidy for nuclear debt; sales tax exemption; average cost pricing; and bulk metering. It was concluded that phasing out the subsidies for grid-supplied electricity and moving to full cost pricing will provide multiple benefits for Ontario. 36 refs., 5 tabs., 5 figs

Cost-Cutting in Higher Education: Lessons Learned from Collaboration, Technology, and Outsourcing Initiatives. Draft.

Science.gov (United States)

Kaganoff, Tessa

This document presents a review of cost-containment initiatives relevant to higher education institutions. Originally commissioned to examine cost containment initiatives carried out by institutions affiliated with the Foundation for Independent Higher Education (FIHE), the paper was expanded to include a sector-wide review of three types of…

Impact of Costing and Cost Analysis Methods on the Result of the Period: Methods Based on Full Cost Theory

Directory of Open Access Journals (Sweden)

Toma Maria

2017-01-01

In light of the above, in the present paper we have proposed that objectives, to approach the methods of calculating full costs (economic or traditional, and comparing them to determine the effect they have on the outcome of the period.

Study of the full-service and low-cost carriers network configuration

Directory of Open Access Journals (Sweden)

Oriol Lordan

2014-10-01

Full Text Available Purpose: The network strategies used by airline carriers have been a recurring subject in air transport research. The aim of this paper is to investigate the relationship between the different operational characteristics of the airline and its route network configuration. Design/methodology/approach: The two main airline carrier typologies - Full-Service and Low-Cost carriers – are analysed using empirical models developed on complex network research relating them to the business model of the airlines. Findings and Originality/value: Just in Europe, one can differentiate between Full-Service and Low-Cost Carriers by complex network analyses. In this process, it has been also found that new concept Low-Cost Carriers, such as Vueling, have network properties closer to Full-Service Carriers. Research limitations/implications: This paper has a limited sample, as includes 26 airline case studies from Europe, United States and Asia. Practical implications: The analysis carried out in this research can help to the assessment of the evolution of the strategies of airline carriers, and has also operational implications, since the configuration of an airline route network can determine its resilience to attacks and errors. Social implications: A better understanding of the properties of airline route networks can benefit airlines, passengers and another stakeholders of the air transport industry. Originality/value: Current research on air transport networks has only considered the global or regional level, but few studies have addressed the study of airline transport networks, and its relationship with their business model.

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

Science.gov (United States)

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

2014-12-01

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

An Analysis of Missile Systems Cost Growth and Implementation of Acquisition Reform Initiatives Using a Hybrid Adjusted Cost Growth Model

National Research Council Canada - National Science Library

Abate, Christopher

2004-01-01

...) data with a hybrid adjusted cost growth (ACG) model. In addition, an analysis of acquisition reform initiatives during the treatment period was conducted to determine if reform efforts impacted missile system cost growth. A pre-reform...

Full cost accounting in the analysis of separated waste collection efficiency: A methodological proposal.

Science.gov (United States)

D'Onza, Giuseppe; Greco, Giulio; Allegrini, Marco

2016-02-01

Recycling implies additional costs for separated municipal solid waste (MSW) collection. The aim of the present study is to propose and implement a management tool - the full cost accounting (FCA) method - to calculate the full collection costs of different types of waste. Our analysis aims for a better understanding of the difficulties of putting FCA into practice in the MSW sector. We propose a FCA methodology that uses standard cost and actual quantities to calculate the collection costs of separate and undifferentiated waste. Our methodology allows cost efficiency analysis and benchmarking, overcoming problems related to firm-specific accounting choices, earnings management policies and purchase policies. Our methodology allows benchmarking and variance analysis that can be used to identify the causes of off-standards performance and guide managers to deploy resources more efficiently. Our methodology can be implemented by companies lacking a sophisticated management accounting system. Copyright © 2015 Elsevier Ltd. All rights reserved.

Costs and cost-effectiveness analysis of 2015 GESIDA/Spanish AIDS National Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults.

Science.gov (United States)

Berenguer, Juan; Rivero, Antonio; Blasco, Antonio Javier; Arribas, José Ramón; Boix, Vicente; Clotet, Bonaventura; Domingo, Pere; González-García, Juan; Knobel, Hernando; Lázaro, Pablo; López, Juan Carlos; Llibre, Josep M; Lozano, Fernando; Miró, José M; Podzamczer, Daniel; Tuset, Montserrat; Gatell, Josep M

2016-01-01

GESIDA and the AIDS National Plan panel of experts suggest a preferred (PR), alternative (AR) and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2015. The objective of this study is to evaluate the costs and the effectiveness of initiating treatment with these regimens. Economic assessment of costs and effectiveness (cost/effectiveness) based on decision tree analyses. Effectiveness was defined as the probability of reporting a viral load de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Cost Analysis of Total Joint Arthroplasty Readmissions in a Bundled Payment Care Improvement Initiative.

Science.gov (United States)

Clair, Andrew J; Evangelista, Perry J; Lajam, Claudette M; Slover, James D; Bosco, Joseph A; Iorio, Richard

2016-09-01

The Bundled Payment for Care Improvement (BPCI) Initiative is a Centers for Medicare and Medicaid Services program designed to promote coordinated and efficient care. This study seeks to report costs of readmissions within a 90-day episode of care for BPCI Initiative patients receiving total knee arthroplasty (TKA) or total hip arthroplasty (THA). From January 2013 through December 2013, 1 urban, tertiary, academic orthopedic hospital admitted 664 patients undergoing either primary TKA or THA through the BPCI Initiative. All patients readmitted to our hospital or an outside hospital within 90-days from the index episode were identified. The diagnosis and cost for each readmission were analyzed. Eighty readmissions in 69 of 664 patients (10%) were identified within 90-days. There were 53 readmissions (45 patients) after THA and 27 readmissions (24 patients) after TKA. Surgical complications accounted for 54% of THA readmissions and 44% of TKA readmissions. These complications had an average cost of $36,038 (range, $6375-$60,137) for THA and $38,953 (range, $4790-$104,794) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $27,979. Medical complications of THA and TKA had an average cost of $22,775 (range, $5678-$82,940) for THA and $24,183 (range, $3306-$186,069) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $11,682. Hospital readmissions after THA and TKA are common and costly. Identifying the causes for readmission and assessing the cost will guide quality improvement efforts. Copyright © 2016 Elsevier Inc. All rights reserved.

Cost of initial management of musculoskeletal injuries due to road traffic crashes: A register-based study from North-West India

Directory of Open Access Journals (Sweden)

Bhanu Awasthi

2017-01-01

Full Text Available Background: There is a paucity of information on the actual costs incurred by the family as a result of musculoskeletal injuries due to road traffic crash from our part of India. This study was conducted with the objective to ascertain the costs of initial management of musculoskeletal injuries due to road traffic crashes. Materials and Methods: This prospective study was conducted as a register-based descriptive study in a tertiary care teaching hospital in a rural area (with a predominantly mountainous terrain of North-West India. All patients with nonfatal musculoskeletal injuries due to road traffic crashes, presenting between 2014 and 2015 and agreeing to participate in the study were included in the study. Results: Of 313 cases, 116 were managed conservatively, whereas in 189 cases, operative intervention was required. In 8 cases, both the modalities of management were required. The average cost of management was Rs. 20,386 in operative group. The average cost in the conservative group was Rs. 3726. Average cost calculated for patients in whom both modality of treatment was required was Rs. 24,000. It was observed that the indirect cost of management was proportionately higher in conservative group. Conclusions: The initial cost of management for patients managed conservatively is less than those managed by operative intervention. Importantly, however, the indirect cost of management is a major contributor to the total cost of management.

Manufacturing Cost Analysis for YSZ-Based FlexCells at Pilot and Full Scale Production Scales

Energy Technology Data Exchange (ETDEWEB)

Scott Swartz; Lora Thrun; Robin Kimbrell; Kellie Chenault

2011-05-01

Significant reductions in cell costs must be achieved in order to realize the full commercial potential of megawatt-scale SOFC power systems. The FlexCell designed by NexTech Materials is a scalable SOFC technology that offers particular advantages over competitive technologies. In this updated topical report, NexTech analyzes its FlexCell design and fabrication process to establish manufacturing costs at both pilot scale (10 MW/year) and full-scale (250 MW/year) production levels and benchmarks this against estimated anode supported cell costs at the 250 MW scale. This analysis will show that even with conservative assumptions for yield, materials usage, and cell power density, a cost of $35 per kilowatt can be achieved at high volume. Through advancements in cell size and membrane thickness, NexTech has identified paths for achieving cell manufacturing costs as low as $27 per kilowatt for its FlexCell technology. Also in this report, NexTech analyzes the impact of raw material costs on cell cost, showing the significant increases that result if target raw material costs cannot be achieved at this volume.

The full financial costs of irrigation services: A discussion on existing ...

African Journals Online (AJOL)

Considering water as an economic good entails, among other requisites, properly assessing the cost incurred by supplying and managing the resource, and the required infrastructure thereof. Regarding irrigation, the International Commission for Irrigation and Drainage (ICID) set up a method for assessing the full financial ...

Penetapan Harga Jual dengan Cost Plus Pricing Menggunakan Pendekatan Full Costing pada Ud Gladys Bakery

OpenAIRE

Moray, Jessica Claudia; Saerang, David Paul Elia; Runtu, Treesje

2014-01-01

Setiap badan USAha didirikan pada prinsipnya bertujuan untuk mendapatkan laba, yang diperoleh dari kegiatan USAha dan dapat bersaing dalam pasar. Harga jual yang terlalu tinggi akan menjadikan produk kurang bersaing di pasar, sementara harga jual yang terlalu rendah tidak akan memberikan keuntungan bagi pengusaha. Tujuan penelitian ini adalah untuk mengetahui cara penetapan harga jual pada UD. Gladys Bakery dengan harga jual menurut metode cost plus pricing menggunakan pendekatan full costin...

Costs and cost-efficacy analysis of the 2016 GESIDA/Spanish AIDS National Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults.

Science.gov (United States)

Rivero, Antonio; Pérez-Molina, José Antonio; Blasco, Antonio Javier; Arribas, José Ramón; Crespo, Manuel; Domingo, Pere; Estrada, Vicente; Iribarren, José Antonio; Knobel, Hernando; Lázaro, Pablo; López-Aldeguer, José; Lozano, Fernando; Moreno, Santiago; Palacios, Rosario; Pineda, Juan Antonio; Pulido, Federico; Rubio, Rafael; de la Torre, Javier; Tuset, Montserrat; Gatell, Josep M

2017-02-01

GESIDA and the AIDS National Plan panel of experts suggest preferred (PR), alternative (AR), and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for the year 2016. The objective of this study is to evaluate the costs and the efficacy of initiating treatment with these regimens. Economic assessment of costs and efficiency (cost/efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50copies/mL at week 48 in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied, only taking into account differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and the costs correspond to those of 2016. A sensitivity deterministic analysis was conducted, building three scenarios for each regimen: base case, most favourable, and least favourable. In the base case scenario, the cost of initiating treatment ranges from 4663 Euros for 3TC+LPV/r (OR) to 10,894 Euros for TDF/FTC+RAL (PR). The efficacy varies from 0.66 for ABC/3TC+ATV/r (AR) and ABC/3TC+LPV/r (OR), to 0.89 for TDF/FTC+DTG (PR) and TDF/FTC/EVG/COBI (AR). The efficiency, in terms of cost/efficacy, ranges from 5280 to 12,836 Euros per responder at 48 weeks, for 3TC+LPV/r (OR), and RAL+DRV/r (OR), respectively. Despite the overall most efficient regimen being 3TC+LPV/r (OR), among the PR and AR, the most efficient regimen was ABC/3TC/DTG (PR). Among the AR regimes, the most efficient was TDF/FTC/RPV. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Costs and cost-efficacy analysis of the 2017 GESIDA/Spanish National AIDS Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults.

Science.gov (United States)

Rivero, Antonio; Pérez-Molina, José Antonio; Blasco, Antonio Javier; Arribas, José Ramón; Asensi, Víctor; Crespo, Manuel; Domingo, Pere; Iribarren, José Antonio; Lázaro, Pablo; López-Aldeguer, José; Lozano, Fernando; Martínez, Esteban; Moreno, Santiago; Palacios, Rosario; Pineda, Juan Antonio; Pulido, Federico; Rubio, Rafael; Santos, Jesús; de la Torre, Javier; Tuset, Montserrat; Gatell, Josep M

2018-05-01

GESIDA and the Spanish National AIDS Plan panel of experts have recommended preferred (PR), alternative (AR) and other regimens (OR) for antiretroviral therapy (ART) as initial therapy in HIV-infected patients for 2017. The objective of this study was to evaluate the costs and the efficiency of initiating treatment with PR and AR. Economic assessment of costs and efficiency (cost-efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied considering only differential direct costs: ART (official prices), management of adverse effects, resistance studies and HLA B*5701 screening. The setting was Spain and the costs correspond to those of 2017. A deterministic sensitivity analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. In the base case scenario, the cost of initiating treatment ranged from 6882 euro for TFV/FTC/RPV (AR) to 10,904 euros for TFV/FTC+RAL (PR). The efficacy varied from 0.82 for TFV/FTC+DRV/p (AR) to 0.92 for TAF/FTC/EVG/COBI (PR). The efficiency, in terms of cost-efficacy, ranged from 7923 to 12,765 euros per responder at 48 weeks, for ABC/3TC/DTG (PR) and TFV/FTC+RAL (PR), respectively. Considering ART official prices, the most efficient regimen was ABC/3TC/DTG (PR), followed by TFV/FTC/RPV (AR) and TAF/FTC/EVG/COBI (PR). Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Costs and cost-efficacy analysis of the 2014 GESIDA/Spanish National AIDS Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults.

Science.gov (United States)

Blasco, Antonio Javier; Llibre, Josep M; Berenguer, Juan; González-García, Juan; Knobel, Hernando; Lozano, Fernando; Podzamczer, Daniel; Pulido, Federico; Rivero, Antonio; Tuset, Montserrat; Lázaro, Pablo; Gatell, Josep M

2015-03-01

GESIDA and the National AIDS Plan panel of experts suggest preferred (PR) and alternative (AR) regimens of antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2014. The objective of this study is to evaluate the costs and the efficiency of initiating treatment with these regimens. An economic assessment was made of costs and efficiency (cost/efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50 copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied by considering only differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and costs correspond to those of 2014. A sensitivity deterministic analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. In the base case scenario, the cost of initiating treatment ranges from 5133 Euros for ABC/3TC+EFV to 11,949 Euros for TDF/FTC+RAL. The efficacy varies between 0.66 for ABC/3TC+LPV/r and ABC/3TC+ATV/r, and 0.89 for TDF/FTC/EVG/COBI. Efficiency, in terms of cost/efficacy, ranges from 7546 to 13,802 Euros per responder at 48 weeks, for ABC/3TC+EFV and TDF/FTC+RAL respectively. Considering ART official prices, the most efficient regimen was ABC/3TC+EFV (AR), followed by the non-nucleoside containing PR (TDF/FTC/RPV and TDF/FTC/EFV). The sensitivity analysis confirms the robustness of these findings. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Guidance Document - Full-cost Recovery for Molybdenum-99 Irradiation Services: Methodology and Implementation

International Nuclear Information System (INIS)

Westmacott, Chad; Cameron, Ron

2012-02-01

At the request of its member countries, the OECD Nuclear Energy Agency (NEA) became involved in global efforts to ensure a reliable supply of molybdenum-99 ( 99 Mo) and its decay product, technetium-99m (' 99m Tc), the most widely used medical radioisotope. The NEA established the High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR) in 2009. Under its first mandate (June 2009-2011), the HLG-MR examined the major issues that affect the short-, medium- and long-term reliability of 99 Mo/' 99m Tc supply and then developed a policy approach to move the supply chain to a sustainable basis and ensure security of supply. The objectives of the HLG-MR during its second mandate (July 2011-2013) are to work towards increasing the long-term security of supply of 99 Mo and ' 99m Tc, especially through the implementation of the HLG-MR policy approach and its associated recommendations. This will entail actions to maintain transparency on global developments, continue communication with the supply chain and end users, evaluate progress toward implementation and provide additional information and analysis where necessary. A key action under the second mandate is to provide guidance on the implementation of the HLG-MR policy approach. This document provides guidance to reactor and alternative production technology (e.g., cyclotrons, accelerators) operators on how to undertake full-cost identification and implement full-cost recovery. The document also discusses issues related to levelling the playing field between old and new reactors. In order to move toward a long-term secure supply of 99 Mo and ' 99m Tc, the HLG-MR policy approach will need to be implemented by all countries that have an impact on the global market - as producers or consumers. A key recommendation of the policy approach is the implementation of full-cost identification and recovery by operators of 99 Mo-producing research reactors or alternative technologies. This document provides the

Cost Analysis of a High Support Housing Initiative for Persons with Severe Mental Illness and Long-Term Psychiatric Hospitalization.

Science.gov (United States)

Rudoler, David; de Oliveira, Claire; Jacob, Binu; Hopkins, Melonie; Kurdyak, Paul

2018-01-01

The objective of this article was to conduct a cost analysis comparing the costs of a supportive housing intervention to inpatient care for clients with severe mental illness who were designated alternative-level care while inpatient at the Centre for Addiction and Mental Health in Toronto. The intervention, called the High Support Housing Initiative, was implemented in 2013 through a collaboration between 15 agencies in the Toronto area. The perspective of this cost analysis was that of the Ontario Ministry of Health and Long-Term Care. We compared the cost of inpatient mental health care to high-support housing. Cost data were derived from a variety of sources, including health administrative data, expenditures reported by housing providers, and document analysis. The High Support Housing Initiative was cost saving relative to inpatient care. The average cost savings per diem were between $140 and $160. This amounts to an annual cost savings of approximately $51,000 to $58,000. When tested through sensitivity analysis, the intervention remained cost saving in most scenarios; however, the result was highly sensitive to health system costs for clients of the High Support Housing Initiative program. This study suggests the High Support Housing Initiative is potentially cost saving relative to inpatient hospitalization at the Centre for Addiction and Mental Health.

Costs and role of ultrasound follow-up of polytrauma patients after initial computed tomography

International Nuclear Information System (INIS)

Maurer, M.H.; Winkler, A.; Powerski, M.J.; Elgeti, F.; Huppertz, A.; Roettgen, R.; Marnitz, T.; Wichlas, F.

2012-01-01

Purpose: To assess the costs and diagnostic gain of abdominal ultrasound follow-up of polytrauma patients initially examined by whole-body computed tomography (CT). Materials and Methods: A total of 176 patients with suspected multiple trauma (126 men, 50 women; age 43.5 ± 17.4 years) were retrospectively analyzed with regard to supplementary and new findings obtained by ultrasound follow-up compared with the results of exploratory FAST (focused assessment with sonography for trauma) at admission and the findings of whole-body CT. A process model was used to document the staff, materials, and total costs of the ultrasound follow-up examinations. Results: FAST yielded 26 abdominal findings (organ injury and/or free intra-abdominal fluid) in 19 patients, while the abdominal scan of whole-body CT revealed 32 findings in 25 patients. FAST had 81 % sensitivity and 100 % specificity. Follow-up ultrasound examinations revealed new findings in 2 of the 25 patients with abdominal injuries detected with initial CT. In the 151 patients without abdominal injuries in the initial CT scan, ultrasound follow-up did not yield any supplementary or new findings. The total costs of an ultrasound follow-up examination were EUR 28.93. The total costs of all follow-up ultrasound examinations performed in the study population were EUR 5658.23. Conclusion: Follow-up abdominal ultrasound yields only a low overall diagnostic gain in polytrauma patients in whom initial CT fails to detect any abdominal injuries but incurs high personnel expenses for radiological departments. (orig.)

Eosinophilic esophagitis: dilate or medicate? A cost analysis model of the choice of initial therapy.

Science.gov (United States)

Kavitt, R T; Penson, D F; Vaezi, M F

2014-07-01

Eosinophilic esophagitis (EoE) is an increasingly recognized clinical entity. The optimal initial treatment strategy in adults with EoE remains controversial. The aim of this study was to employ a decision analysis model to determine the less costly option between the two most commonly employed treatment strategies in EoE. We constructed a model for an index case of a patient with biopsy-proven EoE who continues to be symptomatic despite proton-pump inhibitor therapy. The following treatment strategies were included: (i) swallowed fluticasone inhaler (followed by esophagogastroduodenoscopy [EGD] with dilation if ineffective); and (ii) EGD with dilation (followed by swallowed fluticasone inhaler if ineffective). The time horizon was 1 year. The model focused on cost analysis of initial treatment strategies. The perspective of the healthcare payer was used. Sensitivity analyses were performed to assess the robustness of the model. For every patient whose symptoms improved or resolved with the strategy of fluticasone first followed by EGD, if necessary, it cost an average of $1078. Similarly, it cost an average of $1171 per patient if EGD with dilation was employed first. Sensitivity analyses indicated that initial treatment with fluticasone was the less costly strategy to improve dysphagia symptoms as long as the effectiveness of fluticasone remains at or above 0.62. Swallowed fluticasone inhaler (followed by EGD with dilation if necessary) is the more economical initial strategy when compared with EGD with dilation first. © 2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

[The World Initiative for the Eradication of Poliomyelitis: a long road full of pitfalls].

Science.gov (United States)

Kuss, Jean-Jacques

2011-01-01

The World Initiative for the Eradication of Poliomyelitis (IMEP), launched in 1988, is based on two strategies: mass vaccination with oral polio vaccine (OPV) and surveillance of acute flaccid paralysis (AFP). The disease incidence was reduced by 99%, but eradication, originally scheduled for 2000, has still not been reached in 2010, and four countries continue to be endemic (India, Pakistan, Afghanistan and Nigeria). The obstacles to eradication are the difficulty in reaching all children to be vaccinated, especially in areas of insecurity; the imperfections of OPV--irregular efficacy and genetic instability; and the limitations of surveillance in detecting only the paralytic form of the disease, which often remains asymptomatic. The repeated postponements of the ending of the initiative, which greatly increased the cost of IMEP, spark debate about the actual feasibility of eradication and justification to continue funding in a difficult global economic context, so the initiative remains without significant impact on indicators of the Millennium Goals for Development.

Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia.

Directory of Open Access Journals (Sweden)

Nicholas Graves

Full Text Available The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included.The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011-2012.No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits.The Australian National Hand Hygiene Initiative was cost

Full environmental life cycle cost analysis of concentrating solar power technology: contribution of externalities to overall energy costs

NARCIS (Netherlands)

Corona, B.; Cerrajero, E.; San Miguel, G.

2016-01-01

The aim of this work is to investigate the use of Full Environmental Life Cycle Costing (FeLCC) methodology to evaluate the economic performance of a 50 MW parabolic trough Concentrated Solar Power (CSP) plant operating in hybrid mode with different natural gas inputs (between 0% and 30%). The

Cost effectiveness of arthrocentesis as initial treatment for temporomandibular joint arthralgia: A randomized controlled trial

NARCIS (Netherlands)

Vos, L.M.; Stant, A.D.; Quik, E.H.; Huddleston Slater, J.J.R.; Stegenga, B.

2013-01-01

Objective: To determine the cost effectiveness of arthrocentesis as initial treatment compared to care as usual (CAU) for temporomandibular joint (TMJ) arthralgia. Materials and methods: 80 patients were randomly allocated to arthrocentesis as initial treatment (n = 40) or CAU (n = 40).

Biologically Costly Altruism Depends on Emotional Closeness among Step but Not Half or Full Sibling

Directory of Open Access Journals (Sweden)

Paola Bressan

2009-01-01

Full Text Available We studied altruistic behaviors of varying biological cost (high, medium, and low among siblings of varying genetic relatedness (full, half, and step. In agreement with inclusive fitness theory, the relative importance of either reliable (such as co-residence or heuristic (such as emotional closeness kinship cues depended crucially on the costs of help. When help did not endanger the altruist's life, thus making reciprocation possible, emotional closeness was the strongest predictor of altruism; perceived physical and psychological similarity to the sibling amplified altruistic behavior via their association with emotional closeness. When help endangered the altruist's life, thus making reciprocation unlikely, the strongest predictor of altruism was the ancestrally valid kinship cue of co-residence duration. Emotional closeness predicted costly altruism only for step siblings; its effects were nonsignificant when siblings were genetically related. Our findings support the idea that emotional closeness promotes costly altruistic behavior by serving as a surrogate kinship cue when more reliable cues are missing.

Pretreatment costs of care and time to initial treatment for patients with cancer of unknown primary.

Science.gov (United States)

Walker, Mark S; Weinstein, Laura; Luo, Roger; Marino, Ingrid

2018-06-01

Time to treatment and pretreatment costs may be affected by unknown primary tumor site. This retrospective study used electronic medical record data from patients in ten US community oncology practices. Eligible patients were ≥18 years, diagnosed with cancer of unknown primary (CUP) or known metastatic solid tumor, and presented between 1 January 2012 and 30 June 2014. Patients with CUP (n = 294) had a longer interval than non-CUP patients (n = 92) from presentation to treatment initiation (1.18 vs 0.49 months, p < 0.0001), and had higher pretreatment costs (US$27,882 vs US$20,449, p = 0.0075). When analyzed as monthly cost, the difference between groups in log-cost per month was nonsignificant. Higher pretreatment costs in CUP patients appeared attributable to significantly longer time to initiation of therapy.

[Analysis of costs and cost-effectiveness of preferred GESIDA/National AIDS Plan regimens for initial antiretroviral therapy in human immunodeficiency virus infected adult patients in 2013].

Science.gov (United States)

Blasco, Antonio Javier; Llibre, Josep M; Arribas, José Ramón; Boix, Vicente; Clotet, Bonaventura; Domingo, Pere; González-García, Juan; Knobel, Hernando; López, Juan Carlos; Lozano, Fernando; Miró, José M; Podzamczer, Daniel; Santamaría, Juan Miguel; Tuset, Montserrat; Zamora, Laura; Lázaro, Pablo; Gatell, Josep M

2013-11-01

The GESIDA and National AIDS Plan panel of experts have proposed "preferred regimens" of antiretroviral treatment (ART) as initial therapy in HIV infected patients for 2013. The objective of this study is to evaluate the costs and effectiveness of initiating treatment with these "preferred regimens". An economic assessment of costs and effectiveness (cost/effectiveness) was performed using decision tree analysis models. Effectiveness was defined as the probability of having viral load <50copies/mL at week48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regime was defined as the costs of ART and its consequences (adverse effects, changes of ART regime and drug resistance analyses) during the first 48weeks. The perspective of the analysis is that of the National Health System was applied, only taking into account differential direct costs: ART (official prices), management of adverse effects, resistance studies, and determination of HLA B*5701. The setting is Spain and the costs are those of 2013. A sensitivity deterministic analysis was performed, constructing three scenarios for each regimen: baseline, most favourable, and most unfavourable cases. In the baseline case scenario, the cost of initiating treatment ranges from 6,747euros for TDF/FTC+NVP to 12,059euros for TDF/FTC+RAL. The effectiveness ranges between 0.66 for ABC/3TC+LPV/r and ABC/3TC+ATV/r, and 0.87 for TDF/FTC+RAL and ABC/3TC+RAL. Effectiveness, in terms of cost/effectiveness, varies between 8,396euros and 13,930euros per responder at 48weeks, for TDF/FTC/RPV and TDF/FTC+RAL, respectively. Taking ART at official prices, the most effective regimen was TDF/FTC/RPV, followed by the rest of non-nucleoside containing regimens. The sensitivity analysis confirms the robustness of these findings. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Low-Cost IoT: A Holistic Approach

Directory of Open Access Journals (Sweden)

Augusto Ciuffoletti

2018-05-01

Full Text Available The key factors for a successful smart-city project are its initial cost and its scalability. The initial cost depends on several inter-related aspects that cannot be designed and optimized separately. After the pilot deployment, scaling-up takes place only if the cost remains affordable: an initial financial support may induce dependencies from technologies that become unsustainable in the long period. In addition, the initial adoption of an emerging technology that fails to affirm may jeopardize investment return. This paper investigates a smart-village use case, the success of which strongly depends on the initial cost and scalability, exploring a low-cost way for Internet of Things (IoT. We propose a simple conceptual framework for cost evaluation, and we verify its effectiveness with an exhaustive use case: a prototype sensor designed and tested with its surrounding eco-system. Using experimental results, we can estimate both performance and cost for a pilot system made of fifty sensors deployed in an urban area. We show that such cost grows linearly with system size, taking advantage of widely adopted technologies. The code and the design of the prototype are available, so that all steps are reproducible.

Full-length mRNA sequencing uncovers a widespread coupling between transcription initiation and mRNA processing.

Science.gov (United States)

Anvar, Seyed Yahya; Allard, Guy; Tseng, Elizabeth; Sheynkman, Gloria M; de Klerk, Eleonora; Vermaat, Martijn; Yin, Raymund H; Johansson, Hans E; Ariyurek, Yavuz; den Dunnen, Johan T; Turner, Stephen W; 't Hoen, Peter A C

2018-03-29

The multifaceted control of gene expression requires tight coordination of regulatory mechanisms at transcriptional and post-transcriptional level. Here, we studied the interdependence of transcription initiation, splicing and polyadenylation events on single mRNA molecules by full-length mRNA sequencing. In MCF-7 breast cancer cells, we find 2700 genes with interdependent alternative transcription initiation, splicing and polyadenylation events, both in proximal and distant parts of mRNA molecules, including examples of coupling between transcription start sites and polyadenylation sites. The analysis of three human primary tissues (brain, heart and liver) reveals similar patterns of interdependency between transcription initiation and mRNA processing events. We predict thousands of novel open reading frames from full-length mRNA sequences and obtained evidence for their translation by shotgun proteomics. The mapping database rescues 358 previously unassigned peptides and improves the assignment of others. By recognizing sample-specific amino-acid changes and novel splicing patterns, full-length mRNA sequencing improves proteogenomics analysis of MCF-7 cells. Our findings demonstrate that our understanding of transcriptome complexity is far from complete and provides a basis to reveal largely unresolved mechanisms that coordinate transcription initiation and mRNA processing.

Resource utilization and costs during the initial years of lung cancer screening with computed tomography in Canada.

Science.gov (United States)

Cressman, Sonya; Lam, Stephen; Tammemagi, Martin C; Evans, William K; Leighl, Natasha B; Regier, Dean A; Bolbocean, Corneliu; Shepherd, Frances A; Tsao, Ming-Sound; Manos, Daria; Liu, Geoffrey; Atkar-Khattra, Sukhinder; Cromwell, Ian; Johnston, Michael R; Mayo, John R; McWilliams, Annette; Couture, Christian; English, John C; Goffin, John; Hwang, David M; Puksa, Serge; Roberts, Heidi; Tremblay, Alain; MacEachern, Paul; Burrowes, Paul; Bhatia, Rick; Finley, Richard J; Goss, Glenwood D; Nicholas, Garth; Seely, Jean M; Sekhon, Harmanjatinder S; Yee, John; Amjadi, Kayvan; Cutz, Jean-Claude; Ionescu, Diana N; Yasufuku, Kazuhiro; Martel, Simon; Soghrati, Kamyar; Sin, Don D; Tan, Wan C; Urbanski, Stefan; Xu, Zhaolin; Peacock, Stuart J

2014-10-01

It is estimated that millions of North Americans would qualify for lung cancer screening and that billions of dollars of national health expenditures would be required to support population-based computed tomography lung cancer screening programs. The decision to implement such programs should be informed by data on resource utilization and costs. Resource utilization data were collected prospectively from 2059 participants in the Pan-Canadian Early Detection of Lung Cancer Study using low-dose computed tomography (LDCT). Participants who had 2% or greater lung cancer risk over 3 years using a risk prediction tool were recruited from seven major cities across Canada. A cost analysis was conducted from the Canadian public payer's perspective for resources that were used for the screening and treatment of lung cancer in the initial years of the study. The average per-person cost for screening individuals with LDCT was $453 (95% confidence interval [CI], $400-$505) for the initial 18-months of screening following a baseline scan. The screening costs were highly dependent on the detected lung nodule size, presence of cancer, screening intervention, and the screening center. The mean per-person cost of treating lung cancer with curative surgery was $33,344 (95% CI, $31,553-$34,935) over 2 years. This was lower than the cost of treating advanced-stage lung cancer with chemotherapy, radiotherapy, or supportive care alone, ($47,792; 95% CI, $43,254-$52,200; p = 0.061). In the Pan-Canadian study, the average cost to screen individuals with a high risk for developing lung cancer using LDCT and the average initial cost of curative intent treatment were lower than the average per-person cost of treating advanced stage lung cancer which infrequently results in a cure.

Water resource taxation with full-cost water pricing: lessons from Europe

DEFF Research Database (Denmark)

Andersen, Mikael Skou; Pizzol, Massimo

Green fiscal reform involves removal of environmentally harmful subsidies, introduction of taxes on pollution and resource depletion as well as full-cost pricing for environmental services. One sector which traditionally has been shielded against Green Fiscal Reform is the water sector, where...... social and distributional concerns have had priority over charging policies. This may seem a paradox, as the water sector is of major financial significance and traditionally accounts for 1-2 per cent of GDP in developed nations. Moreover, in the European Union the Water Framework Directive prescribes...

Cost and consequences of noncompliance with osteoporosis treatment among women initiating therapy.

Science.gov (United States)

Modi, Ankita; Siris, Ethel S; Tang, Jackson; Sen, Shuvayu

2015-04-01

The objective was to evaluate compliance with osteoporosis (OP) treatments and determine the fracture and healthcare burden associated with noncompliance. This retrospective analysis of a US claims database identified women initiating an OP medication from 1 January 2002 to 30 June 2009. Patients were ≥55 years and had ≥1 pharmacy claim for a bisphosphonate or non-bisphosphonate (raloxifene, calcitonin, teriparatide); the index date was the first pharmacy claim. There were three study periods: baseline (12 months pre-index); compliance period (0-12 months post-index); and follow-up period (12-24 months post-index). Medication possession ratio (MPR) was calculated during the compliance period to differentiate two cohorts: compliant (MPR ≥ 80%) and noncompliant (MPR costs), all adjusted for patient demographic and clinical characteristics. Overall, 685,505 women initiating OP therapy were identified and 57,913 (8.4%) met the inclusion criteria: only 23,430 (40.5%) were compliant and 34,483 (59.5%) were noncompliant. Mean age was 64 years. Noncompliance was associated with a 20% higher risk of any fracture (odds ratio: 1.20, 95% CI = 1.07-1.35), a higher incidence rate ratio (IRR) for inpatient utilization (IRR: 1.26, 95% CI = 1.19-1.34) and a lower rate of outpatient utilization (IRR: 0.97, 95% CI = 0.95-0.98). Noncompliant patients had 13% higher medical costs (cost ratio: 1.13, 95% CI = 1.06-1.21) than compliant patients. Inclusion in this study required 36 months of continuous healthcare coverage. Thus, the results are primarily applicable to a stable, managed care population and may not be generalizable to other populations. Noncompliance with OP therapy was associated with a higher risk of fracture, higher all-cause medical costs and a higher frequency of inpatient service utilization. Additional research is needed to identify barriers to compliance with OP therapy.

The Business Change Initiative: A Novel Approach to Improved Cost and Schedule Management

Science.gov (United States)

Shinn, Stephen A.; Bryson, Jonathan; Klein, Gerald; Lunz-Ruark, Val; Majerowicz, Walt; McKeever, J.; Nair, Param

2016-01-01

Goddard Space Flight Center's Flight Projects Directorate employed a Business Change Initiative (BCI) to infuse a series of activities coordinated to drive improved cost and schedule performance across Goddard's missions. This sustaining change framework provides a platform to manage and implement cost and schedule control techniques throughout the project portfolio. The BCI concluded in December 2014, deploying over 100 cost and schedule management changes including best practices, tools, methods, training, and knowledge sharing. The new business approach has driven the portfolio to improved programmatic performance. The last eight launched GSFC missions have optimized cost, schedule, and technical performance on a sustained basis to deliver on time and within budget, returning funds in many cases. While not every future mission will boast such strong performance, improved cost and schedule tools, management practices, and ongoing comprehensive evaluations of program planning and control methods to refine and implement best practices will continue to provide a framework for sustained performance. This paper will describe the tools, techniques, and processes developed during the BCI and the utilization of collaborative content management tools to disseminate project planning and control techniques to ensure continuous collaboration and optimization of cost and schedule management in the future.

Functionality of the approach of hierarchical analysis in the full cost accounting in the IRP of a metropolitan airport

International Nuclear Information System (INIS)

Cicone, Decio; Morales Udaeta, Miguel Edgar; Aquiles Baesso Grimoni, Jose; Ribeiro Galvao, Luiz Claudio

2008-01-01

This work shows the application of the analytic hierarchy process (AHP) in the full cost accounting (FCA) within the integrated resource planning (IRP) process. For this purpose, a pioneer case was developed and different energy solutions of supply and demand for a metropolitan airport (Congonhas) were considered [Moreira, E.M., 2005. Modelamento energetico para o desenvolvimento limpo de aeroporto metropolitano baseado na filosofia do PIR-O caso da metropole de Sao Paulo. Dissertacao de mestrado, GEPEA/USP]. These solutions were compared and analyzed utilizing the software solution 'Decision Lens' that implements the AHP. The final part of this work has a classification of resources that can be considered to be the initial target as energy resources, thus facilitating the restraints of the IRP of the airport and setting parameters aiming at sustainable development

Purchasing motors in the light of full-cost calculation; Beschaffung von Motoren unter der Vollkostenbetrachtung

Energy Technology Data Exchange (ETDEWEB)

Mauchle, P.; Schnyder, G.

2006-07-01

This final report published by the Swiss Federal Office of Energy (SFOE) presents the results of a study made on how full-cost calculation can help define the optimal purchasing strategy for electrical drives. According to the authors, taking total life-cycle costs into consideration also guarantees economical operation and helps avoid unexpected service costs. The report describes the goals of the project and co-operation with industry and users. Factors influencing life-cycle costs are looked at in detail, including investments, installation and operator-training, operation and monitoring as well as maintenance and repair. Also, energy costs are looked at, as are environmental aspects and the disposal of drives taken out of service. The calculation of the economic feasibility of two types of motor is looked at. Sample Calls for Tender are presented and software for the evaluation of offers is briefly discussed.

A framework of initiatives for successful application of life cycle costing (LCC in industrialised building system (IBS in Malaysian construction industry

Directory of Open Access Journals (Sweden)

Shamsuddin Siti Mazzuana

2017-01-01

Full Text Available Industrialised Building System (IBS contributes a great shift in sustainable construction and benefits the society. Previous studies have proven in general that one of the hindrances in promoting sustainable in IBS, is a high cost for any pre-cast material specifically thus effected the overall cost. The introduction of Life Cycle Costing (LCC leads into providing a better and comprehensive cost estimation, including projecting actual cost to operate the building, hence providing a better baseline for decision making. The lacking application of LCC in IBS is still in trivial impact, therefore, this paper presents a framework which produced by expressing the successful initiatives of LCC and IBS in Malaysia construction industry. The framework developed based on findings from the extensive literature reviews, 164 responded questionnaires, and 19 expert opinions, which has three sections: Strategy Development, System Development and the last part is Decision Level. Aspects of objectivity, practicality, reliability, completeness that were likely to be implemented in the Malaysian construction industry were used. There are significant opinions on the usefulness and completeness of the proposed framework in providing a comprehensive cost estimates which helps much in deciding to carry out IBS or remain with a traditional construction method.

Utilization and costs of lumbar and full spine radiography by Ontario chiropractors from 1994 to 2001.

Science.gov (United States)

Ammendolia, Carlo; Côté, Pierre; Hogg-Johnson, Sheilah; Bombardier, Claire

2009-07-01

In Ontario, chiropractors see one-third of patients who seek care for low back pain. Previous studies suggest that chiropractors have high utilization rates of lumbar and full spine radiography. There has been a proliferation of evidence-based guidelines recommending that plain film radiography be used only to assess high-risk patients with low back pain. Evidence for the use of full spine radiography, except for the evaluation of scoliosis is lacking. It is uncertain what impact the growing evidence against their use has had on radiography utilization by Ontario chiropractors. To describe the annual costs and use of lumbar and full spine plain film radiography among Ontario chiropractors between 1994 and 2001. Time-trend analysis of radiography utilization by Ontario chiropractors. Chiropractic claims data submitted to the Ontario Health Insurance Plan or the Workplace Safety & Insurance Board from 1994/1995 to 2000/2001. Change in the annual cost and proportion of claimants receiving lumbar and full spine radiography. Time-trend analysis of chiropractic claims submitted to the Ontario Health Insurance Plan (OHIP) or Workplace Safety & Insurance Board (WSIB) from 1994/1995 to 2000/2001 fiscal years. During the 7-year period, the proportion of OHIP claimants receiving lumbar spine radiography decreased from 4.54% to 3.25% and for full spine radiography from 3.87% to 3.04%. For WSIB claimants, lumbar spine radiography deceased from 6.49% to 3.30% of claimants and full spine radiography from 1.51% to 0.94%. OHIP payments for lumbar spine radiography decreased 12.7% to $562,944, whereas full spine radiography payments decreased 5.3% to $1,071,408. WSIB lumbar and full spine radiography payments decreased 44.2% and 34.3% to $31,202 and $11,713 respectively. Claims data from the two largest third-party payers of chiropractic services in Ontario, suggest that lumbar and full spine radiography, and their associated costs decreased steadily between 1994 and 2001.

Analysis of Cost of Rework on Time and Cost Performance of Building Construction Projects in Abuja, Nigeria

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Emmanuel Chidiebere Eze

2018-01-01

Full Text Available Rework is a menace that leads to undesired and unnecessary loss of efforts, it degrades project cost and schedule performance of construction projects, both at design and construction phases. This study therefore, analyzed the impact of cost of rework on time and cost performance of building construction projects in Nigerian, using selected commercial building project within the country’s capital. A pro forma was adopted for gathering data on rework cost, project cost and time of selected building projects, while structured questionnaire was used to collect information on the likely measures for reducing rework incidences from construction professionals that were involved in the delivery of the identified projects. Regression analysis, relative importance index and Kruskal-Walis test were employed for data analysis. The study revealed a significant relationship between the cost of rework and initial and final project cost of delivering commercial buildings, as an average of 3.53% impact on the initial project cost, 46.60% contribution to cost overrun, and p-value of 0.000 was observed on all assessed projects. For the project delivery time, a significant relationship between the cost of rework and initial and final project duration, as an average of 7.35% impact on the initial delivery time, extra 19 days and p-value of 0.000 was observed on all assessed projects. Team building and education, management commitment, employee involvement, were some of the best possible measures to minimized rework problems.

Understanding Consumer Preference Between Low Cost Airlines and Full Service Carriers : A Study on Consumer Choice and Decisions

OpenAIRE

Lee, Alex Hoong Onn

2008-01-01

The emergence of low cost or no frills airlines in last decade or so have posed considerable threat to the businesses of traditional full service airlines. The competition between the different type of airlines have changed the landscape of the airline industry tremendously and have provided air travelers with options which are unprecedented. The aim of this study is to understand consumer preference between low cost and full service airlines and to determine what are the motivations or facto...

Purchasing motors under consideration of full-cost pricing; Beschaffung von Motoren unter der Vollkostenbetrachtung (inklusive Permanentmagneterregte-Synchronmotoren) - Schlussbericht

Energy Technology Data Exchange (ETDEWEB)

Mauchle, P. [Schnyder Ingenieure AG, Huenenberg (Switzerland); Ritz, Ch. [Schnyder Ingenieure AG, Steg (Switzerland)

2007-07-01

This final report for the Swiss Federal Office of Energy (SFOE) takes a look at how full-cost pricing should be considered when purchasing electric motors. The authors consider it essential that the overall life-cycle costs are carefully considered. This also guarantees economical operation and enables users to avoid unexpected costs throughout the service life of the motor. The aim of this project was to provide industrial companies with suitable tools for calculating the overall life-cycle costs of motors at the time of their acquisition. These tools take the form of a sample 'Call for Tender' for motors along with software for calculating life-cycle costs. The factors involved, such as investment, installation costs, energy and environmental costs as well as operational, maintenance and disposal costs are examined.

Comparative cost-effectiveness of a fluticasone-propionate/salmeterol combination versus anticholinergics as initial maintenance therapy for chronic obstructive pulmonary disease

Directory of Open Access Journals (Sweden)

An

2010-12-01

Full Text Available Anand A Dalal1, Melissa H Roberts2, Hans V Petersen2, Christopher M Blanchette3, Douglas W Mapel41US Health Outcomes, GlaxoSmithKline, Research Triangle Park, NC; 2Division of Clinical and Outcomes Research, Lovelace Respiratory Research Institute, Albuquerque, NM; 3Kannapolis, North Carolina; 4Lovelace Clinic Foundation, Albuquerque, NM, USAPurpose: Relative costs and utilization-related outcomes of a fluticasone propionate 250 µg + salmeterol 50 µg combination (FSC, tiotropium bromide, and ipratropium as initial maintenance therapy in COPD have not been compared in a commercially-insured population.Methods: This retrospective, observational cohort study used health care claims data from January 2004 to June 2009 from a large administrative database for patients aged ≥40 years with COPD. Time-to-first COPD-related health care event beginning 30 days following therapy initiation with FSC (n = 16,684, ipratropium alone or in fixed dose combination with albuterol (n = 14,449, or tiotropium (n = 12,659 was estimated using Cox proportional hazard models that controlled for differences in patient demographic characteristics, health care utilization, and comorbidities at baseline. Mean adjusted costs and numbers of COPD-related health care encounters and prescription medication fills were compared among patients with 12 months of follow-up (FSC, n = 12,595; ipratropium, n = 10,617; tiotropium, n = 9126.Results: With FSC as the reference, risk for a COPD-related hospitalization and/or emergency department visit was significantly higher for ipratropium (hazard ratio [HR] 1.64, 95% confidence interval [CI] 1.50–1.79 and tiotropium (HR 1.29, CI 1.17–1.41. Mean adjusted 12-month COPD-related total health care costs were lower for FSC ($2068, standard deviation [SD] $1190 than for ipratropium ($2841, SD $1858 and tiotropium ($2408, SD $1511, both P < 0.05. Mean number of COPD-related hospitalizations, emergency department visits, and outpatient

Making the Organization Fly Organizational Identification and Citizenship in Full-Service and Low-Cost Airlines

NARCIS (Netherlands)

Peters, K.; Tevichapong, Passagorn; Haslam, S. Alexander; Postmes, Tom

2010-01-01

Recently, the service industry has seen a low-cost sector emerge alongside the traditional full-service sector. We explored whether these business models have different implications for employee cooperation, one factor that plays an important role in organizational functioning. Drawing on the social

Cost-utility analysis of the fixed-dose combination of dolutegravir/abacavir/lamivudine as initial treatment of HIV+ patients in Spain

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Santiago Moreno Guillen

2017-09-01

Full Text Available Objective: Fixed-dose combinations of antiretroviral drugs have meant an important step forward in simplifying treatment and improving compliance and has led to an increased effectiveness of therapy, a viral load decrease and improving the quality of life of patients. The single-table formulation of dolutegravir with abacavir and lamivudine (DTG/ABC/3TC is a highly efficacious and well-tolerated once-daily regimen for HIV-infected patients. The objective of the study was to assess the incremental cost-utility ratio of the fixed-dose combination of (DTG/ABC/3TC versus the combinations emtricitabine/tenofovir/efavirenz (FTC/TDF/EFV, and darunavir/r (DRV/r or raltegravir (RAL with emtricitabine/tenofovir (FTC/TDF or abacavir/lamivudine (ABC/3TC as initial antiretroviral therapy in patients infected with HIV-1 from the perspective of the Spanish National Health System. Method: The ARAMIS model, which uses a microsimulation approach to simulate the individual changes in each patient from the start of treatment to death through a Markov chain of descriptive health states of the disease, was adapted to Spain. The alternatives used for comparison were the fixed-dose combination of emtricitabine/tenofovir/efavirenz (FTC/TDF/EFV, and the fixed- dose combinations of emtricitabine/tenofovir (FTC/TDF or abacavir/lamivudine (ABC/3TC with darunavir/r (DRV/r or raltegravir (RAL. The probability of achieving virological suppression by the treatments included in the model was obtained from clinical trials SINGLE, SPRING-2 and FLAMINGO and the costs were expressed in € (2015. The model use the perspective of the Spanish National Health System, with a lifetime horizon and a discount rate of 3% was applied to cost and effectiveness. Results: Treatment initiation with DTG/ABC/3TC was dominant when it was compared with treatment initiation with all the comparators: vs. FTC/TDF/EFV (-67 210.71€/QALY, vs. DRV/r + FTC/TDF or ABC/3TC (-1 787 341.44€/QALY, and vs

Initial investigation into lower-cost CT for resource limited regions of the world

Science.gov (United States)

Dobbins, James T., III; Wells, Jered R.; Segars, W. Paul; Li, Christina M.; Kigongo, Christopher J. N.

2010-04-01

This paper describes an initial investigation into means for producing lower-cost CT scanners for resource limited regions of the world. In regions such as sub-Saharan Africa, intermediate level medical facilities serving millions have no CT machines, and lack the imaging resources necessary to determine whether certain patients would benefit from being transferred to a hospital in a larger city for further diagnostic workup or treatment. Low-cost CT scanners would potentially be of immense help to the healthcare system in such regions. Such scanners would not produce state-of-theart image quality, but rather would be intended primarily for triaging purposes to determine the patients who would benefit from transfer to larger hospitals. The lower-cost scanner investigated here consists of a fixed digital radiography system and a rotating patient stage. This paper describes initial experiments to determine if such a configuration is feasible. Experiments were conducted using (1) x-ray image acquisition, a physical anthropomorphic chest phantom, and a flat-panel detector system, and (2) a computer-simulated XCAT chest phantom. Both the physical phantom and simulated phantom produced excellent image quality reconstructions when the phantom was perfectly aligned during acquisition, but artifacts were noted when the phantom was displaced to simulate patient motion. An algorithm was developed to correct for motion of the phantom and demonstrated success in correcting for 5-mm motion during 360-degree acquisition of images. These experiments demonstrated feasibility for this approach, but additional work is required to determine the exact limitations produced by patient motion.

Models of Disease Vector Control: When Can Aggressive Initial Intervention Lower Long-Term Cost?

Science.gov (United States)

Oduro, Bismark; Grijalva, Mario J; Just, Winfried

2018-04-01

Insecticide spraying of housing units is an important control measure for vector-borne infections such as Chagas disease. As vectors may invade both from other infested houses and sylvatic areas and as the effectiveness of insecticide wears off over time, the dynamics of (re)infestations can be approximated by [Formula: see text]-type models with a reservoir, where housing units are treated as hosts, and insecticide spraying corresponds to removal of hosts. Here, we investigate three ODE-based models of this type. We describe a dual-rate effect where an initially very high spraying rate can push the system into a region of the state space with low endemic levels of infestation that can be maintained in the long run at relatively moderate cost, while in the absence of an aggressive initial intervention the same average cost would only allow a much less significant reduction in long-term infestation levels. We determine some sufficient and some necessary conditions under which this effect occurs and show that it is robust in models that incorporate some heterogeneity in the relevant properties of housing units.

A simulation model to estimate the cost and effectiveness of alternative dialysis initiation strategies.

Science.gov (United States)

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

2006-01-01

Patients with end-stage renal disease (ESRD) require dialysis to maintain survival. The optimal timing of dialysis initiation in terms of cost-effectiveness has not been established. We developed a simulation model of individuals progressing towards ESRD and requiring dialysis. It can be used to analyze dialysis strategies and scenarios. It was embedded in an optimization frame worked to derive improved strategies. Actual (historical) and simulated survival curves and hospitalization rates were virtually indistinguishable. The model overestimated transplantation costs (10%) but it was related to confounding by Medicare coverage. To assess the model's robustness, we examined several dialysis strategies while input parameters were perturbed. Under all 38 scenarios, relative rankings remained unchanged. An improved policy for a hypothetical patient was derived using an optimization algorithm. The model produces reliable results and is robust. It enables the cost-effectiveness analysis of dialysis strategies.

Prevalence and cost of full-time research fellowships during general surgery residency: a national survey.

Science.gov (United States)

Robertson, Charles M; Klingensmith, Mary E; Coopersmith, Craig M

2009-01-01

To quantify the prevalence, outcomes, and cost of surgical resident research. General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1 to 3 years performing full-time research. No comprehensive data exists on the scope of this practice. Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program. Response rate was 200 of 239 (84%). A total of 381 of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and postresidency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (P < 0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of Accreditation Council for Graduate Medical Education work hour regulations for clinical residents, whereas a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%). Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. Although performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after postgraduate training.

Two-Year Costs and Quality in the Comprehensive Primary Care Initiative.

Science.gov (United States)

Dale, Stacy B; Ghosh, Arkadipta; Peikes, Deborah N; Day, Timothy J; Yoon, Frank B; Taylor, Erin Fries; Swankoski, Kaylyn; O'Malley, Ann S; Conway, Patrick H; Rajkumar, Rahul; Press, Matthew J; Sessums, Laura; Brown, Randall

2016-06-16

The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would produce changes in care delivery that would improve the quality and reduce the costs of care at 497 primary care practices in seven regions across the United States. Support included the provision of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support. We tracked changes in the delivery of care by practices participating in the initiative and used difference-in-differences regressions to compare changes over the first 2 years of the initiative in Medicare expenditures, health care utilization, claims-based measures of quality, and patient experience for Medicare fee-for-service beneficiaries attributed to initiative practices and a group of matched comparison practices. During the first 2 years, initiative practices received a median of $115,000 per clinician in care-management fees. The practices reported improvements in approaches to the delivery of primary care in areas such as management of the care of high-risk patients and enhanced access to care. Changes in average monthly Medicare expenditures per beneficiary did not differ significantly between initiative and comparison practices when care-management fees were not taken into account (-$11; 95% confidence interval [CI], -$23 to $1; P=0.07; negative values indicate less growth in spending at initiative practices) or when these fees were taken into account ($7; 95% CI, -$5 to $19; P=0.27). The only significant differences in other measures were a 3% reduction in primary care visits for initiative practices relative to comparison practices (Pinitiative practices relative to comparison practices (P=0.006 and Pinitiative have reported progress in transforming the delivery of primary care. However, at this point these practices have not yet shown savings in expenditures for Medicare Parts A and B after

Optimal Cost-Analysis and Design of Circular Footings

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Prabir K. Basudhar

2012-10-01

Full Text Available The study pertains to the optimal cost-analysis and design of a circular footing subjected to generalized loadings using sequential unconstrained minimization technique (SUMT in conjunction with Powell’s conjugate direction method for multidimensional search and quadratic interpolation method for one dimensional minimization. The cost of the footing is minimized satisfying all the structural and geotechnical engineering design considerations. As extended penalty function method has been used to convert the constrained problem into an unconstrained one, the developed technique is capable of handling both feasible and infeasible initial design vector. The net saving in cost starting from the best possible manual design ranges from 10 to 20 %. For all practical purposes, the optimum cost is independent of the initial design point. It was observed that for better convergence, the transition parameter  should be chosen at least 100 times the initial penalty parameter kr .

77 FR 33007 - Submission for Review: Initial Certification of Full-Time School Attendance, RI 25-41

Science.gov (United States)

2012-06-04

..., electronic, mechanical, or other technological collection techniques or other forms of information technology... OFFICE OF PERSONNEL MANAGEMENT Submission for Review: Initial Certification of Full-Time School... and other federal agencies the opportunity to comment on a revised information collection request (ICR...

77 FR 71200 - Submission for Review: Initial Certification of Full-Time School Attendance, RI 25-41

Science.gov (United States)

2012-11-29

..., mechanical, or other technological collection techniques or other forms of information technology, e.g... OFFICE OF PERSONNEL MANAGEMENT Submission for Review: Initial Certification of Full-Time School... and other federal agencies the opportunity to comment on a revised information collection request (ICR...

An Analysis of Costs and Cenefits Associated with Initial Contracting Technical Education and Training for Unrestricted Marine Officers

Science.gov (United States)

2017-03-01

Distance learning education can be very valuable for working adults, especially for busy service members. The NPS DLP offers a defense-focused...COSTS AND BENEFITS ASSOCIATED WITH INITIAL CONTRACTING TECHNICAL EDUCATION AND TRAINING FOR UNRESTRICTED MARINE OFFICERS by Lee A. White...WITH INITIAL CONTRACTING TECHNICAL EDUCATION AND TRAINING FOR UNRESTRICTED MARINE OFFICERS 5. FUNDING NUMBERS 6. AUTHOR(S) Lee A. White 7. PERFORMING

Integrating the Carbon and Water Footprints’ Costs in the Water Framework Directive 2000/60/EC Full Water Cost Recovery Concept: Basic Principles Towards Their Reliable Calculation and Socially Just Allocation

Directory of Open Access Journals (Sweden)

Anastasia Papadopoulou

2012-01-01

Full Text Available This paper presents the basic principles for the integration of the water and carbon footprints cost into the resource and environmental costs respectively, taking the suggestions set by the Water Framework Directive (WFD 2000/60/EC one step forward. WFD states that full water cost recovery (FWCR should be based on the estimation of the three sub-costs related: direct; environmental; and resource cost. It also strongly suggests the EU Member States develop and apply effective water pricing policies to achieve FWCR. These policies must be socially just to avoid any social injustice phenomena. This is a very delicate task to handle, especially within the fragile economic conditions that the EU is facing today. Water losses play a crucial role for the FWC estimation. Water losses should not be neglected since they are one of the major “water uses” in any water supply network. A methodology is suggested to reduce water losses and the related Non Revenue Water (NRW index. An Expert Decision Support System is proposed to assess the FWC incorporating the Water and Carbon Footprint costs.

Cost and performance of innovative remediation technologies

International Nuclear Information System (INIS)

Cummings, J.B.; Kingscott, J.W.; Fiedler, L.D.

1995-01-01

The selection and use of more cost-effective remedies requires better access to data on the performance and cost of technologies used in the field. To make data more widely available, the US Environmental Protection Agency is working jointly with member agencies of the Federal Remediation Technologies Round table to publish case studies of full-scale remediation and demonstration projects. EPA, DoD, and DOE have published case studies of cleanup projects primarily consisting of bioremediation, soil vapor extraction, and thermal desorption. Within the limits of this initial data set, the paper evaluates technology performance and cost. In the analysis of cost factors, the paper shows the use of a standardized Work Breakdown Structure (WBS). Use of the WBS will be important in future reporting of completed projects to facilitate cost comparison. The paper notes the limits to normalization and thus cross-site comparison which can be achieved using the WBS. The paper identifies conclusions from initial efforts to compile cost and performance data, highlights the importance of such efforts to the overall remediation effort, and discusses future cost and performance documentation efforts

Prevalence and Cost of Full-Time Research Fellowships During General Surgery Residency – A National Survey

Science.gov (United States)

Robertson, Charles M.; Klingensmith, Mary E.; Coopersmith, Craig M.

2009-01-01

Structured Abstract Objective To quantify the prevalence, outcomes, and cost of surgical resident research. Summary Background Data General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1-3 years performing full-time research. No comprehensive data exists on the scope of this practice. Methods Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program. Results Response rate was 200/239 (84%). A total of 381 out of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and post-residency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (p<0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of ACGME work hour regulations for clinical residents, while a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%). Conclusions Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. While performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after post-graduate training. PMID:19106692

Treatment Patterns and Associated Health Care Costs Before and After Treatment Initiation Among Pulmonary Arterial Hypertension Patients in the United States.

Science.gov (United States)

Burger, Charles D; Ozbay, A Burak; Lazarus, Howard M; Riehle, Ellen; Montejano, Leslie B; Lenhart, Gregory; White, R James

2018-02-13

Despite multiple treatment options, the prognosis of pulmonary arterial hypertension (PAH) remains poor. PAH patients experience a high economic burden due to comorbidities, hospitalizations, and medication costs. Although combination therapy has been shown to reduce hospitalizations, the relationship between treatment, health care utilization, and costs remains unclear. To provide a characterization of health care utilization and costs in real-world settings by comparing periods before and after initiating PAH-specific treatment. This retrospective study identified PAH patients in the Truven Health MarketScan Commercial and Medicare Supplemental Databases between 2010 and 2014 who initiated treatment with endothelin receptor antagonists (ERAs), phosphodiesterase-5 inhibitors (PDE-5Is), or soluble guanylate cyclase (sGC) stimulators. The index date was the date of the first PAH pharmacy claim. We included patients with ≥ 2 medical claims with diagnoses for PAH (ICD-9-CM: 416.0, 416.8) or PAH-related conditions and continuous enrollment in medical and pharmacy benefits for the 6 months before and after the index date. Treatment patterns were assessed at the drug class level (ERAs, PDE-5Is, sGC stimulators, and prostacyclins) from outpatient pharmacy claims during the 6-month post-index period. All-cause and PAH-related utilization and costs were measured. McNemar's and paired t-tests were used to compare patients' health care resource utilization and costs in the 6-month pre- and posttreatment periods. A total of 3,908 patients met the selection criteria. The study sample was 63% female with a mean age of 63 ± 15 years. Only 5% of patients began initial combination therapy for PAH, defined as claims for ≥ 2 medication classes within the first 30 days of treatment. Treatment interruption (≥ 30-day gap in days supply) of any PAH-specific medication was observed in 38% of patients. Compared with the 6-month pre-index period, the proportion of patients in the 6

Combining Time-Driven Activity-Based Costing with Clinical Outcome in Cost-Effectiveness Analysis to Measure Value in Treatment of Depression.

Directory of Open Access Journals (Sweden)

Samir El Alaoui

Full Text Available A major challenge of mental health care is to provide safe and effective treatment with limited resources. The main purpose of this study was to examine a value-based approach in clinical psychiatry when evaluating a process improvement initiative. This was accomplished by using the relatively new time driven activity based costing (TDABC method within the more widely adopted cost-effectiveness analysis framework for economic evaluation of healthcare technologies. The objective was to evaluate the cost-effectiveness of allowing psychologists to perform post-treatment assessment previously performed by psychiatrists at an outpatient clinic treating depression using internet-based cognitive-behavioral therapy (ICBT.Data was collected from 568 adult patients treated with ICBT for depression during 2013-2014. The TDABC methodology was used to estimate total healthcare costs, including development of process maps for the complete cycle of care and estimation of resource use and minute costs of staff, hospital space and materials based on their relative proportions used. Clinical outcomes were measured using the Patient Health Questionnaire depression scale (PHQ-9 before and after treatment and at 6-month follow-up. Cost-effectiveness analyses (CEA was performed and the results presented as incremental net benefits (INB, cost-effectiveness acceptability curves (CEACs and confidence ellipses to demonstrate uncertainty around the value of the organizational intervention.Taking into account the complete healthcare process (from referral to follow-up assessment, treatment costs decreased from $709 (SD = $130 per patient in 2013 to $659 (SD = $134 in 2014 while treatment effectiveness was maintained; 27% had achieved full remission from depression after treatment (PHQ-9 < 5 during both 2013 and 2014 and an additional 35% and 33% had achieved partial remission in 2013 and 2014, respectively. At follow-up, 42% were in full remission after treatment during

Full-scale testing, production and cost analysis data for the advanced composite stabilizer for Boeing 737 aircraft. Volume 1: Technical summary

Science.gov (United States)

Aniversario, R. B.; Harvey, S. T.; Mccarty, J. E.; Parsons, J. T.; Peterson, D. C.; Pritchett, L. D.; Wilson, D. R.; Wogulis, E. R.

1983-01-01

The full scale ground test, ground vibration test, and flight tests conducted to demonstrate a composite structure stabilizer for the Boeing 737 aircraft and obtain FAA certification are described. Detail tools, assembly tools, and overall production are discussed. Cost analyses aspects covered include production costs, composite material usage factors, and cost comparisons.

Literature review of the passenger airline business models : Full service carrier, low-cost carrier and charter airlines

NARCIS (Netherlands)

Carmona Benitez, R.B.; Lodewijks, G.

2008-01-01

The deregulation and liberalization of the air transportation industry have developed three main passenger business models: full service carriers, low-cost carriers, and charter airlines. Deregulation removed regulated fares and routes increasing competition and yields. Airlines business models main

Cost-effectiveness of initiating antiretroviral therapy at different points in TB treatment in HIV-TB co-infected ambulatory patients in South Africa

Science.gov (United States)

Naidoo, Kogieleum; Grobler, Anneke C; Deghaye, Nicola; Reddy, Tarylee; Gengiah, Santhanalakshmi; Gray, Andrew; Karim, Salim Abdool

2015-01-01

Objective Initiation of antiretroviral therapy (ART) during tuberculosis (TB) treatment improves survival in TB-HIV co-infected patients. In patients with CD4+ counts benefit of early ART initiation. The purpose of this study was to assess the costs and cost effectiveness of starting ART at various time points during TB treatment in patients with CD4+ counts ≥50cells/mm3. Methods In the SAPiT trial, 642 HIV-TB co-infected patients were randomized to three arms, either receiving ART within 4 weeks of starting TB treatment (early treatment arm; Arm-1), after the intensive phase of TB treatment (late treatment arm; Arm-2), or after completing TB treatment (sequential arm; Arm-3). Direct healthcare costs were measured from a provider perspective using a micro-costing approach. The incremental cost per death averted was calculated using the trial outcomes. Results For patients with CD4+ count≥50cells/mm3, median monthly variable costs per patient were $116, $113 and $102 in Arms-1, -2 and -3, respectively. There were 12 deaths in 177 patients in Arm-1, 8 deaths in 180 patients in the Arm-2 and 19 deaths in 172 patients in Arm-3. While the costs were lower in Arm-3, it had a substantially higher mortality rate. The incremental cost per death averted associated with moving from Arm-3 to Arm-2 was $4199. There was no difference in mortality between Arm-1 and Arm-2, but Arm-1 was slightly more expensive. Conclusions Initiation of ART after the completion of the intensive phase of TB treatment is cost effective for patients with CD4+ counts≥50cells/mm3. PMID:26167618

overall cost in recurrent soft-tissue sarcoma

Directory of Open Access Journals (Sweden)

Arash O. Naghavi

2017-01-01

Full Text Available Purpose : Adjuvant brachytherapy (AB with immediate (IR and staged reconstruction (SR are distinct treatment modalities available for patients with recurrent soft tissue sarcoma (STS. Although SR may offer local control and toxicity benefit, it requires additional upfront procedures, and there is no evidence that it improves overall survival. With the importance of value-based care, our goal is to identify which technique is more cost effective. Material and methods : A retrospective review of 22 patients with recurrent extremity STS treated with resection followed by AB alone. Hospital charges were used to compare the cost between SR and IR at the time of initial treatment, at 6-month intervals following surgery, and cumulative cost comparisons at 18 months. Results : Median follow-up was 31 months. Staged reconstruction (n = 12 was associated with an 18-month local control benefit (85% vs. 42%, p = 0.034, compared to IR (n = 10. Staged reconstruction had a longer hospital stay during initial treatment (10 vs. 3 days, p = 0.002, but at 18 months, the total hospital stay was no longer different (11 vs. 11 days. Initially, there was no difference in the cost of SR and IR. With longer follow-up, cost eventually favored SR, which was attributed primarily to the costs associated with local failure (LF. On multivariate analysis, cost of initial treatment was associated with length of hospital stay (~$4.5K per hospital day, p < 0.001, and at 18 months, the cumulative cost was ~175K lower with SR (p = 0.005 and $58K higher with LF (p = 0.02. Conclusions : In recurrent STS, SR has a longer initial hospital stay when compared to IR. At 18 months, SR had lower rates of LF, translating to lower total costs for the patient. SR is the more cost-effective brachytherapy approach in the treatment of STS, and should be considered as healthcare transitions into value-based medicine.

Construction cost prediction model for conventional and sustainable college buildings in North America

Directory of Open Access Journals (Sweden)

Othman Subhi Alshamrani

2017-03-01

Full Text Available The literature lacks in initial cost prediction models for college buildings, especially comparing costs of sustainable and conventional buildings. A multi-regression model was developed for conceptual initial cost estimation of conventional and sustainable college buildings in North America. RS Means was used to estimate the national average of construction costs for 2014, which was subsequently utilized to develop the model. The model could predict the initial cost per square feet with two structure types made of steel and concrete. The other predictor variables were building area, number of floors and floor height. The model was developed in three major stages, such as preliminary diagnostics on data quality, model development and validation. The developed model was successfully tested and validated with real-time data.

Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia

Science.gov (United States)

Graves, Nicholas; Page, Katie; Martin, Elizabeth; Brain, David; Hall, Lisa; Campbell, Megan; Fulop, Naomi; Jimmeison, Nerina; White, Katherine; Paterson, David; Barnett, Adrian G.

2016-01-01

Background The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included. Methods The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011–2012. Findings No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits. Conclusions The Australian National Hand

Costing the lifecycle of networked learning: documenting the costs from conception to evaluation

Directory of Open Access Journals (Sweden)

Paul Bacsich

2000-12-01

Full Text Available Analysing the costs of new learning technologies within the educational sector is currently a neglected area, yet the issue of how to spend money effectively in this context is a question that must be answered. This question is made especially pertinent with the current expansion of information technology into higher and further education. To know the costeffectiveness of these initiatives, it is first necessary to gain some comprehension of the costs involved. This must be done in a way that is comprehensible to everyone in academia. A recently completed research study undertaken by the authors addressed these problems.

Synthesis of the ICT4RED initiative

CSIR Research Space (South Africa)

Herselman, M

2014-12-01

Full Text Available on Sustainability and how value is derived through improved decision-making. The issue of sustainability, and how it plays an important role in the ICT4RED initiative, is discussed. Total Cost of Ownership-, Cost utility- and Tablet selection-models, which were...&E), models, guidelines and tools. Arranged access to digital content on the content servers at each school which teachers and learners can download via Wi-Fi to their tablets. Access to McMillan and Pearson e-books. Developed processes...

Unbundling payments for radioisotopes from radiopharmaceuticals and from diagnostic procedures: A tool to support the implementation of full-cost recovery. NEA discussion document

International Nuclear Information System (INIS)

2012-01-01

The objective of the NEA's HLG-MR policy approach is to ensure a long-term secure supply. The HLG-MR has determined that to attain that objective, a necessary (but not sufficient) requirement is that irradiation services in the 99 Mo/ 99m Tc supply chain must be provided on a full-cost recovery (FCR) basis (OECD-NEA, 2011). The HLG-MR policy approach also recommended that supply chain participants should implement payment reforms that promote full-cost recovery within their reimbursement systems. Reforms might include separate radioisotope pricing or auditing, separate radioisotope payment, differential radioisotope payment for FCR, or other approaches to promote a complete transition to full-cost recovery

Combining Time-Driven Activity-Based Costing with Clinical Outcome in Cost-Effectiveness Analysis to Measure Value in Treatment of Depression.

Science.gov (United States)

El Alaoui, Samir; Lindefors, Nils

2016-01-01

A major challenge of mental health care is to provide safe and effective treatment with limited resources. The main purpose of this study was to examine a value-based approach in clinical psychiatry when evaluating a process improvement initiative. This was accomplished by using the relatively new time driven activity based costing (TDABC) method within the more widely adopted cost-effectiveness analysis framework for economic evaluation of healthcare technologies. The objective was to evaluate the cost-effectiveness of allowing psychologists to perform post-treatment assessment previously performed by psychiatrists at an outpatient clinic treating depression using internet-based cognitive-behavioral therapy (ICBT). Data was collected from 568 adult patients treated with ICBT for depression during 2013-2014. The TDABC methodology was used to estimate total healthcare costs, including development of process maps for the complete cycle of care and estimation of resource use and minute costs of staff, hospital space and materials based on their relative proportions used. Clinical outcomes were measured using the Patient Health Questionnaire depression scale (PHQ-9) before and after treatment and at 6-month follow-up. Cost-effectiveness analyses (CEA) was performed and the results presented as incremental net benefits (INB), cost-effectiveness acceptability curves (CEACs) and confidence ellipses to demonstrate uncertainty around the value of the organizational intervention. Taking into account the complete healthcare process (from referral to follow-up assessment), treatment costs decreased from $709 (SD = $130) per patient in 2013 to $659 (SD = $134) in 2014 while treatment effectiveness was maintained; 27% had achieved full remission from depression after treatment (PHQ-9 cost-effectiveness plane at both post-treatment and at follow-up, indicating that the ICBT treatment was less costly and equally effective after staff reallocation. Treating patients to the target

Perhitungan Biaya Produksi Ayam Bakar Dengan Metode Full Costing (Studi Kasus Ayam Bakar Kaki Lima Jalan Dr. Mansyur Iii Padang Bulan Medan)

OpenAIRE

Marthsari, Rica

2016-01-01

To avoid errors in the calculation of cost of production and cost efficient to produce required an appropriate method. The exact method used in calculating the cost of production is the full costing method. As for the problem of this research is an error in the calculation of production costs generated often causes the price is set too low or too high. This resulted in an incompatibility of the expected profit with the actual profit we earn. The purpose of this study is to analyze the prod...

Building a good initial model for full-waveform inversion using frequency shift filter

Science.gov (United States)

Wang, Guanchao; Wang, Shangxu; Yuan, Sanyi; Lian, Shijie

2018-05-01

Accurate initial model or available low-frequency data is an important factor in the success of full waveform inversion (FWI). The low-frequency helps determine the kinematical relevant components, low-wavenumber of the velocity model, which are in turn needed to avoid FWI trap in local minima or cycle-skipping. However, in the field, acquiring data that common point of low- and high-frequency signal, then utilize the high-frequency data to obtain the low-wavenumber velocity model. It is well known that the instantaneous amplitude envelope of a wavelet is invariant under frequency shift. This means that resolution is constant for a given frequency bandwidth, and independent of the actual values of the frequencies. Based on this property, we develop a frequency shift filter (FSF) to build the relationship between low- and high-frequency information with a constant frequency bandwidth. After that, we can use the high-frequency information to get a plausible recovery of the low-wavenumber velocity model. Numerical results using synthetic data from the Marmousi and layer model demonstrate that our proposed envelope misfit function based on the frequency shift filter can build an initial model with more accurate long-wavelength components, when low-frequency signals are absent in recorded data.

Restoration ecology: two-sex dynamics and cost minimization.

Directory of Open Access Journals (Sweden)

Ferenc Molnár

Full Text Available We model a spatially detailed, two-sex population dynamics, to study the cost of ecological restoration. We assume that cost is proportional to the number of individuals introduced into a large habitat. We treat dispersal as homogeneous diffusion in a one-dimensional reaction-diffusion system. The local population dynamics depends on sex ratio at birth, and allows mortality rates to differ between sexes. Furthermore, local density dependence induces a strong Allee effect, implying that the initial population must be sufficiently large to avert rapid extinction. We address three different initial spatial distributions for the introduced individuals; for each we minimize the associated cost, constrained by the requirement that the species must be restored throughout the habitat. First, we consider spatially inhomogeneous, unstable stationary solutions of the model's equations as plausible candidates for small restoration cost. Second, we use numerical simulations to find the smallest rectangular cluster, enclosing a spatially homogeneous population density, that minimizes the cost of assured restoration. Finally, by employing simulated annealing, we minimize restoration cost among all possible initial spatial distributions of females and males. For biased sex ratios, or for a significant between-sex difference in mortality, we find that sex-specific spatial distributions minimize the cost. But as long as the sex ratio maximizes the local equilibrium density for given mortality rates, a common homogeneous distribution for both sexes that spans a critical distance yields a similarly low cost.

The cost of antiretroviral therapy in Haiti

Directory of Open Access Journals (Sweden)

Fitzgerald Daniel W

2008-02-01

Full Text Available Abstract Background We determined direct medical costs, overhead costs, societal costs, and personnel requirements for the provision of antiretroviral therapy (ART to patients with AIDS in Haiti. Methods We examined data from 218 treatment-naïve adults who were consecutively initiated on ART at the GHESKIO Center in Port-au-Prince, Haiti between December 23, 2003 and May 20, 2004 and calculated costs and personnel requirements for the first year of ART. Results The mean total cost of treatment per patient was $US 982 including $US 846 in direct costs, $US 114 for overhead, and $US 22 for societal costs. The direct cost per patient included generic ART medications $US 355, lab tests $US 130, nutrition $US 117, hospitalizations $US 62, pre-ART evaluation $US 58, labor $US 51, non-ART medications $US 39, outside referrals $US 31, and telephone cards for patient retention $US 3. Higher treatment costs were associated with hospitalization, change in ART regimen, TB treatment, and survival for one year. We estimate that 1.5 doctors and 2.5 nurses are required to treat 1000 patients in the first year after initiating ART. Conclusion Initial ART treatment in Haiti costs approximately $US 1,000 per patient per year. With generic first-line antiretroviral drugs, only 36% of the cost is for medications. Patients who change regimens are significantly more expensive to treat, highlighting the need for less-expensive second-line drugs. There may be sufficient health care personnel to treat all HIV-infected patients in urban areas of Haiti, but not in rural areas. New models of HIV care are needed for rural areas using assistant medical officers and community health workers.

Impact of initiation of asenapine on patterns of utilization and cost of healthcare resources associated with the treatment of bipolar I disorder.

Science.gov (United States)

Chitnis, Abhishek; Wang, Rosa; Sun, Shawn X; Dixit, Shailja; Tawah, Alie; Boulanger, Luke

2015-01-01

To assess the impact of initiation of asenapine on "real-world" levels of utilization and cost of healthcare services for the treatment of bipolar I disorder (BPD) in the US. Using two large US healthcare claims databases that collectively included commercially insured patients aged a BPD diagnosis, plus psychiatric medications and the costs thereof (2012 dollars) were deemed 'BPD-related'. Differences in BPD-related utilization and cost of healthcare services were compared between the pre- and post-index periods. A total of 1403 patients met all selection criteria; the mean age was 42.8 years and 70.6% were women. Relative to pre-index, significant decreases were noted in post-index use of BPD-related healthcare services, most notably admissions (from 24.0% to 12.3% during the post-index period) and emergency department visits (from 4.6% to 2.6%) (both p levels of utilization of BPD-related healthcare services and costs decreased during the 6-month period immediately following initiation of asenapine therapy.

Application of light-initiated explosive for simulating x-ray blowoff impulse effects on a full scale reentry vehicle

International Nuclear Information System (INIS)

Benham, R.A.; Mathews, F.H.; Higgins, P.B.

1976-01-01

Laboratory nuclear effects testing allows the study of reentry vehicle response to simulated exoatmospheric x-ray encounters. Light-initiated explosive produces the nearly simultaneous impulse loading of a structure by using a spray painted coating of explosive which is detonated by an intense flash of light. A lateral impulse test on a full scale reentry vehicle is described which demonstrates that the light-initiated explosive technique can be extended to the lateral loading of very large systems involving load discontinuities. This experiment required the development of a diagnostic method for verifying the applied impulse, and development of a large light source for simultaneously initiating the explosive over the surface of the vehicle. Acceptable comparison between measured strain response and code predictions is obtained. The structural capability and internal response of a vehicle subjected to an x-ray environment was determined from a light-initiated explosive test

Cost-effectiveness of magnetic resonance imaging versus ultrasound for the detection of symptomatic full-thickness supraspinatus tendon tears.

Science.gov (United States)

Gyftopoulos, Soterios; Guja, Kip E; Subhas, Naveen; Virk, Mandeep S; Gold, Heather T

2017-12-01

The purpose of this study was to determine the value of magnetic resonance imaging (MRI) and ultrasound-based imaging strategies in the evaluation of a hypothetical population with a symptomatic full-thickness supraspinatus tendon (FTST) tear using formal cost-effectiveness analysis. A decision analytic model from the health care system perspective for 60-year-old patients with symptoms secondary to a suspected FTST tear was used to evaluate the incremental cost-effectiveness of 3 imaging strategies during a 2-year time horizon: MRI, ultrasound, and ultrasound followed by MRI. Comprehensive literature search and expert opinion provided data on cost, probability, and quality of life estimates. The primary effectiveness outcome was quality-adjusted life-years (QALYs) through 2 years, with a willingness-to-pay threshold set to $100,000/QALY gained (2016 U.S. dollars). Costs and health benefits were discounted at 3%. Ultrasound was the least costly strategy ($1385). MRI was the most effective (1.332 QALYs). Ultrasound was the most cost-effective strategy but was not dominant. The incremental cost-effectiveness ratio for MRI was $22,756/QALY gained, below the willingness-to-pay threshold. Two-way sensitivity analysis demonstrated that MRI was favored over the other imaging strategies over a wide range of reasonable costs. In probabilistic sensitivity analysis, MRI was the preferred imaging strategy in 78% of the simulations. MRI and ultrasound represent cost-effective imaging options for evaluation of the patient thought to have a symptomatic FTST tear. The results indicate that MRI is the preferred strategy based on cost-effectiveness criteria, although the decision between MRI and ultrasound for an imaging center is likely to be dependent on additional factors, such as available resources and workflow. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Full-field and anomaly initialization using a low-order climate model: a comparison and proposals for advanced formulations

Science.gov (United States)

Carrassi, A.; Weber, R. J. T.; Guemas, V.; Doblas-Reyes, F. J.; Asif, M.; Volpi, D.

2014-04-01

Initialization techniques for seasonal-to-decadal climate predictions fall into two main categories; namely full-field initialization (FFI) and anomaly initialization (AI). In the FFI case the initial model state is replaced by the best possible available estimate of the real state. By doing so the initial error is efficiently reduced but, due to the unavoidable presence of model deficiencies, once the model is let free to run a prediction, its trajectory drifts away from the observations no matter how small the initial error is. This problem is partly overcome with AI where the aim is to forecast future anomalies by assimilating observed anomalies on an estimate of the model climate. The large variety of experimental setups, models and observational networks adopted worldwide make it difficult to draw firm conclusions on the respective advantages and drawbacks of FFI and AI, or to identify distinctive lines for improvement. The lack of a unified mathematical framework adds an additional difficulty toward the design of adequate initialization strategies that fit the desired forecast horizon, observational network and model at hand. Here we compare FFI and AI using a low-order climate model of nine ordinary differential equations and use the notation and concepts of data assimilation theory to highlight their error scaling properties. This analysis suggests better performances using FFI when a good observational network is available and reveals the direct relation of its skill with the observational accuracy. The skill of AI appears, however, mostly related to the model quality and clear increases of skill can only be expected in coincidence with model upgrades. We have compared FFI and AI in experiments in which either the full system or the atmosphere and ocean were independently initialized. In the former case FFI shows better and longer-lasting improvements, with skillful predictions until month 30. In the initialization of single compartments, the best

Un-bundling payments for radioisotopes from radiopharmaceuticals and from diagnostic procedures: A tool to support the implementation of full-cost recovery - NEA discussion document

International Nuclear Information System (INIS)

2012-09-01

The objective of the NEA's HLG-MR policy approach is to ensure a long-term secure supply. The HLG-MR has determined that to attain that objective, a necessary (but not sufficient) requirement is that irradiation services in the 99 Mo/' 99m Tc supply chain must be provided on a full-cost recovery (FCR) basis (OECD-NEA, 2011). The HLG-MR policy approach also recommended that supply chain participants should implement payment reforms that promote full-cost recovery within their reimbursement systems. Reforms might include separate radioisotope pricing or auditing, separate radioisotope payment, differential radioisotope payment for FCR, or other approaches to promote a complete transition to full-cost recovery. This paper is written to provide a basis for further discussion on the use of separate reimbursement to encourage the move to full-cost recovery. Separate reimbursement is one tool that could be used by public and private health insurance to support the move to ensuring sufficient reimbursement rates (or payments) for 99 Mo/' 99m Tc while the industry moves to full-cost recovery for irradiation services, paying for outage reserve capacity and transitioning to using LEU targets. Other tools are available (such as differential payments, separate radioisotope payments, auditing) that could lead to similar outcomes that support the changes necessary in the 99 Mo/' 99m Tc supply chain to ensure a long-term reliable supply of these important medical isotopes

Initial results from a charge exchange q-diagnostic on TEXT-U

International Nuclear Information System (INIS)

Valanju, P.M.; Duraiappah, L.; Bengtson, R.D.; Karzhavin, Y.; Nikitin, A.

1994-01-01

The authors present initial results from a new q-diagnostic for TEXT-Upgrade. This method is based on using a toroidal array of detectors to determine the plane in which beam-injected neutrals are emitted after two charge-exchange collisions. The potential advantages are low cost, full plasma accessibility, and good time resolution. Their initial series of experiments on TEXT-U established the feasibility of this technique

Estimation of marginal costs at existing waste treatment facilities

DEFF Research Database (Denmark)

Martinez Sanchez, Veronica; Hulgaard, Tore; Hindsgaul, Claus

2016-01-01

, marginal costs were not (provided a response was initiated at the WtE to keep constant the utilized thermal capacity). Failing to systematically address and include costs in existing waste facilities in decision-making may unintendedly lead to higher overall costs at societal level. To avoid misleading...... a constant thermal load, (ii) Refused-Derived-Fuel (RDF) was included to maintain a constant thermal load, or (iii) no reaction occurred resulting in a reduced waste throughput without full utilization of the facility capacity. Results demonstrated that marginal costs of diversion from WtE were up to eleven...

Revision Arthroscopic Repair Versus Latarjet Procedure in Patients With Recurrent Instability After Initial Repair Attempt: A Cost-Effectiveness Model.

Science.gov (United States)

Makhni, Eric C; Lamba, Nayan; Swart, Eric; Steinhaus, Michael E; Ahmad, Christopher S; Romeo, Anthony A; Verma, Nikhil N

2016-09-01

To compare the cost-effectiveness of arthroscopic revision instability repair and Latarjet procedure in treating patients with recurrent instability after initial arthroscopic instability repair. An expected-value decision analysis of revision arthroscopic instability repair compared with Latarjet procedure for recurrent instability followed by failed repair attempt was modeled. Inputs regarding procedure cost, clinical outcomes, and health utilities were derived from the literature. Compared with revision arthroscopic repair, Latarjet was less expensive ($13,672 v $15,287) with improved clinical outcomes (43.78 v 36.76 quality-adjusted life-years). Both arthroscopic repair and Latarjet were cost-effective compared with nonoperative treatment (incremental cost-effectiveness ratios of 3,082 and 1,141, respectively). Results from sensitivity analyses indicate that under scenarios of high rates of stability postoperatively, along with improved clinical outcome scores, revision arthroscopic repair becomes increasingly cost-effective. Latarjet procedure for failed instability repair is a cost-effective treatment option, with lower costs and improved clinical outcomes compared with revision arthroscopic instability repair. However, surgeons must still incorporate clinical judgment into treatment algorithm formation. Level IV, expected value decision analysis. Copyright © 2016. Published by Elsevier Inc.

The Role of Logistics in Practical Levelized Cost of Energy Reduction Implementation and Government Sponsored Cost Reduction Studies: Day and Night in Offshore Wind Operations and Maintenance Logistics

Directory of Open Access Journals (Sweden)

Thomas Poulsen

2017-04-01

Full Text Available This paper reveals that logistics make up at least 17% of annual operational expenditure costs for offshore wind farms. Annual operational expenditure is found to vary by a factor of 9.5, making its share of levelized cost of energy for offshore wind range from 13% to 57%. These are key findings of a 20-month research project targeting cost reduction initiatives for offshore wind systems. The findings reveal that cost-out measures are difficult to implement due to cultural differences. Implementation efforts are rendered by personnel located offshore in a harsh sea environment which is in stark contrast to the shore-based office personnel who develop studies directing cost reduction efforts. This paper details the company motivation to join industry-wide cost reduction initiatives. A business case for offshore wind operations and maintenance logistics yielding 1% savings in levelized cost of energy is included on how to expand working hours from daytime to also work at night.

Benefit-Cost Analysis of Undergraduate Education Programs: An Example Analysis of the Freshman Research Initiative.

Science.gov (United States)

Walcott, Rebecca L; Corso, Phaedra S; Rodenbusch, Stacia E; Dolan, Erin L

2018-01-01

Institutions and administrators regularly have to make difficult choices about how best to invest resources to serve students. Yet economic evaluation, or the systematic analysis of the relationship between costs and outcomes of a program or policy, is relatively uncommon in higher education. This type of evaluation can be an important tool for decision makers considering questions of resource allocation. Our purpose with this essay is to describe methods for conducting one type of economic evaluation, a benefit-cost analysis (BCA), using an example of an existing undergraduate education program, the Freshman Research Initiative (FRI) at the University of Texas Austin. Our aim is twofold: to demonstrate how to apply BCA methodologies to evaluate an education program and to conduct an economic evaluation of FRI in particular. We explain the steps of BCA, including assessment of costs and benefits, estimation of the benefit-cost ratio, and analysis of uncertainty. We conclude that the university's investment in FRI generates a positive return for students in the form of increased future earning potential. © 2018 R. L. Walcott et al. CBE—Life Sciences Education © 2018 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Dynamic modeling and simulation of power transformer maintenance costs

Directory of Open Access Journals (Sweden)

Ristić Olga

2016-01-01

Full Text Available The paper presents the dynamic model of maintenance costs of the power transformer functional components. Reliability is modeled combining the exponential and Weibull's distribution. The simulation was performed with the aim of corrective maintenance and installation of the continuous monitoring system of the most critical components. Simulation Dynamic System (SDS method and VENSIM PLE software was used to simulate the cost. In this way, significant savings in maintenance costs will be achieved with a small initial investment. [Projekat Ministarstva nauke Republike Srbije, br. III 41025 i br. OI 171007

Benchmarking for Cost Improvement. Final report

Energy Technology Data Exchange (ETDEWEB)

1993-09-01

The US Department of Energy`s (DOE) Office of Environmental Restoration and Waste Management (EM) conducted the Benchmarking for Cost Improvement initiative with three objectives: Pilot test benchmarking as an EM cost improvement tool; identify areas for cost improvement and recommend actions to address these areas; provide a framework for future cost improvement. The benchmarking initiative featured the use of four principal methods (program classification, nationwide cost improvement survey, paired cost comparison and component benchmarking). Interested parties contributed during both the design and execution phases. The benchmarking initiative was conducted on an accelerated basis. Of necessity, it considered only a limited set of data that may not be fully representative of the diverse and complex conditions found at the many DOE installations. The initiative generated preliminary data about cost differences and it found a high degree of convergence on several issues. Based on this convergence, the report recommends cost improvement strategies and actions. This report describes the steps taken as part of the benchmarking initiative and discusses the findings and recommended actions for achieving cost improvement. The results and summary recommendations, reported below, are organized by the study objectives.

The Haiti Breast Cancer Initiative: Initial Findings and Analysis of Barriers-to-Care Delaying Patient Presentation

Directory of Open Access Journals (Sweden)

Ketan Sharma

2013-01-01

Full Text Available Background. In Haiti, breast cancer patients present at such advanced stages that even modern therapies offer modest survival benefit. Identifying the personal, sociocultural, and economic barriers-to-care delaying patient presentation is crucial to controlling disease. Methods. Patients presenting to the Hôpital Bon Sauveur in Cange were prospectively accrued. Delay was defined as 12 weeks or longer from initial sign/symptom discovery to presentation, as durations greater than this cutoff correlate with reduced survival. A matched case-control analysis with multivariate logistic regression was used to identify factors predicting delay. Results. Of N=123 patients accrued, 90 (73% reported symptom-presentation duration and formed the basis of this study: 52 patients presented within 12 weeks of symptoms, while 38 patients waited longer than 12 weeks. On logistic regression, lower education status (OR = 5.6, P=0.03, failure to initially recognize mass as important (OR = 13.0, P<0.01, and fear of treatment cost (OR = 8.3, P=0.03 were shown to independently predict delayed patient presentation. Conclusion. To reduce stage at presentation, future interventions must educate patients on the recognition of initial breast cancer signs and symptoms and address cost concerns by providing care free of charge and/or advertising that existing care is already free.

Decreased health care utilization and health care costs in the inpatient and emergency department setting following initiation of ketogenic diet in pediatric patients: The experience in Ontario, Canada.

Science.gov (United States)

Whiting, Sharon; Donner, Elizabeth; RamachandranNair, Rajesh; Grabowski, Jennifer; Jetté, Nathalie; Duque, Daniel Rodriguez

2017-03-01

To assess the change in inpatient and emergency department utilization and health care costs in children on the ketogenic diet for treatment of epilepsy. Data on children with epilepsy initiated on the ketogenic diet (KD) Jan 1, 2000 and Dec 31, 2010 at Ontario pediatric hospitals were linked to province wide inpatient, emergency department (ED) data at the Institute for Clinical Evaluative Sciences. ED and inpatient visits and costs for this cohort were compared for a maximum of 2 years (730days) prior to diet initiation and for a maximum of 2 years (730days) following diet initiation. KD patient were compared to matched group of children with epilepsy who did not receive the ketogenic diet (no KD). Children on the KD experienced a mean decrease in ED visits of 2.5 visits per person per year [95% CI (1.5-3.4)], and a mean decrease of 0.8 inpatient visits per person per year [95% CI (0.3-1.3)], following diet initiation. They had a mean decrease in ED costs of $630 [95% CI (249-1012)] per person per year and a median decrease in inpatient costs of $1059 [IQR: 7890; pdiet experienced a mean reduction of 2.1 ED visits per child per year [95% CI (1.0-3.2)] and a mean decrease of 0.6 [95% CI (0.1-1.1)] inpatient visits per child per year. Patients on the KD experienced a reduction of $442 [95% CI (34.4-850)] per child per year more in ED costs than the matched group. The ketogenic diet group had greater median decrease in inpatient costs per child per year than the matched group [pketogenic diet, experienced decreased ED and inpatient visits as well as costs following diet initiation in Ontario, Canada. Copyright © 2017 Elsevier B.V. All rights reserved.

Cost of Care for the Initial Management of Ovarian Cancer.

Science.gov (United States)

Bercow, Alexandra S; Chen, Ling; Chatterjee, Sudeshna; Tergas, Ana I; Hou, June Y; Burke, William M; Ananth, Cande V; Neugut, Alfred I; Hershman, Dawn L; Wright, Jason D

2017-12-01

To examine the cost of care during the first year after a diagnosis of ovarian cancer, estimate the sources of cost, and explore the out-of-pocket costs. We performed a retrospective cohort study of women with ovarian cancer diagnosed from 2009 to 2012 who underwent both surgery and adjuvant chemotherapy using the Truven Health MarketScan database. This database is comprised of patients covered by commercial insurance sponsored by more than 100 employers in the United States. Medical expenditures, including physician reimbursement, for a 12-month period beginning on the date of surgery were estimated. All payments were examined, including out-of-pocket costs for patients. Payments were divided into expenditures for inpatient care, outpatient care (including chemotherapy), and outpatient drug costs. The 12-month treatment period was divided into three phases: surgery to 30 days (operative period), 1-6 months (adjuvant therapy), and 6-12 months after surgery. The primary outcome was the overall cost of care within the first year of diagnosis of ovarian cancer; secondary outcomes included assessment of factors associated with cost. A total of 26,548 women with ovarian cancer who underwent surgery were identified. After exclusion of patients with incomplete insurance enrollment or coverage, those who did not undergo chemotherapy, and those with capitated plans, our cohort consisted of 5,031 women. The median total medical expenditures per patient during the first year after the index procedure were $93,632 (interquartile range $62,319-140,140). Inpatient services accounted for $30,708 (interquartile range $20,102-51,107; 37.8%) in expenditures, outpatient services $52,700 (interquartile range $31,210-83,206; 58.3%), and outpatient drug costs $1,814 (interquartile range $603-4,402; 3.8%). The median out-of-pocket expense was $2,988 (interquartile range $1,649-5,088). This included $1,509 (interquartile range $705-2,878) for outpatient services, $589 (interquartile range

NATO Initiatives to Improve Life Cycle Costing

NARCIS (Netherlands)

Smit, M.C.

2009-01-01

There is a long and documented history of both cost growth and estimating optimism within military programmes. This is particularly the case for multi-national programmes. The NATO ALP-10 –Guidance on Integrated Logistics Support for multi-national equipment projects (ILS) dated June 1990 (Reference

Time-driven activity-based costing: a driver for provider engagement in costing activities and redesign initiatives.

Science.gov (United States)

McLaughlin, Nancy; Burke, Michael A; Setlur, Nisheeta P; Niedzwiecki, Douglas R; Kaplan, Alan L; Saigal, Christopher; Mahajan, Aman; Martin, Neil A; Kaplan, Robert S

2014-11-01

To date, health care providers have devoted significant efforts to improve performance regarding patient safety and quality of care. To address the lagging involvement of health care providers in the cost component of the value equation, UCLA Health piloted the implementation of time-driven activity-based costing (TDABC). Here, the authors describe the implementation experiment, share lessons learned across the care continuum, and report how TDABC has actively engaged health care providers in costing activities and care redesign. After the selection of pilots in neurosurgery and urology and the creation of the TDABC team, multidisciplinary process mapping sessions, capacity-cost calculations, and model integration were coordinated and offered to engage care providers at each phase. Reviewing the maps for the entire episode of care, varying types of personnel involved in the delivery of care were noted: 63 for the neurosurgery pilot and 61 for the urology pilot. The average cost capacities for care coordinators, nurses, residents, and faculty were $0.70 (range $0.63-$0.75), $1.55 (range $1.28-$2.04), $0.58 (range $0.56-$0.62), and $3.54 (range $2.29-$4.52), across both pilots. After calculating the costs for material, equipment, and space, the TDABC model enabled the linking of a specific step of the care cycle (who performed the step and its duration) and its associated costs. Both pilots identified important opportunities to redesign care delivery in a costconscious fashion. The experimentation and implementation phases of the TDABC model have succeeded in engaging health care providers in process assessment and costing activities. The TDABC model proved to be a catalyzing agent for cost-conscious care redesign.

Implementation of life cycle costing for a commercial building: case of a residential apartment at Yogyakarta

Directory of Open Access Journals (Sweden)

Kaming Peter F

2017-01-01

Full Text Available Analysis of a design process is very important in controlling the initial costs and future costs in possession of an investment project such as commercial building. Therefore, it should be wise to perform a life cycle cost analysis to determine the cost of any category contained in future cost of the building. The analysis also provide information to see how much the total cost incurred by a development project from initial to the future cost by implementing BS ISO 15686 part 5: 2008, regarding life cycle costing. The purpose of this study is to identify the cost proportion and make long-term plans of a commercial building in term of its life cycle costing from a case of a residential apartment in Yogyakarta, Indonesia. Results of the study show that there are three groups that make up the life cycle cost: the cost of development of the building, the operating costs, and the cost of maintenance and replacement. For a long-term plan the life cycle cost for 25 years the percentage obtained as follows, initial development cost of 42%, operational costs 39%, maintenance and replacement costs 19%. The results would also make comparison with other existing commercial buildings.

Use of Iodine-based contrast media in digital full-field mammography - initial experience

International Nuclear Information System (INIS)

Diekmann, F.; Diekmann, S.; Taupitz, M.; Bick, U.; Winzer, K.-J.; Huettner, C.; Muller, S.; Jeunehomme, F.; Hamm, B.

2003-01-01

Aim: To investigate the use of iodine-based contrast media in digital full-field mammography. Methods: After performing initial phantom studies, seven patients underwent digital mammography (Senographe 2000D, GE Medical Systems, Milwaukee, USA) using a specially filtered beam before as well as 60, 120, and 180 seconds after injection of 80 ml of iodine contrast medium (Ultravist 370, Schering AG, Germany). The precontrast mammograms were then subtracted from the postcontrast mammograms and the resulting images compared with a contrast-enhanced dynamic MRI study, performed on all women. Results: Contrast medium accumulation within the tumors was visualized with a good quality in all cases. The conditions under which successful contrast-enhanced digital mammography can be performed were determined in phantom studies. Conclusions: Contrast-enhanced digital mammography has a potential for improving the visualization of breast tumors in mammography using special beam filtering, adjusted X-ray parameters, proper timing, and suitable subtraction software. (orig.) [de

Sustainability Life Cycle Cost Analysis of Roof Waterproofing Methods Considering LCCO2

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Sangyong Kim

2013-12-01

Full Text Available In a construction project, selection of an appropriate method in the planning/design stage is very important for ensuring effective project implementation and success. Many companies have adopted the life cycle cost (LCC method, one of the methods for analyzing economic efficiency, for appropriate decision-making in the basic/detailed design stage by estimating overall costs and expenses generated over the entire project. This paper presents an LCC method for calculating the LCC of CO2 (LCCO2, based on materials committed during the lifecycle of a structure for each roof waterproofing method and adding this cost to the LCC for comparative analysis. Thus, this technique presents the LCC that includes the cost of CO2 emission. The results show that in terms of initial construction cost, asphalt waterproofing had the highest CO2 emission cost, followed by sheet waterproofing. LCCO2 did not greatly influence the initial construction cost and maintenance cost, as it is relatively smaller than the LCC. However, when the number of durable years was changed, the LCC showed some changes.

Biofuels cost developments in the EU27+ until 2030. Full-chain cost assessment and implications of policy options. REFUEL WP4 final report

International Nuclear Information System (INIS)

Londo, H.M.; Lensink, S.M.; Deurwaarder, E.P.; Wakker, A.; De Wit, M.; Junginger, M.; Koenighofer, K; Jungmeier, G.

2008-02-01

With the rapid developments in the biofuels domain comes the need for biofuel policies that spur their introduction in a responsible way. The REFUEL project, supported by the EU Intelligent Energy Europe programme, develops a road map for biofuels in the EU27+ up to 2030. This WP4 report shows the results of a full-chain analysis of the costs of different biofuels. Effects of different levels of biofuel target setting were analysed, and also the impact of different additional policy measures, such as the introduction of a CO2 pricing mechanism and specific subsidies

Cost-effectiveness of preventing dental caries and full mouth dental reconstructions among Alaska Native children in the Yukon–Kuskokwim delta region of Alaska

Science.gov (United States)

Atkins, Charisma Y.; Thomas, Timothy K.; Lenaker, Dane; Day, Gretchen M.; Hennessy, Thomas W.; Meltzer, Martin I.

2016-01-01

Objective We conducted a cost-effectiveness analysis of five specific dental interventions to help guide resource allocation. Methods We developed a spreadsheet-based tool, from the healthcare payer perspective, to evaluate the cost effectiveness of specific dental interventions that are currently used among Alaska Native children (6-60 months). Interventions included: water fluoridation, dental sealants, fluoride varnish, tooth brushing with fluoride toothpaste, and conducting initial dental exams on children caries treatments completed by a dental provider in the dental chair, while 161 children received FMDRs completed by a dental surgeon in an operating room. The average cost of treating dental caries in the dental chair was $1,467 (~258,000 per year); while the cost of treating FMDRs was $9,349 (~1.5 million per year). All interventions were shown to prevent caries and FMDRs; however tooth brushing prevented the greatest number of caries at minimum and maximum effectiveness with 1,433 and 1,910, respectively. Tooth brushing also prevented the greatest number of FMDRs (159 and 211) at minimum and maximum effectiveness. Conclusions All of the dental interventions evaluated were shown to produce cost savings. However, the level of that cost saving is dependent on the intervention chosen. PMID:26990678

Potential costs of breast augmentation mammaplasty.

Science.gov (United States)

Schmitt, William P; Eichhorn, Mitchell G; Ford, Ronald D

2016-01-01

Augmentation mammaplasty is one of the most common surgical procedures performed by plastic surgeons. The aim of this study was to estimate the cost of the initial procedure and its subsequent complications, as well as project the cost of Food and Drug Administration (FDA)-recommended surveillance imaging. The potential costs to the individual patient and society were calculated. Local plastic surgeons provided billing data for the initial primary silicone augmentation and reoperative procedures. Complication rates used for the cost analysis were obtained from the Allergen Core study on silicone implants. Imaging surveillance costs were considered in the estimations. The average baseline initial cost of silicone augmentation mammaplasty was calculated at $6335. The average total cost of primary breast augmentation over the first decade for an individual patient, including complications requiring reoperation and other ancillary costs, was calculated at $8226. Each decade thereafter cost an additional $1891. Costs may exceed $15,000 over an averaged lifetime, and the recommended implant surveillance could cost an additional $33,750. The potential cost of a breast augmentation, which includes the costs of complications and imaging, is significantly higher than the initial cost of the procedure. Level III, economic and decision analysis study. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Peak capacity analysis of coal power in China based on full-life cycle cost model optimization

Science.gov (United States)

Yan, Xiaoqing; Zhang, Jinfang; Huang, Xinting

2018-02-01

13th five-year and the next period are critical for the energy and power reform of China. In order to ease the excessive power supply, policies have been introduced by National Energy Board especially toward coal power capacity control. Therefore the rational construction scale and scientific development timing for coal power are of great importance and paid more and more attentions. In this study, the comprehensive influence of coal power reduction policies is analyzed from diverse point of views. Full-life cycle cost model of coal power is established to fully reflect the external and internal cost. Then this model is introduced in an improved power planning optimization theory. The power planning and diverse scenarios production simulation shows that, in order to meet the power, electricity and peak balance of power system, China’s coal power peak capacity is within 1.15 ∼ 1.2 billion kilowatts before or after 2025. The research result is expected to be helpful to the power industry in 14th and 15th five-year periods, promoting the efficiency and safety of power system.

Cost Accounting as a Possible Solution for Financial Sustainability of Croatian Public Hospitals

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Ivana Dražić Lutilsky

2016-12-01

Full Text Available The purpose of this paper is to present the current usage of cost accounting methodology in Croatian public hospitals through conducted empirical research and to provide opinions of accountants and financial officers regarding possible implementation of cost accounting methodology in public hospitals. In the paper, the authors analyze the accounting system in Croatian public hospitals, identifying the flaws of the current accounting system with regard to the recording and allocation of costs. National healthcare systems of different European countries provide a theoretical background for the usage of accrual accounting basis and cost accounting methodologies, showing better governance and financial sustainability of public hospitals which have introduced cost accounting methodology. The conducted empirical research shows that accountants and financial officers believe that the healthcare system in Croatia is ready for a change in the current accounting system based on the modified accrual basis through the implementation of accrual accounting basis and full costing approach to cost allocation. Full costing approach is also known as activity-based accounting method for cost allocation. The authors also recommend some initial steps for implementation of the new cost accounting system in Croatian public hospitals.

Cost-Benefit Analysis for the Concentrated Solar Power in China

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Shuxia Yang

2018-01-01

Full Text Available In 2016, the first batch of concentrated solar power (CSP demonstration projects of China was formally approved. Due to the important impact of the cost-benefit on the investment decisions and policy-making, this paper adopted the static payback period (SP, net present value (NPV, net present value rate (NPVR, and internal rate of return (IRR to analyze and discuss the cost-benefit of CSP demonstration plants. The results showed the following. (1 The SP of CSP systems is relatively longer, due to high initial investment; but the cost-benefit of CSP demonstration plants as a whole is better, because of good expected incomes. (2 Vast majority of CSP projects could gain excess returns, on the basis of meeting the profitability required by the benchmark yield of 10%. (3 The cost-benefit of solar tower CSP technology (IRR of 12.33% is better than that of parabolic trough CSP technology (IRR of 11.72% and linear Fresnel CSP technology (IRR of 11.43%. (4 The annual electricity production and initial costs have significant impacts on the cost-benefit of CSP systems; the effects of operation and maintenance costs and loan interest rate on the cost-benefit of CSP systems are relatively smaller but cannot be ignored.

The Annual Economic Burden of Syphilis: An Estimation of Direct, Productivity, and Intangible Costs for Syphilis in Guangdong Initiative for Comprehensive Control of Syphilis Sites.

Science.gov (United States)

Zou, Yaming; Liao, Yu; Liu, Fengying; Chen, Lei; Shen, Hongcheng; Huang, Shujie; Zheng, Heping; Yang, Bin; Hao, Yuantao

2017-11-01

Syphilis has continuously posed a great challenge to China. However, very little data existed regarding the cost of syphilis. Taking Guangdong Initiative for Comprehensive Control of Syphilis area as the research site, we aimed to comprehensively measure the annual economic burden of syphilis from a societal perspective. Newly diagnosed and follow-up outpatient cases were investigated by questionnaire. Reported tertiary syphilis cases and medical institutions cost were both collected. The direct economic burden was measured by the bottom-up approach, the productivity cost by the human capital method, and the intangible burden by the contingency valuation method. Three hundred five valid early syphilis cases and 13 valid tertiary syphilis cases were collected in the investigation to estimate the personal average cost. The total economic burden of syphilis was US $729,096.85 in Guangdong Initiative for Comprehensive Control of Syphilis sites in the year of 2014, with medical institutions cost accounting for 73.23% of the total. Household average direct cost of early syphilis was US $23.74. Average hospitalization cost of tertiary syphilis was US $2,749.93. Of the cost to medical institutions, screening and testing comprised the largest proportion (26%), followed by intervention and case management (22%) and operational cost (21%). Household average productivity cost of early syphilis was US $61.19. Household intangible cost of syphilis was US $15,810.54. Syphilis caused a substantial economic burden on patients, their families, and society in Guangdong. Household productivity and intangible costs both shared positive relationships with local economic levels. Strengthening the prevention and effective treatment of early syphilis could greatly help to lower the economic burden of syphilis.

New economic initiatives are designed to protect the environment

International Nuclear Information System (INIS)

Fleet, B.; Fleet, N.S.

1992-01-01

The use of economic initiatives or economic instruments as an alternative to or as support for existing environmental legislation is reviewed. The most controversial area of economic incentives is the concept of creating a market in pollution rights. While emissions trading can enable economic growth in areas of high pollution, this approach is only marginally different than the traditional regulatory approach. Environmental economics is complex, with mixtures of private and public costs. Social costs include subsidies, waste treatment, landfill disposal costs, etc. More intangible social costs include public health costs and damage to the natural environment. Conventional economic approaches ignore most such social costs. Several European countries have started to develop a green gross national product (GNP) which sets out an alternative approach to the traditional measure of economic activity by subtracting a figure for harm to the environment from economic activity. This ambitious approach attempts to measure the costs of all toxic discharges along with the disappearance of plant and animal life and other environmental changes. A powerful new tool for the environmental manager is full cost accounting, which uses a long (10-20 y) window for projects, anticipates the impact of stricter discharge standards, and attempts to quantify a range of less tangible social costs elements, such as liability, improved environmental image, etc. Various strategies can be ranked on the basis of their future risk cost. The application of full cost accounting models, small business, computer models and expert systems, developing country debt-for-nature swaps, and environmental risk assessment are discussed. 12 refs

Cost-Effectiveness Analysis (CEA) of Intravenous Urography (IVU) and Unenhanced Multidetector Computed Tomography (MDCT) for Initial Investigation of Suspected Acute Ureterolithiasis

International Nuclear Information System (INIS)

Eikefjord, E.; Askildsen, J.E.; Roervik, J.

2008-01-01

Background: It is important to compare the cost and effectiveness of multidetector computed tomography (MDCT) and intravenous urography (IVU) to determine the most cost-effective alternative for the initial investigation of acute ureterolithiasis. Purpose: To analyze the task-specific variable costs combined with the diagnostic effect of MDCT and IVU for patients with acute flank pain, and to determine which is most cost effective. Material and Methods: 119 patients with acute flank pain suggestive of stone disease (ureterolithiasis) were examined by both MDCT and IVU. Variable costs related to medical equipment, consumption material, equipment control, and personnel were calculated. The diagnostic effect was assessed. Results: The variable costs of MDCT versus IVU were EUR 32 and EUR 117, respectively. This significant difference was mainly due to savings in examination time, higher annual examination frequency, lower material costs, and no use of contrast media. As for diagnostic effect, MDCT proved considerably more accurate in the diagnosis of stone disease than IVU and markedly more accurate concerning differential diagnoses. Conclusion: MDCT had lower differential costs and a higher capacity to determine correctly stone disease and differential diagnoses, as compared to IVU, in patients with acute flank pain. Consequently, MDCT is a dominant alternative to IVU when evaluated exclusively from a cost-effective perspective

Costs and role of ultrasound follow-up of polytrauma patients after initial computed tomography; Kosten und Stellenwert von Ultraschallverlaufskontrollen bei polytraumatisierten Patienten nach initialer Computertomografie

Energy Technology Data Exchange (ETDEWEB)

Maurer, M.H.; Winkler, A.; Powerski, M.J.; Elgeti, F.; Huppertz, A.; Roettgen, R.; Marnitz, T. [Charite - Universitaetsmedizin Berlin (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Wichlas, F. [Charite - Universitaetsmedizin Berlin (Germany). Centrum fuer Muskuloskeletale Chirurgie

2012-01-15

Purpose: To assess the costs and diagnostic gain of abdominal ultrasound follow-up of polytrauma patients initially examined by whole-body computed tomography (CT). Materials and Methods: A total of 176 patients with suspected multiple trauma (126 men, 50 women; age 43.5 {+-} 17.4 years) were retrospectively analyzed with regard to supplementary and new findings obtained by ultrasound follow-up compared with the results of exploratory FAST (focused assessment with sonography for trauma) at admission and the findings of whole-body CT. A process model was used to document the staff, materials, and total costs of the ultrasound follow-up examinations. Results: FAST yielded 26 abdominal findings (organ injury and/or free intra-abdominal fluid) in 19 patients, while the abdominal scan of whole-body CT revealed 32 findings in 25 patients. FAST had 81 % sensitivity and 100 % specificity. Follow-up ultrasound examinations revealed new findings in 2 of the 25 patients with abdominal injuries detected with initial CT. In the 151 patients without abdominal injuries in the initial CT scan, ultrasound follow-up did not yield any supplementary or new findings. The total costs of an ultrasound follow-up examination were EUR 28.93. The total costs of all follow-up ultrasound examinations performed in the study population were EUR 5658.23. Conclusion: Follow-up abdominal ultrasound yields only a low overall diagnostic gain in polytrauma patients in whom initial CT fails to detect any abdominal injuries but incurs high personnel expenses for radiological departments. (orig.)

Summary report on close-coupled subsurface barrier technology: Initial field trials to full-scale demonstration

International Nuclear Information System (INIS)

Heiser, J.H.

1997-09-01

The primary objective of this project was to develop and demonstrate the installation and measure the performance of a close-coupled barrier for the containment of subsurface waste or contaminant migration. A close-coupled barrier is produced by first installing a conventional, low-cost, cement-grout containment barrier followed by a thin lining of a polymer grout. The resultant barrier is a cement-polymer composite that has economic benefits derived from the cement and performance benefits from the durable and resistant polymer layer. The technology has matured from a regulatory investigation of the issues concerning the use of polymers to laboratory compatibility and performance measurements of various polymer systems to a pilot-scale, single column injection at Sandia to full-scale demonstration. The feasibility of the close-coupled barrier concept was proven in a full-scale cold demonstration at Hanford, Washington and then moved to the final stage with a full-scale demonstration at an actual remediation site at Brookhaven National Laboratory (BNL). At the Hanford demonstration the composite barrier was emplaced around and beneath a 20,000 liter tank. The secondary cement layer was constructed using conventional jet grouting techniques. Drilling was completed at a 45 degree angle to the ground, forming a cone-shaped barrier. The primary barrier was placed by panel jet-grouting with a dual-wall drill stem using a two part polymer grout. The polymer chosen was a high molecular weight acrylic. At the BNL demonstration a V-trough barrier was installed using a conventional cement grout for the secondary layer and an acrylic-gel polymer for the primary layer. Construction techniques were identical to the Hanford installation. This report summarizes the technology development from pilot- to full-scale demonstrations and presents some of the performance and quality achievements attained

Novel cost effective full scale mussel shell bioreactors for metal removal and acid neutralization.

Science.gov (United States)

DiLoreto, Z A; Weber, P A; Olds, W; Pope, J; Trumm, D; Chaganti, S R; Heath, D D; Weisener, C G

2016-12-01

Acid mine drainage (AMD) impacted waters are a worldwide concern for the mining industry and countries dealing with this issue; both active and passive technologies are employed for the treatment of such waters. Mussel shell bioreactors (MSB) represent a passive technology that utilizes waste from the shellfish industry as a novel substrate. The aim of this study is to provide insight into the biogeochemical dynamics of a novel full scale MSB for AMD treatment. A combination of water quality data, targeted geochemical extractions, and metagenomic analyses were used to evaluate MSB performance. The MSB raised the effluent pH from 3.4 to 8.3 while removing up to ∼99% of the dissolved Al, and Fe and >90% Ni, Tl, and Zn. A geochemical gradient was observed progressing from oxidized to reduced conditions with depth. The redox conditions helped define the microbial consortium that consists of a specialized niche of organisms that influence elemental cycling (i.e. complex Fe and S cycling). MSB technology represents an economic and effective means of full scale, passive AMD treatment that is an attractive alternative for developing economies due to its low cost and ease of implementation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Information Technology Budgets and Costs: Do You Know What Your Information Technology Costs Each Year?

Science.gov (United States)

Dugan, Robert E.

2002-01-01

Discusses yearly information technology costs for academic libraries. Topics include transformation and modernization activities that affect prices and budgeting; a cost model for information technologies; life cycle costs, including initial costs and recurring costs; cost benchmarks; and examples of pressures concerning cost accountability. (LRW)

Full system decontamination feasibility studies

International Nuclear Information System (INIS)

Denault, R.P.; LeSurf, J.E.; Walschot, F.W.

1988-01-01

Many chemical decontaminations have been performed on subsystems in light water reactors (BWRs and PWRs) but none on the full system (including the fuel) of large, (>500 MWe) investor owned reactors. Full system decontaminations on pressure-tubed reactors have been shown to facilitate maintenance, inspection, repair and replacement of reactor components. Further advantages are increased reactor availability and plant life extension. A conceptual study has been performed for EPRI (for PWRs) and Commonwealth Edison Co (for BWRs) into the applicability and cost benefit of full system decontaminations (FSD). The joint study showed that FSDs in both PWRs and BWRs, with or without the fuel included in the decontamination, are feasible and cost beneficial provided a large amount of work is to be done following the decontamination. The large amounts of radioactive waste generated can be managed using current technologies. Considerable improvements in waste handling, and consequent cost savings, can be obtained if new techniques which are now reaching commercial application are used. (author)

Assessing the full costs of water, liquid waste, energy and solid waste infrastructure in the Fraser Valley Regional District (FVRD)

International Nuclear Information System (INIS)

Pollard, D.

2001-01-01

This document presents a newly drafted growth strategy developed by the Fraser Valley Regional District (FVRD) in British Columbia. It guides the sustainable growth, change and development of the region for the next 25 years and deals with air pollution, water quality, traffic congestion, affordable housing, employment, energy use, parks and green space. In particular, this case study develops a method to apply full cost accounting (FCA) to a growth strategy. FCA is the most appropriate way to approach a sustainable strategy because it considers economic, social and environmental issues. The study also includes the development of a software tool consisting of an ACCESS database and an ARCVIEW GIS file for compiling and analyzing detailed infrastructure profiles which can be used to assess the full costs of different growth scenarios. The following four issue categories of environmental and economic indicators of FVRD performance were addressed: solid waste, water and wastewater, energy, and infrastructure costs. Each issue category was then used to establish a set of 5 performance indicators that can be measured and assessed over time. These included solid waste, water consumption, wastewater, energy consumption and air emissions. The database and methodology developed for this project is suitable for other regions. The software can be viewed by contacting the Sheltair Group Resource Consultants Inc. in Vancouver

Cost Analysis in Shoulder Arthroplasty Surgery

Directory of Open Access Journals (Sweden)

Matthew J. Teusink

2012-01-01

Full Text Available Cost in shoulder surgery has taken on a new focus with passage of the Patient Protection and Affordable Care Act. As part of this law, there is a provision for Accountable Care Organizations (ACOs and the bundled payment initiative. In this model, one entity would receive a single payment for an episode of care and distribute funds to all other parties involved. Given its reproducible nature, shoulder arthroplasty is ideally situated to become a model for an episode of care. Currently, there is little research into cost in shoulder arthroplasty surgery. The current analyses do not provide surgeons with a method for determining the cost and outcomes of their interventions, which is necessary to the success of bundled payment. Surgeons are ideally positioned to become leaders in ACOs, but in order for them to do so a methodology must be developed where accurate costs and outcomes can be determined for the episode of care.

Weighted Activity and Costing of Surveillance and Control in Animal Epidemiology

Directory of Open Access Journals (Sweden)

Duboz Raphaël

2013-01-01

Full Text Available Activity based modeling and simulation is a very promising field. It has recently demonstrated its potential from modeling software development methods [9] to the design of low energy sensors. In this position paper, I would like to initiate a reflexion on the use of the weighted activity in the context of financial costing using the formulation recently proposed by X. Hu and B.P. Zeigler [5]. I propose here to formalize a recent approach of costing, the Time-Driven Activity Based Costing [3], using the theoretical modeling framework initiated by B.P. Zeigler [6]. I argue that this specification can potentially improve the traditional model of Time-Driven Activity Based Costing. I illustrate the approach in the context of surveillance and control in animal epidemiology. The demonstration of its effectiveness is not done in this position paper. Nevertheless, as the existing costing systems are designed to support decision making in business management, the scenario based approach proposed in this paper should be very useful to support decisions in complex management situations.

Impact of generic alendronate cost on the cost-effectiveness of osteoporosis screening and treatment.

Directory of Open Access Journals (Sweden)

Smita Nayak

Full Text Available Since alendronate became available in generic form in the Unites States in 2008, its price has been decreasing. The objective of this study was to investigate the impact of alendronate cost on the cost-effectiveness of osteoporosis screening and treatment in postmenopausal women.Microsimulation cost-effectiveness model of osteoporosis screening and treatment for U.S. women age 65 and older. We assumed screening initiation at age 65 with central dual-energy x-ray absorptiometry (DXA, and alendronate treatment for individuals with osteoporosis; with a comparator of "no screening" and treatment only after fracture occurrence. We evaluated annual alendronate costs of $20 through $800; outcome measures included fractures; nursing home admission; medication adverse events; death; costs; quality-adjusted life-years (QALYs; and incremental cost-effectiveness ratios (ICERs in 2010 U.S. dollars per QALY gained. A lifetime time horizon was used, and direct costs were included. Base-case and sensitivity analyses were performed.Base-case analysis results showed that at annual alendronate costs of $200 or less, osteoporosis screening followed by treatment was cost-saving, resulting in lower total costs than no screening as well as more QALYs (10.6 additional quality-adjusted life-days. When assuming alendronate costs of $400 through $800, screening and treatment resulted in greater lifetime costs than no screening but was highly cost-effective, with ICERs ranging from $714 per QALY gained through $13,902 per QALY gained. Probabilistic sensitivity analyses revealed that the cost-effectiveness of osteoporosis screening followed by alendronate treatment was robust to joint input parameter estimate variation at a willingness-to-pay threshold of $50,000/QALY at all alendronate costs evaluated.Osteoporosis screening followed by alendronate treatment is effective and highly cost-effective for postmenopausal women across a range of alendronate costs, and may be cost

Managing costs at Ginna Station

International Nuclear Information System (INIS)

Mecredy, R.C.

1990-01-01

A nuclear power plant with a capital cost of $88 million and an annual operations and maintenance (O and M) cost of $3.2 million that is operated by a plant staff of 59 people? The Ginna nuclear power plant was indeed such a plant in 1970, its first full year of operation. Today that same plant has a total invested capital cost of $400 million with an annual capital cost, including upgrade projects which are being amortized, of $37 million. The annual O and M expenditure is nearly $60 million, and the total staffing, both plant and corporate support, is nearly 600 people. The result of this increased cost has been a dramatic narrowing of the cost margin between Ginna and coal units in the rochester Gas and Electric system. While increased expenditures have resulted in improved reliability and operability, and have increased the margins of safety, it is becoming necessary to implement cost monitoring and control measures so that each dollar spent provides maximum value. The factors which have contributed to the increased capital and O and M expenditures are well known. They include a broad range of safety, reliability, and operating projects and activities. Current upward pressures on cost include initiatives such as procurement control, procedure upgrades, configuration management, enhanced maintenance activities, and equipment replacements and upgrades

Investing in cow-welfare – a cost-effective initiative?

DEFF Research Database (Denmark)

Kudahl, Anne Braad; Kirchner, Marlene; Denwood, Matt

2017-01-01

The aim of the project was to identify the most cost-effective investments in improving welfare for Danish dairy herds by identifying the most serious welfare problems and their causes, suggesting solutions and calculating the economic consequences of investing in the solutions.......The aim of the project was to identify the most cost-effective investments in improving welfare for Danish dairy herds by identifying the most serious welfare problems and their causes, suggesting solutions and calculating the economic consequences of investing in the solutions....

Costs of fire suppression forces based on cost-aggregation approach

Science.gov (United States)

Gonz& aacute; lez-Cab& aacute; Armando n; Charles W. McKetta; Thomas J. Mills

1984-01-01

A cost-aggregation approach has been developed for determining the cost of Fire Management Inputs (FMls)-the direct fireline production units (personnel and equipment) used in initial attack and large-fire suppression activities. All components contributing to an FMI are identified, computed, and summed to estimate hourly costs. This approach can be applied to any FMI...

Environmental Parametric Cost Model in Oil and Gas EPC Contracts

Directory of Open Access Journals (Sweden)

Madjid Abbaspour

2018-01-01

Full Text Available This study aims at identifying the parameters that govern the environmental costs in oil and gas projects. An initial conceptual model was proposed. Next, the costs of environmental management work packages were estimated, separately and were applied in project control tools (WBS/CBS. Then, an environmental parametric cost model was designed to determine the environmental costs and relevant weighting factors. The suggested model can be considered as an innovative approach to designate the environmental indicators in oil and gas projects. The validity of variables was investigated based on Delphi method. The results indicated that the project environmental management’s weighting factor is 0.87% of total project’s weighting factor.

Cost and cost-effectiveness of smear-positive tuberculosis treatment by Health Extension Workers in Southern Ethiopia: a community randomized trial.

Directory of Open Access Journals (Sweden)

Daniel G Datiko

Full Text Available UNLABELLED: Treatments by HEWs in the health posts and general health workers at health facility were compared along a community-randomized trial. Costs were analysed from societal perspective in 2007 in US $ using standard methods. We prospectively enrolled smear positive patients, and calculated cost-effectiveness as the cost per patient successfully treated. The total cost for each successfully treated smear-positive patient was higher in health facility ($158.9 compared with community ($61.7. Community-based treatment reduced the total, patient and caregiver cost by 61.2%, 68.1% and 79.8%, respectively. Involving HEWs added a total cost of $8.80 (14.3% of total cost on health service per patient treated in the community. CONCLUSIONS/SIGNIFICANCE: Community-based treatment by HEWs costs only 39% of what treatment by general health workers costs for similar outcomes. Involving HEWs in TB treatment is a cost effective treatment alternative to the health service, to the patients and the family. There is an economic and public health reason to consider involving HEWs in TB treatment in Ethiopia. However, community-based treatment requires initial investment to start its implementation, training and supervision. TRIAL REGISTRATION: ClinicalTrials.gov NCT00803322.

THE COST OF PRODUCTION UNDER DIRECT COSTING AND ABSORPTION COSTING – A COMPARATIVE APPROACH

Directory of Open Access Journals (Sweden)

Bunea-Bontaş Cristina Aurora

2013-04-01

Full Text Available Managerial accounting has an important role in strategic management of a company, being designed especially for managers, in order to optimise their decision regarding operating activities. One of the objectives of managerial accounting is the cost calculation, for measuring inventory costs, and the costs and profitability of products and services. Cost calculation systems can vary in terms of which costs are assigned to cost objects, two significant calculation systems being adopted by the costing theory: full cost accounting, which includes all costs of production as product costs, and partial cost accounting, which includes only those costs that vary with output. This article provides a comparative approach regarding the differences between the calculation of the cost of production under direct costing and absorption costing. It also examines the implication of using each of these calculation systems on the financial position and financial performance of the companies reported on the statement of financial position and the income statement. Finally, the advantages of using direct costing for internal reporting are discussed, considering that this method is not acceptable for external reporting to stockholders and other external users.

Collecting costs of community prevention programs: communities putting prevention to work initiative.

Science.gov (United States)

Khavjou, Olga A; Honeycutt, Amanda A; Hoerger, Thomas J; Trogdon, Justin G; Cash, Amanda J

2014-08-01

Community-based programs require substantial investments of resources; however, evaluations of these programs usually lack analyses of program costs. Costs of community-based programs reported in previous literature are limited and have been estimated retrospectively. To describe a prospective cost data collection approach developed for the Communities Putting Prevention to Work (CPPW) program capturing costs for community-based tobacco use and obesity prevention strategies. A web-based cost data collection instrument was developed using an activity-based costing approach. Respondents reported quarterly expenditures on labor; consultants; materials, travel, and services; overhead; partner efforts; and in-kind contributions. Costs were allocated across CPPW objectives and strategies organized around five categories: media, access, point of decision/promotion, price, and social support and services. The instrument was developed in 2010, quarterly data collections took place in 2011-2013, and preliminary analysis was conducted in 2013. Preliminary descriptive statistics are presented for the cost data collected from 51 respondents. More than 50% of program costs were for partner organizations, and over 20% of costs were for labor hours. Tobacco communities devoted the majority of their efforts to media strategies. Obesity communities spent more than half of their resources on access strategies. Collecting accurate cost information on health promotion and disease prevention programs presents many challenges. The approach presented in this paper is one of the first efforts successfully collecting these types of data and can be replicated for collecting costs from other programs. Copyright © 2014 American Journal of Preventive Medicine. All rights reserved.

Procedures for Determining Historical Full Costs. Technical Report 65. Second Edition.

Science.gov (United States)

National Association of College and University Business Officers, Washington, DC.

The procedures form the costing component of the National Center for Higher Education Management Systems'"Information Exchange Procedures" (IEP). The IEP are a set of standard definitions and procedures for collecting information about disciplines and student degree programs, outcomes of instructional programs, and general institutional…

Cost Minimization Analysis of Different Strategies of Management of Clinically Significant Scorpion Envenomation Among Pediatric Patients.

Science.gov (United States)

Sinha, Madhumita; Quan, Dan; McDonald, Fred W; Valdez, André

2016-12-01

Scorpion antivenom was recently approved for use in patients with clinically significant scorpion envenomation in the United States; no formal economic analysis on its impact on cost of management has been performed. Three different strategies of management of scorpion envenomation with systemic neurotoxic symptoms in children were compared for cost minimization from a societal perspective. In strategy I, patients were managed with supportive care only without antivenom. In strategy II, an aggressive strategy of full-dose antivenom (initial dose of 3 vials with the use of additional vials administered 1 vial at a time) was considered. In strategy III, a single-vial serial antivenom dosing strategy titrated to clinical response was considered. Clinical probabilities for the different strategies were obtained from retrospective review of medical records of patients with scorpion envenomation over a 10-year period at our institution. Baseline cost values were obtained from patient reimbursement data from our institution. In baseline analysis, strategy I of supportive care only with no antivenom was least costly at US $3466.50/patient. Strategy III of single-vial serial dosing was intermediate but less expensive than strategy II of full-dose antivenom, with an incremental cost of US $3171.08 per patient. In a 1-way sensitivity analysis, at a threshold antivenom cost of US $1577.87, strategy III of single-vial serial dosing became the least costly strategy. For children with scorpion envenomation, use of a management strategy based on serial dosing of antivenom titrated to clinical response is less costly than a strategy of initial use of full-dose antivenom.

Research on Initiation Sensitivity of Solid Explosive and Planer Initiation System

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N Matsuo

2016-09-01

Full Text Available Firstly, recently, there are a lot of techniques being demanded for complex process, various explosive initiation method and highly accurate control of detonation are needed. In this research, the metal foil explosion using high current is focused attention on the method to obtain linear or planate initiation easily, and the main evaluation of metal foil explosion to initiate explosive was conducted. The explosion power was evaluated by observing optically the underwater shock wave generated from the metal foil explosion. Secondly, in high energy explosive processing, there are several applications, such as shock compaction, explosive welding, food processing and explosive forming. In these explosive applications, a high sensitive explosive has been mainly used. The high sensitive explosive is so dangerous, since it can lead to explosion suddenly. So, for developing explosives, the safety is the most important thing as well as low manufacturing cost and explosive characteristics. In this work, we have focused on the initiation sensitivity of a solid explosive and performed numerical analysis of sympathetic detonation. The numerical analysis is calculated by LS-DYNA 3D (commercial code. To understand the initiation reaction of an explosive, Lee-Tarver equation was used and impact detonation process was analyzed by ALE code. Configuration of simulation model is a quarter of circular cylinder. The donor type of explosive (SEP was used as initiation explosive. When the donor explosive is exploded, a shock wave is generated and it propagates into PMMA, air and metallic layers in order. During passing through the layers, the shock wave is attenuated and finally, it has influence on the acceptor explosive, Comp. B. Here, we evaluate the initiation of acceptor explosive and discuss about detonation pressure, reactive rate of acceptor explosive and attenuation of impact pressure.

A life cycle cost economics model for projects with uniformly varying operating costs. [management planning

Science.gov (United States)

Remer, D. S.

1977-01-01

A mathematical model is developed for calculating the life cycle costs for a project where the operating costs increase or decrease in a linear manner with time. The life cycle cost is shown to be a function of the investment costs, initial operating costs, operating cost gradient, project life time, interest rate for capital and salvage value. The results show that the life cycle cost for a project can be grossly underestimated (or overestimated) if the operating costs increase (or decrease) uniformly over time rather than being constant as is often assumed in project economic evaluations. The following range of variables is examined: (1) project life from 2 to 30 years; (2) interest rate from 0 to 15 percent per year; and (3) operating cost gradient from 5 to 90 percent of the initial operating costs. A numerical example plus tables and graphs is given to help calculate project life cycle costs over a wide range of variables.

Determining the True Cost to Deliver Total Hip and Knee Arthroplasty Over the Full Cycle of Care: Preparing for Bundling and Reference-Based Pricing.

Science.gov (United States)

DiGioia, Anthony M; Greenhouse, Pamela K; Giarrusso, Michelle L; Kress, Justina M

2016-01-01

The Affordable Care Act accelerates health care providers' need to prepare for new care delivery platforms and payment models such as bundling and reference-based pricing (RBP). Thriving in this environment will be difficult without knowing the true cost of care delivery at the level of the clinical condition over the full cycle of care. We describe a project in which we identified true costs for both total hip and total knee arthroplasty. With the same tool, we identified cost drivers in each segment of care delivery and collected patient experience information. Combining cost and experience information with outcomes data we already collect allows us to drive costs down while protecting outcomes and experiences, and compete successfully in bundling and RBP programs. Copyright © 2016 Elsevier Inc. All rights reserved.

Initial Tests on First Full-size Endcap Crystals

CERN Document Server

Davies, Gavin; Lecoq, Paul; Marcos, Roger; Schneegans, Marc; Sempere-Roldan, P

1999-01-01

At the end of last year the first full size ECAL endcap crystals were delivered to CERN.Thirty in number, they were produced to the final geometrical specifications; 220mm long with a rear square face of 30mm and a front square face of 28.6mm. All were de livered polished. The visual inspection, dimension, transmission, light yield and light yield uniformity tests carried out since are discussed, with particular emphasis on the light yield uniformity. The results are very encouraging.

Towards a low-cost, full-service air quality data archival system

NARCIS (Netherlands)

Samourkasidis, Argyris; Athanasiadis, Ioannis N.

2014-01-01

We present our explorations towards a low-cost solution for creating an autonomous environmental data archival system. AiRCHIVE is a software platform for providing open access to sensor data with different ways, that account for machine interoperability. It is built with Raspberry Pi, a

IDC reengineering Phase 2 & 3 US industry standard cost estimate summary

Energy Technology Data Exchange (ETDEWEB)

Harris, James M. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Huelskamp, Robert M. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2015-01-01

Sandia National Laboratories has prepared a ROM cost estimate for budgetary planning for the IDC Reengineering Phase 2 & 3 effort, using a commercial software cost estimation tool calibrated to US industry performance parameters. This is not a cost estimate for Sandia to perform the project. This report provides the ROM cost estimate and describes the methodology, assumptions, and cost model details used to create the ROM cost estimate. ROM Cost Estimate Disclaimer Contained herein is a Rough Order of Magnitude (ROM) cost estimate that has been provided to enable initial planning for this proposed project. This ROM cost estimate is submitted to facilitate informal discussions in relation to this project and is NOT intended to commit Sandia National Laboratories (Sandia) or its resources. Furthermore, as a Federally Funded Research and Development Center (FFRDC), Sandia must be compliant with the Anti-Deficiency Act and operate on a full-cost recovery basis. Therefore, while Sandia, in conjunction with the Sponsor, will use best judgment to execute work and to address the highest risks and most important issues in order to effectively manage within cost constraints, this ROM estimate and any subsequent approved cost estimates are on a 'full-cost recovery' basis. Thus, work can neither commence nor continue unless adequate funding has been accepted and certified by DOE.

Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study

Directory of Open Access Journals (Sweden)

Berger Ariel

2012-10-01

Full Text Available Abstract Background Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and benzodiazepine anxiolytics are used in the US to treat generalized anxiety disorder (GAD. While benzodiazepines typically provide rapid symptomatic relief, long-term use is not recommended due to risks of dependency, sedation, falls, and accidents. Methods Using a US health insurance database, we identified all persons with GAD (ICD-9-CM diagnosis code 300.02 who began a long-term course of treatment (≥90 days with a benzodiazepine anxiolytic between 1/1/2003 and 12/31/2007, We compared healthcare utilization and costs over the six-month periods preceding and following the date of treatment initiation (“pretreatment” and “post-treatment”, respectively, and focused attention on accident-related encounters (e.g., for treatment of fractures and care received for other reasons possibly related benzodiazepine use (e.g., sedation, dizziness. Results A total of 866 patients met all study entry criteria; 25% of patients began treatment on an add-on basis (i.e., adjunctive to escitalopram, paroxetine, sertraline, or venlafaxine, while 75% of patients did not receive concomitant therapy. Mean total healthcare costs increased by $2334 between the pretreatment and post-treatment periods (from $4637 [SD=$9840] to $6971 [$17,002]; p Conclusions Healthcare costs increase in patients with GAD beginning long-term (≥90 days treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use.

Cost-Effectiveness Model for Chemoimmunotherapy Options in Patients with Previously Untreated Chronic Lymphocytic Leukemia Unsuitable for Full-Dose Fludarabine-Based Therapy.

Science.gov (United States)

Becker, Ursula; Briggs, Andrew H; Moreno, Santiago G; Ray, Joshua A; Ngo, Phuong; Samanta, Kunal

2016-06-01

To evaluate the cost-effectiveness of treatment with anti-CD20 monoclonal antibody obinutuzumab plus chlorambucil (GClb) in untreated patients with chronic lymphocytic leukemia unsuitable for full-dose fludarabine-based therapy. A Markov model was used to assess the cost-effectiveness of GClb versus other chemoimmunotherapy options. The model comprised three mutually exclusive health states: "progression-free survival (with/without therapy)", "progression (refractory/relapsed lines)", and "death". Each state was assigned a health utility value representing patients' quality of life and a specific cost value. Comparisons between GClb and rituximab plus chlorambucil or only chlorambucil were performed using patient-level clinical trial data; other comparisons were performed via a network meta-analysis using information gathered in a systematic literature review. To support the model, a utility elicitation study was conducted from the perspective of the UK National Health Service. There was good agreement between the model-predicted progression-free and overall survival and that from the CLL11 trial. On incorporating data from the indirect treatment comparisons, it was found that GClb was cost-effective with a range of incremental cost-effectiveness ratios below a threshold of £30,000 per quality-adjusted life-year gained, and remained so during deterministic and probabilistic sensitivity analyses under various scenarios. GClb was estimated to increase both quality-adjusted life expectancy and treatment costs compared with several commonly used therapies, with incremental cost-effectiveness ratios below commonly referenced UK thresholds. This article offers a real example of how to combine direct and indirect evidence in a cost-effectiveness analysis of oncology drugs. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Procedures for initiation, cost-sharing and management of OECD projects in nuclear safety

International Nuclear Information System (INIS)

2002-01-01

The OECD (CSNI) projects aim to produce results relevant for the safe operation of nuclear power plants through international collaborative projects. In general, the projects consist of advanced experimental programmes that are conducted at specialized facilities. At present, the following OECD (CSNI) projects are in operation: - The Halden Project, covering fuel/materials and I and C/Human Factors issues; - The Cabri Project, addressing reactivity transients on high burnup fuels; - The MASCA Project, which deals with in-vessel corium phenomena; - The OLHF Project, dealing with lower head failure mechanisms; - The SETH Project addressing thermal-hydraulics issues, started in 2001; - The MCCI Project on ex-vessel coolability and melt-concrete interaction. There are significant differences among these projects in terms of their motivation, size and scope. The Halden Project and the Cabri Water Loop Project are large undertakings where the host organisations assume full and direct responsibility for the project establishment and administration - as well as for the negotiation with relevant parties on the terms of participation. In the other cases, instead, the NEA secretariat has a more direct responsibility, conferred by the CSNI, in establishing the project technical and financial basis, as well as for its implementation and administration. The objective of this procedure is to provide a common basis for the establishment and management of the OECD projects in the area of nuclear safety. It is a follow-up of a recommendation expressed by the CSNI Bureau during its meeting in October 2001, where the procedures for the establishment and management of the OECD (CSNI) projects in nuclear safety were addressed. While this procedure attempts at defining general guidelines for project initiation, financing and management, one should bear in mind that each project has its own motivation, background and framework. Thus, some degree of flexibility in project structure

Potential savings of harmonising hospital and community formularies for chronic disease medications initiated in hospital.

Directory of Open Access Journals (Sweden)

Lauren Lapointe-Shaw

Full Text Available Hospitals in Canada manage their formularies independently, yet many inpatients are discharged on medications which will be purchased through publicly-funded programs. We sought to determine how much public money could be saved on chronic medications if hospitals promoted the initiation of agents with the lowest outpatient formulary prices.We used administrative databases for the province of Ontario to identify patients initiated on a proton pump inhibitor (PPI, angiotensin-converting enzyme (ACE inhibitor or angiotensin receptor blocker (ARB following hospital admission from April 1(st 2008-March 31(st 2009. We assessed the cost to the Ontario Drug Benefit Program (ODB over the year following initiation and determined the cost savings if prescriptions were substituted with the least expensive agent in each class.The cost for filling all PPI, ACE inhibitor and ARB prescriptions was $ 2.48 million, $968 thousand and $325 thousand respectively. Substituting the least expensive agent could have saved $1.16 million (47% for PPIs, $162 thousand (17% for ACE inhibitors and $14 thousand (4% for ARBs over the year following discharge.In a setting where outpatient prescriptions are publicly funded, harmonising outpatient formularies with inpatient therapeutic substitution resulted in modest cost savings and may be one way to control rising pharmaceutical costs.

Study on the Full-cost Accounting System in Hospital Financial Management%医院财务管理中全成本合算系统的研究

Institute of Scientific and Technical Information of China (English)

姜婷

2013-01-01

This paper mainly describes the value for using full-cost accounting system in hospital financial management, the following principle of full-cost accounting in the implementation process and the main problems and contradictions of full-cost accounting in the implementation of hospital. The paper makes everyone has a deep understanding for using full-cost accounting system in hospital financial management by investigating these problems.%本文主要是通过对医院财务管理中采用全成本合算系统的价值意义、全成本核算在实施过程中所遵循的原理以及医院在实施全成本核算中所面临的主要的问题和存在的主要矛盾来展开描述，通过对这些问题的探讨使得大家对医院财务管理中采用全成本核算系统有一个更加深入的认识。

NASA Instrument Cost/Schedule Model

Science.gov (United States)

Habib-Agahi, Hamid; Mrozinski, Joe; Fox, George

2011-01-01

NASA's Office of Independent Program and Cost Evaluation (IPCE) has established a number of initiatives to improve its cost and schedule estimating capabilities. 12One of these initiatives has resulted in the JPL developed NASA Instrument Cost Model. NICM is a cost and schedule estimator that contains: A system level cost estimation tool; a subsystem level cost estimation tool; a database of cost and technical parameters of over 140 previously flown remote sensing and in-situ instruments; a schedule estimator; a set of rules to estimate cost and schedule by life cycle phases (B/C/D); and a novel tool for developing joint probability distributions for cost and schedule risk (Joint Confidence Level (JCL)). This paper describes the development and use of NICM, including the data normalization processes, data mining methods (cluster analysis, principal components analysis, regression analysis and bootstrap cross validation), the estimating equations themselves and a demonstration of the NICM tool suite.

Building Energy and Cost Performance: An Analysis of Thirty Melbourne Case Studies

Directory of Open Access Journals (Sweden)

Yu Lay Langston

2012-11-01

Full Text Available This study investigates the energy and cost performance of thirty recent buildings in Melbourne, Australia. Commonly, building design decisions are based on issues pertaining to construction cost, and consideration of energy performance is made only within the context of the initial project budget. Even where energy is elevated to more importance, operating energy is seen as the focus and embodied energy is nearly always ignored. For the first time, a large sample of buildings has been assembled and analyzed to improve the understanding of both energy and cost performance over their full life cycle, which formed the basis of a wider doctoral study into the inherent relationship between energy and cost. The aim of this paper is to report on typical values for embodied energy, operating energy, capital cost and operating cost per square metre for a range of building functional types investigated in this research. The conclusion is that energy and cost have quite different profiles across projects, and yet the mean GJ/m2 or cost/m2 have relatively low coefficients of variation and therefore may be useful as benchmarks of typical building performance.  

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

Energy Technology Data Exchange (ETDEWEB)

None

2014-05-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2014-05-27

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

Review of the cost of venous thromboembolism

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Fernandez MM

2015-08-01

Full Text Available Maria M Fernandez,1 Susan Hogue,1 Ronald Preblick,2 Winghan Jacqueline Kwong2 1RTI-Health Solutions, Market Access and Outcomes Strategy, Research Triangle Park, NC, 2Daiichi Sankyo, Inc., Health Economics & Outcomes Research, Parsippany, NJ, USA Background: Venous thromboembolism (VTE is the second most common medical complication and a cause of excess length of hospital stay. Its incidence and economic burden are expected to increase as the population ages. We reviewed the recent literature to provide updated cost estimates on VTE management. Methods: Literature search strategies were performed in PubMed, Embase, Cochrane Collaboration, Health Economic Evaluations Database, EconLit, and International Pharmaceutical Abstracts from 2003–2014. Additional studies were identified through searching bibliographies of related publications. Results: Eighteen studies were identified and are summarized in this review; of these, 13 reported data from the USA, four from Europe, and one from Canada. Three main cost estimations were identified: cost per VTE hospitalization or per VTE readmission; cost for VTE management, usually reported annually or during a specific period; and annual all-cause costs in patients with VTE, which included the treatment of complications and comorbidities. Cost estimates per VTE hospitalization were generally similar across the US studies, with a trend toward an increase over time. Cost per pulmonary embolism hospitalization increased from $5,198–$6,928 in 2000 to $8,764 in 2010. Readmission for recurrent VTE was generally more costly than the initial index event admission. Annual health plan payments for services related to VTE also increased from $10,804–$16,644 during the 1998–2004 period to an estimated average of $15,123 for a VTE event from 2008 to 2011. Lower costs for VTE hospitalizations and annualized all-cause costs were estimated in European countries and Canada. Conclusion: Costs for VTE treatment are

Cost-effectiveness analysis of HLA-B*58: 01 genetic testing before initiation of allopurinol therapy to prevent allopurinol-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in a Malaysian population.

Science.gov (United States)

Chong, Huey Yi; Lim, Yi Heng; Prawjaeng, Juthamas; Tassaneeyakul, Wichittra; Mohamed, Zahurin; Chaiyakunapruk, Nathorn

2018-02-01

Studies found a strong association between allopurinol-induced Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) and the HLA-B*58:01 allele. HLA-B*58:01 screening-guided therapy may mitigate the risk of allopurinol-induced SJS/TEN. This study aimed to evaluate the cost-effectiveness of HLA-B*58:01 screening before allopurinol therapy initiation compared with the current practice of no screening for Malaysian patients with chronic gout in whom a hypouricemic agent is indicated. This cost-effectiveness analysis adopted a societal perspective with a lifetime horizon. A decision tree model coupled with Markov models were developed to estimate the costs and outcomes, represented by quality-adjusted life years (QALYs) gained, of three treatment strategies: (a) current practice (allopurinol initiation without HLA-B*58:01 screening); (b) HLA-B*58:01 screening before allopurinol initiation; and (c) alternative treatment (probenecid) without HLA-B*58:01 screening. The model was populated with data from literature review, meta-analysis, and published government documents. Cost values were adjusted for the year 2016, with costs and health outcomes discounted at 3% per annum. A series of sensitivity analysis including probabilistic sensitivity analysis were carried out to determine the robustness of the findings. Both HLA-B*58:01 screening and probenecid prescribing were dominated by current practice. Compared with current practice, HLA-B*58:01 screening resulted in 0.252 QALYs loss per patient at an additional cost of USD 322, whereas probenecid prescribing resulted in 1.928 QALYs loss per patient at an additional cost of USD 2203. One SJS/TEN case would be avoided for every 556 patients screened. At the cost-effectiveness threshold of USD 8695 per QALY, the probability of current practice being the best choice is 99.9%, in contrast with 0.1 and 0% in HLA-B*58:01 screening and probenecid prescribing, respectively. This is because of the low incidence of

Potential cost savings with terrestrial rabies control

Directory of Open Access Journals (Sweden)

Cherry Bryan

2007-04-01

Full Text Available Abstract Background The cost-benefit of raccoon rabies control strategies such as oral rabies vaccination (ORV are under evaluation. As an initial quantification of the potential cost savings for a control program, the collection of selected rabies cost data was pilot tested for five counties in New York State (NYS in a three-year period. Methods Rabies costs reported to NYS from the study counties were computerized and linked to a human rabies exposure database. Consolidated costs by county and year were averaged and compared. Results Reported rabies-associated costs for all rabies variants totalled $2.1 million, for human rabies postexposure prophylaxes (PEP (90.9%, animal specimen preparation/shipment to laboratory (4.7%, and pet vaccination clinics (4.4%. The proportion that may be attributed to raccoon rabies control was 37% ($784,529. Average costs associated with the raccoon variant varied across counties from $440 to $1,885 per PEP, $14 to $44 per specimen, and $0.33 to $15 per pet vaccinated. Conclusion Rabies costs vary widely by county in New York State, and were associated with human population size and methods used by counties to estimate costs. Rabies cost variability must be considered in developing estimates of possible ORV-related cost savings. Costs of PEPs and specimen preparation/shipments, as well as the costs of pet vaccination provided by this study may be valuable for development of more realistic scenarios in economic modelling of ORV costs versus benefits.

Global Methane Initiative

Science.gov (United States)

The Global Methane Initiative promotes cost-effective, near-term methane recovery through partnerships between developed and developing countries, with participation from the private sector, development banks, and nongovernmental organizations.

COST BENEFIT ANALYSIS OF A DG INTEGRATED SYSTEM: CASE STUDY

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Ch. V. S. S. SAILAJA

2017-09-01

Full Text Available Distributed Generation is capable of meeting the load of the consumers partially or completely. Depending on the type of DG involved it can be operated in interconnected mode and islanded mode. The availability of numerous alternatives present for the DG technologies and large initial investments necessitates a detailed cost benefit analysis for the implementation of DG technologies. In this work an attempt has been made to study the costs involved in implementing the DG technologies. A practical system having two kinds of distributed generation i.e., Diesel Generator and solar photovoltaic system for its back up purpose is considered. A detailed cost analysis of the two DG technologies is carried out.

Chronic care model and cost reduction in initial health: a new approach for satisfaction and improvement of chronicity

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Stefano Marcelli

2017-10-01

Full Text Available Nowadays, the number of elderly is growing, with consequent increase of chronic diseases. An effective approach to reduce the costs incurred is required. The Chronic Care Model has proven to be a good starting point for a better management of economic and human resources.

The cost of hemodialysis in a large hemodialysis center

Directory of Open Access Journals (Sweden)

Khalid Al Saran

2012-01-01

Full Text Available To assess the cost of hemodialysis (HD delivered at our center according to the treatment protocols based on the current Kidney Disease Outcome Quality Initiative (K/DOQI guidelines, we analyzed our cost data during the period from 1st of January 2007 to 30th of June 2010. The methods were used to determine both direct costs (related to dialysis treatment such as dialysis disposables, dialysis related drugs, medical personnel, out-patient medications, laboratory and other ancillary services and overhead costs (building, maintenance and engineering costs, housekeeping, and administrative personnel. During the study period, an average of 2,500 HD sessions per month were performed for 200 patients. The mean total cost per HD session was calculated as 297 US dollars (USD [1,114 Saudi Riyals (SR], and the mean total cost of dialysis per patient per year was 46,332 USD (173,784 SR. Direct costs contributed to 81.15% of the total cost from which the personnel cost represented 41.11% and dialysis disposables represented 13.64%, while medications (outpatient and intravenous dialysis related medications including albumin, erythropoiesis stimulating agents, iron and vitamin D3 accounted for 12.47% of the total cost. Our total cost level is well below the average cost in the industrialized countries.

Initial public offerings in Brazil (2004-2006: Valuation with the use of multiples and discounting of cash flows using the appropriate cost of equity

Directory of Open Access Journals (Sweden)

Luiz Felipe Jacques da Motta

2008-10-01

Full Text Available The pricing process of new shares in IPOs has been under study in several countries. This paper initially looks at the valuation process using multiples and seeks to classify the new shares under two categories: underpriced or overpriced at the time of the IPOs. Analysis of the cost of equity, comparing betas at the time of the offerings (usually calculated as the betas of comparable companies and the betas of the companies after 12 months of trading, is also carried out. Companies in the sample are those that went public between 2004 and 2006. Results indicated that companies were not undervalued, even after some high short-term returns. However there is no statistical evidence that they were overvalued. Finally, results indicated that betas after twelve months of trading are significantly higher than the comparable companies’ betas used at the time of the IPOs.

Study protocol for the Integra Initiative to assess the benefits and costs of integrating sexual and reproductive health and HIV services in Kenya and Swaziland

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Warren Charlotte E

2012-11-01

Full Text Available Abstract Background In sub-Saharan Africa (SSA there are strong arguments for the provision of integrated sexual and reproductive health (SRH and HIV services. Most HIV transmissions are sexually transmitted or associated with pregnancy, childbirth, and breastfeeding. Many of the behaviours that prevent HIV transmission also prevent sexually transmitted infections and unintended pregnancies. There is potential for integration to increase the coverage of HIV services, as individuals who use SRH services can benefit from HIV services and vice-versa, as well as increase cost-savings. However, there is a dearth of empirical evidence on effective models for integrating HIV/SRH services. The need for robust evidence led a consortium of three organizations – International Planned Parenthood Federation, Population Council and the London School of Hygiene & Tropical Medicine – to design/implement the Integra Initiative. Integra seeks to generate rigorous evidence on the feasibility, effectiveness, cost and impact of different models for delivering integrated HIV/SRH services in high and medium HIV prevalence settings in SSA. Methods/design A quasi-experimental study will be conducted in government clinics in Kenya and Swaziland – assigned into intervention/comparison groups. Two models of service delivery are investigated: integrating HIV care/treatment into 1 family planning and 2 postnatal care. A full economic-costing will be used to assess the costs of different components of service provision, and the determinants of variations in unit costs across facilities/service models. Health facility assessments will be conducted at four time-periods to track changes in quality of care and utilization over time. A two-year cohort study of family planning/postnatal clients will assess the effect of integration on individual outcomes, including use of SRH services, HIV status (known/unknown and pregnancy (planned/unintended. Household surveys within some

ON A COURNOT DUOPOLY GAME WITH DIFFERENTIATED GOODS, HETEROGENEOUS EXPECTATIONS AND A COST FUNCTION INCLUDING EMISSION COSTS

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Georges SARAFOPOULOS

2017-07-01

Full Text Available In this study we investigate the dynamics of a nonlinear Cournot- type duopoly game with differentiated goods, linear demand and a cost function that includes emission costs. The game is modeled with a system of two difference equations. Existence and stability of equilibria of this system are studied. We show that the model gives more complex chaotic and unpredictable trajectories as a consequence of change in the parameter of horizontal product differentiation and a higher (lower degree of product differentiation (weaker or fiercer competition destabilize (stabilize the economy. The chaotic features are justified numerically via computing Lyapunov numbers and sensitive dependence on initial conditions. Also, we show that in this case there are stable trajectories and a higher (lower degree of product differentiation does not tend to destabilize the economy.

The costs of reducing the excess CO{sub 2} emissions. Reduction potential and costs in certain sector; Hvad koster det at reducere CO{sup 2}-mankoen? - Reduktionspotentiale og omkostninger i udvalgte sektorer

Energy Technology Data Exchange (ETDEWEB)

NONE

2003-07-01

The report presents the results from the project 'The costs of reducing the excess CO{sub 2} emissions - reduction potential and costs in certain sectors'. The aim of the project has been to elucidate the full extent of the reduction potentials and the costs for certain CO{sub 2} reducing initiatives, which are not included in the present projections of the excess CO{sub 2} emissions. The initiatives included in this report are: Accumulation of methane from Danish disposal facilities; Accumulation of methane from disposal facilities in Russia; Reduction in the use of industrial greenhouse gases; Aquifer disposal of CO{sub 2} in the underground; Offshore CO{sub 2} disposal in oil fields in the North Sea. Furthermore, the report presents a general evaluation of the potential of methane accumulation from wastewater treatment. (ba)

Low-cost autonomous orbit control about Mars: Initial simulation results

Science.gov (United States)

Dawson, S. D.; Early, L. W.; Potterveld, C. W.; Königsmann, H. J.

1999-11-01

Interest in studying the possibility of extraterrestrial life has led to the re-emergence of the Red Planet as a major target of planetary exploration. Currently proposed missions in the post-2000 period are routinely calling for rendezvous with ascent craft, long-term orbiting of, and sample-return from Mars. Such missions would benefit greatly from autonomous orbit control as a means to reduce operations costs and enable contact with Mars ground stations out of view of the Earth. This paper present results from initial simulations of autonomously controlled orbits around Mars, and points out possible uses of the technology and areas of routine Mars operations where such cost-conscious and robust autonomy could prove most effective. These simulations have validated the approach and control philosophies used in the development of this autonomous orbit controller. Future work will refine the controller, accounting for systematic and random errors in the navigation of the spacecraft from the sensor suite, and will produce prototype flight code for inclusion on future missions. A modified version of Microcosm's commercially available High Precision Orbit Propagator (HPOP) was used in the preparation of these results due to its high accuracy and speed of operation. Control laws were developed to allow an autonomously controlled spacecraft to continuously control to a pre-defined orbit about Mars with near-optimal propellant usage. The control laws were implemented as an adjunct to HPOP. The GSFC-produced 50 × 50 field model of the Martian gravitational potential was used in all simulations. The Martian atmospheric drag was modeled using an exponentially decaying atmosphere based on data from the Mars-GRAM NASA Ames model. It is hoped that the simple atmosphere model that was implemented can be significantly improved in the future so as to approach the fidelity of the Mars-GRAM model in its predictions of atmospheric density at orbital altitudes. Such additional work

Paying the full cost of power : an indicative comparative analysis of residential electricity rates across Canadian provinces

International Nuclear Information System (INIS)

Goulding, A.J.; Sabatier, G.

2005-01-01

This study was commissioned to review electricity rates charged to residential consumers across Canada and to determine how the basics of ratemaking change from province to province. Rates in each province vary significantly due to differences in the industry structure and their resource base. It was noted that direct comparisons are difficult because some rates reflect the financing, fuel and opportunity costs of power. For that reason, a simple adjustment factor was developed for fair comparison between jurisdictions. This assessment compared the all-in cost to final consumers which includes power generation, transmission, distribution and all other charges, as calculated by Statistics Canada. It was revealed that Alberta is Canada's only province where prices to final consumers reflect the market value of the underlying commodity. Ratepayers have the advantage of not being responsible for bad investment choices in the power sector and there are no hidden subsidies due to provincial ownership of power resources. Another consumer advantage is that they receive appropriate price signals in terms of energy consumption and conservation. This report suggests that low electricity rates in other provinces can be expected to rise much more rapidly than those in Alberta in the coming decade as consumers may be charged the full value of the electricity they use. 18 refs., 9 figs

Lives Saved Tool (LiST costing: a module to examine costs and prioritize interventions

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Lori A. Bollinger

2017-11-01

Full Text Available Abstract Background Achieving the Sustainable Development Goals will require careful allocation of resources in order to achieve the highest impact. The Lives Saved Tool (LiST has been used widely to calculate the impact of maternal, neonatal and child health (MNCH interventions for program planning and multi-country estimation in several Lancet Series commissions. As use of the LiST model increases, many have expressed a desire to cost interventions within the model, in order to support budgeting and prioritization of interventions by countries. A limited LiST costing module was introduced several years ago, but with gaps in cost types. Updates to inputs have now been added to make the module fully functional for a range of uses. Methods This paper builds on previous work that developed an initial version of the LiST costing module to provide costs for MNCH interventions using an ingredients-based costing approach. Here, we update in 2016 the previous econometric estimates from 2013 with newly-available data and also include above-facility level costs such as program management. The updated econometric estimates inform percentages of intervention-level costs for some direct costs and indirect costs. These estimates add to existing values for direct cost requirements for items such as drugs and supplies and required provider time which were already available in LiST Costing. Results Results generated by the LiST costing module include costs for each intervention, as well as disaggregated costs by intervention including drug and supply costs, labor costs, other recurrent costs, capital costs, and above-service delivery costs. These results can be combined with mortality estimates to support prioritization of interventions by countries. Conclusions The LiST costing module provides an option for countries to identify resource requirements for scaling up a maternal, neonatal, and child health program, and to examine the financial impact of different

ASSESSING THE COSTS OF THE THERMAL REHABILITATIONS OF A STUDIO BLOCK ENVELOPE

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DINU R.C.

2017-06-01

Full Text Available A view to reducing thermal energy consumption for a block of studios, this paper presents an assessment of the costs of energy efficient building materials used for the thermal rehabilitation of the analyzed building’s tire. Based on information obtained from the evaluation of heat energy consumption and of the actual heat balance of the studios block, resulted the necessity for thermal rehabilitation. These works aimed equally both exterior walls as well as exterior windows and doors and involves a certain level of initial costs wich will be recovered through lower cost of the consumed thermal energy after thermal rehabilitation of the building tire.

Costs and Benefits to Pregnant Male Pipefish Caring for Broods of Different Sizes.

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Gry Sagebakken

Full Text Available Trade-offs between brood size and offspring size, offspring survival, parental condition or parental survival are classic assumptions in life history biology. A reduction in brood size may lessen these costs of care, but offspring mortality can also result in an energetic gain, if parents are able to utilize the nutrients from the demised young. Males of the broad-nosed pipefish (Syngnathus typhle care for the offspring by brooding embryos in a brood pouch. Brooding males can absorb nutrients that emanate from embryos, and there is often a reduction in offspring number over the brooding period. In this study, using two experimentally determined brood sizes (partially and fully filled brood pouches, we found that full broods resulted in larger number of developing offspring, despite significantly higher absolute and relative embryo mortality, compared to partial broods. Male survival was also affected by brood size, with males caring for full broods having poorer survival, an effect that together with the reduced embryo survival was found to negate the benefit of large broods. We found that embryo mortality was lower when the brooding males were in good initial condition, that embryos in broods with low embryo mortality weighed more, and surprisingly, that males in higher initial condition had embryos of lower weight. Brood size, however, did not affect embryo weight. Male final condition, but not initial condition, correlated with higher male survival. Taken together, our results show costs and benefits of caring for large brood sizes, where the numerical benefits come with costs in terms of both embryo survival and survival of the brooding father, effects that are often mediated via male condition.

Reducing Reforestation Costs in Lebanon: Adaptive Field Trials

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Garabet (Garo Haroutunian

2017-05-01

Full Text Available Lebanon’s Ministry of Environment initiated a project in 2009 to determine low-cost reforestation techniques for stone pine (Pinus pinea and Lebanon cedar (Cedrus libani for large-scale land rehabilitation activities in the arid Middle East. Irrigation (several techniques vs. no water, planting (8- to 18-month-old seedlings, seeding, and soil preparation methods were evaluated in three sets of adaptive management field trials. The aim was to reduce reforestation costs while still achieving sufficient regeneration. A key result for management was that non-irrigated seed planting of stone pine and possibly of Lebanon cedar showed promise for cost-effective reforestation and could be competitive with seedlings, given correct seed source and planting conditions. Stone pine seeds collected from nearby mother trees and planted without irrigation on sandy soil showed 35% survival for <600 USD/ha; seedlings planted without irrigation cost about 2500 USD/ha and achieved 50–70% survival (costs based on 800 seedlings/ha. Water supplements increased establishment costs over 2 years without concomitant improvements to survival. Future studies should evaluate how soil texture and soil preparation interact with other factors to affect seed germination and survival for each species.

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

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

2013-10-01

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

Cost-effective sequencing of full-length cDNA clones powered by a de novo-reference hybrid assembly.

Science.gov (United States)

Kuroshu, Reginaldo M; Watanabe, Junichi; Sugano, Sumio; Morishita, Shinichi; Suzuki, Yutaka; Kasahara, Masahiro

2010-05-07

Sequencing full-length cDNA clones is important to determine gene structures including alternative splice forms, and provides valuable resources for experimental analyses to reveal the biological functions of coded proteins. However, previous approaches for sequencing cDNA clones were expensive or time-consuming, and therefore, a fast and efficient sequencing approach was demanded. We developed a program, MuSICA 2, that assembles millions of short (36-nucleotide) reads collected from a single flow cell lane of Illumina Genome Analyzer to shotgun-sequence approximately 800 human full-length cDNA clones. MuSICA 2 performs a hybrid assembly in which an external de novo assembler is run first and the result is then improved by reference alignment of shotgun reads. We compared the MuSICA 2 assembly with 200 pooled full-length cDNA clones finished independently by the conventional primer-walking using Sanger sequencers. The exon-intron structure of the coding sequence was correct for more than 95% of the clones with coding sequence annotation when we excluded cDNA clones insufficiently represented in the shotgun library due to PCR failure (42 out of 200 clones excluded), and the nucleotide-level accuracy of coding sequences of those correct clones was over 99.99%. We also applied MuSICA 2 to full-length cDNA clones from Toxoplasma gondii, to confirm that its ability was competent even for non-human species. The entire sequencing and shotgun assembly takes less than 1 week and the consumables cost only approximately US$3 per clone, demonstrating a significant advantage over previous approaches.

Clinical and cost-effectiveness of internal limiting membrane peeling for patients with idiopathic full thickness macular hole. Protocol for a Randomised Controlled Trial: FILMS (Full-thickness macular hole and Internal Limiting Membrane peeling Study

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Cook Jonathan

2008-11-01

Full Text Available Abstract Background A full-thickness macular hole (FTMH is a common retinal condition associated with impaired vision. Randomised controlled trials (RCTs have demonstrated that surgery, by means of pars plana vitrectomy and post-operative intraocular tamponade with gas, is effective for stage 2, 3 and 4 FTMH. Internal limiting membrane (ILM peeling has been introduced as an additional surgical manoeuvre to increase the success of the surgery; i.e. increase rates of hole closure and visual improvement. However, little robust evidence exists supporting the superiority of ILM peeling compared with no-peeling techniques. The purpose of FILMS (Full-thickness macular hole and Internal Limiting Membrane peeling Study is to determine whether ILM peeling improves the visual function, the anatomical closure of FTMH, and the quality of life of patients affected by this disorder, and the cost-effectiveness of the surgery. Methods/Design Patients with stage 2–3 idiopathic FTMH of less or equal than 18 months duration (based on symptoms reported by the participant and with a visual acuity ≤ 20/40 in the study eye will be enrolled in this FILMS from eight sites across the UK and Ireland. Participants will be randomised to receive combined cataract surgery (phacoemulsification and intraocular lens implantation and pars plana vitrectomy with postoperative intraocular tamponade with gas, with or without ILM peeling. The primary outcome is distance visual acuity at 6 months. Secondary outcomes include distance visual acuity at 3 and 24 months, near visual acuity at 3, 6, and 24 months, contrast sensitivity at 6 months, reading speed at 6 months, anatomical closure of the macular hole at each time point (1, 3, 6, and 24 months, health related quality of life (HRQOL at six months, costs to the health service and the participant, incremental costs per quality adjusted life year (QALY and adverse events. Discussion FILMS will provide high quality evidence on the

Incorporating psychological influences in probabilistic cost analysis

Energy Technology Data Exchange (ETDEWEB)

Kujawski, Edouard; Alvaro, Mariana; Edwards, William

2004-01-08

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

An Insight Into the Two Costing Technique: Absorption Costing and Marginal Costing

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Mariam Nawaz

2013-02-01

Full Text Available This paper will investigate the controversy that is innate between the two costing techniques; Absorption Costing and Marginal Costing and would throw light on which costing technique better serves its purpose in helping management for decision making process and if Marginal Costing technique is concluded as better technique then why it should not be used for external reporting purpose. This paper will only crystallize and highlight the issues descriptively and will not resolve the issues that are inherent between the two costing techniques. The unique thing about this paper is that it is in favor of treating fixed cost as product cost that is it is supporting the advocates of Absorption Costing Technique but it is against to consider profit as a function of production rather it believes that profit should only be considered as function of sales for stock valuation and to help management in decision making process that is, regarding this point it is supporting advocates of Marginal Costing.

Low Cost Vision Based Personal Mobile Mapping System

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M. M. Amami

2014-03-01

Full Text Available Mobile mapping systems (MMS can be used for several purposes, such as transportation, highway infrastructure mapping and GIS data collecting. However, the acceptance of these systems is not wide spread and their use is still limited due the high cost and dependency on the Global Navigation Satellite System (GNSS. A low cost vision based personal MMS has been produced with an aim to overcome these limitations. The system has been designed to depend mainly on cameras and use of low cost GNSS and inertial sensors to provide a bundle adjustment solution with initial values. The system has the potential to be used indoor and outdoor. The system has been tested indoors and outdoors with different GPS coverage, surrounded features, and narrow and curvy paths. Tests show that the system is able to work in such environments providing 3D coordinates of better than 10 cm accuracy.

ANN Based Approach for Estimation of Construction Costs of Sports Fields

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Michał Juszczyk

2018-01-01

Full Text Available Cost estimates are essential for the success of construction projects. Neural networks, as the tools of artificial intelligence, offer a significant potential in this field. Applying neural networks, however, requires respective studies due to the specifics of different kinds of facilities. This paper presents the proposal of an approach to the estimation of construction costs of sports fields which is based on neural networks. The general applicability of artificial neural networks in the formulated problem with cost estimation is investigated. An applicability of multilayer perceptron networks is confirmed by the results of the initial training of a set of various artificial neural networks. Moreover, one network was tailored for mapping a relationship between the total cost of construction works and the selected cost predictors which are characteristic of sports fields. Its prediction quality and accuracy were assessed positively. The research results legitimatize the proposed approach.

Cost Analysis of the STONE Randomized Trial: Can Health Care Costs be Reduced One Test at a Time?

Science.gov (United States)

Melnikow, Joy; Xing, Guibo; Cox, Ginger; Leigh, Paul; Mills, Lisa; Miglioretti, Diana L; Moghadassi, Michelle; Smith-Bindman, Rebecca

2016-04-01

Decreasing the use of high-cost tests may reduce health care costs. To compare costs of care for patients presenting to the emergency department (ED) with suspected kidney stones randomized to 1 of 3 initial imaging tests. Patients were randomized to point-of-care ultrasound (POC US, least costly), radiology ultrasound (RAD US), or computed tomography (CT, most costly). Subsequent testing and treatment were the choice of the treating physician. A total of 2759 patients at 15 EDs were randomized to POC US (n=908), RAD US, (n=893), or CT (n=958). Mean age was 40.4 years; 51.8% were male. All medical care documented in the trial database in the 7 days following enrollment was abstracted and coded to estimate costs using national average 2012 Medicare reimbursements. Costs for initial ED care and total 7-day costs were compared using nonparametric bootstrap to account for clustering of patients within medical centers. Initial ED visit costs were modestly lower for patients assigned to RAD US: $423 ($411, $434) compared with patients assigned to CT: $448 ($438, $459) (Pcosts were not significantly different between groups: $1014 ($912, $1129) for POC US, $970 ($878, $1078) for RAD US, and $959 ($870, $1044) for CT. Hospital admissions contributed over 50% of total costs, though only 11% of patients were admitted. Mean total costs (and admission rates) varied substantially by site from $749 to $1239. Assignment to a less costly test had no impact on overall health care costs for ED patients. System-level interventions addressing variation in admission rates from the ED might have greater impact on costs.

Pressure ulcer dressings in critical patients: a cost analysis

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Dinara Raquel Araújo Silva

Full Text Available Abstract OBJECTIVE To assess the direct cost of dressings in pressure ulcer treatment. METHOD This was a descriptive observational study conducted at an intensive care unit in the Northeast region of Brazil, between November and December 2015. Data were gathered using the Pressure Ulcer Scale for Healing and a form to characterize and assess costs. Values in Brazilian reais (BRL were converted into U.S. dollars at the exchange rate of USD 0.26/BRL. Univariate and bivariate analyses were conducted. RESULTS The sample consisted of 15 patients with at least stage 2 ulcers. There was a significant reduction in costs with dressing materials between the initial and final assessments (p=0.002, with a mean of USD 11.9 (±7.4. The most common topical treatments used were essential fatty acids and papain. CONCLUSION Cost reduction was proportional to the stage of pressure ulcer. The role of nurses in creating evidence-based care plans is crucial to improve care management.

Studies on the ANN implementation in the macro BIM cost analyzes

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Michał Juszczyk

2017-06-01

Full Text Available The paper presents an approach which combines the concept of macro-level BIM-based cost analyzes and application of artificial intelligence tools – namely artificial neural networks. Discussion and foundations of the proposed approach are introduced in the paper to clarify the problem’s core. An exemplary case study reports the results of initial studies on the application of neural networks for the purposes of BIM-based cost analysis of a buildings’ floor structural frame. The results obtained justify the proposal of application of neural networks as a supportive mathematical tool in the problem presented in the paper.

Assessing the Multiple Benefits of Clean Energy Full Report

Science.gov (United States)

Guidance for state energy, environmental, and economic policy makers to identify and quantify the many benefits of clean energy to support the development and implementation of cost-effective clean energy initiatives.

Low cost solar air heater

International Nuclear Information System (INIS)

Gill, R.S.; Singh, Sukhmeet; Singh, Parm Pal

2012-01-01

Highlights: ► Single glazed low cost solar air heater is more efficient during summer while double glazed is better in winter. ► For the same initial investment, low cost solar air heaters collect more energy than packed bed solar air heater. ► During off season low cost solar air heater can be stored inside as it is light in weight. - Abstract: Two low cost solar air heaters viz. single glazed and double glazed were designed, fabricated and tested. Thermocole, ultraviolet stabilised plastic sheet, etc. were used for fabrication to reduce the fabrication cost. These were tested simultaneously at no load and with load both in summer and winter seasons along with packed bed solar air heater using iron chips for absorption of radiation. The initial costs of single glazed and double glazed are 22.8% and 26.8% of the initial cost of packed bed solar air heater of the same aperture area. It was found that on a given day at no load, the maximum stagnation temperatures of single glazed and double glazed solar air heater were 43.5 °C and 62.5 °C respectively. The efficiencies of single glazed, double glazed and packed bed solar air heaters corresponding to flow rate of 0.02 m 3 /s-m 2 were 30.29%, 45.05% and 71.68% respectively in winter season. The collector efficiency factor, heat removal factor based on air outlet temperature and air inlet temperature for three solar air heaters were also determined.

COSTS CALCULATION OF TARGET COSTING METHOD

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Sebastian UNGUREANU

2014-06-01

Full Text Available Cost information system plays an important role in every organization in the decision making process. An important task of management is ensuring control of the operations, processes, sectors, and not ultimately on costs. Although in achieving the objectives of an organization compete more control systems (production control, quality control, etc., the cost information system is important because monitors results of the other. Detailed analysis of costs, production cost calculation, quantification of losses, estimate the work efficiency provides a solid basis for financial control. Knowledge of the costs is a decisive factor in taking decisions and planning future activities. Managers are concerned about the costs that will appear in the future, their level underpinning the supply and production decisions as well as price policy. An important factor is the efficiency of cost information system in such a way that the information provided by it may be useful for decisions and planning of the work.

The Neuroeconomics of Tobacco Demand: An Initial Investigation of the Neural Correlates of Cigarette Cost-Benefit Decision Making in Male Smokers.

Science.gov (United States)

Gray, Joshua C; Amlung, Michael T; Owens, Max; Acker, John; Brown, Courtney L; Brody, Gene H; Sweet, Lawrence H; MacKillop, James

2017-02-03

How the brain processes cigarette cost-benefit decision making remains largely unknown. Using functional magnetic resonance imaging (fMRI), this study investigated the neural correlates of decisions for cigarettes (0-10 cigarettes) at varying levels of price during a Cigarette Purchase Task (CPT) in male regular smokers (N = 35). Differential neural activity was examined between choices classified as inelastic, elastic, and suppressed demand, operationalized as consumption unaffected by cost, partially suppressed by cost, and entirely suppressed by cost, respectively. Decisions reflecting elastic demand, putatively the most effortful decisions, elicited greater activation in regions associated with inhibition and planning (e.g., middle frontal gyrus and inferior frontal gyrus), craving and interoceptive processing (anterior insula), and conflict monitoring (e.g., anterior cingulate cortex). Exploratory examination in a harmonized dataset of both cigarette and alcohol demand (N = 59) suggested common neural activation patterns across commodities, particularly in the anterior insula, caudate, anterior cingulate, medial frontal gyrus, and dorsolateral prefrontal cortex. Collectively, these findings provide initial validation of a CPT fMRI paradigm; reveal the interplay of brain regions associated with executive functioning, incentive salience, and interoceptive processing in cigarette decision making; and add to the literature implicating the insula as a key brain region in addiction.

Assessing the cost of electronic health records: a review of cost indicators.

Science.gov (United States)

Gallego, Ana Isabel; Gagnon, Marie-Pierre; Desmartis, Marie

2010-11-01

We systematically reviewed PubMed and EBSCO business, looking for cost indicators of electronic health record (EHR) implementations and their associated benefit indicators. We provide a set of the most common cost and benefit (CB) indicators used in the EHR literature, as well as an overall estimate of the CB related to EHR implementation. Overall, CB evaluation of EHR implementation showed a rapid capital-recovering process. On average, the annual benefits were 76.5% of the first-year costs and 308.6% of the annual costs. However, the initial investments were not recovered in a few studied implementations. Distinctions in reporting fixed and variable costs are suggested.

Initial laparoscopic basic skills training shortens the learning curve of laparoscopic suturing and is cost-effective.

Science.gov (United States)

Stefanidis, Dimitrios; Hope, William W; Korndorffer, James R; Markley, Sarah; Scott, Daniel J

2010-04-01

Laparoscopic suturing is an advanced skill that is difficult to acquire. Simulator-based skills curricula have been developed that have been shown to transfer to the operating room. Currently available skills curricula need to be optimized. We hypothesized that mastering basic laparoscopic skills first would shorten the learning curve of a more complex laparoscopic task and reduce resource requirements for the Fundamentals of Laparoscopic Surgery suturing curriculum. Medical students (n = 20) with no previous simulator experience were enrolled in an IRB-approved protocol, pretested on the Fundamentals of Laparoscopic Surgery suturing model, and randomized into 2 groups. Group I (n = 10) trained (unsupervised) until proficiency levels were achieved on 5 basic tasks; Group II (n = 10) received no basic training. Both groups then trained (supervised) on the Fundamentals of Laparoscopic Surgery suturing model until previously reported proficiency levels were achieved. Two weeks later, they were retested to evaluate their retention scores, training parameters, instruction requirements, and cost between groups using t-test. Baseline characteristics and performance were similar for both groups, and 9 of 10 subjects in each group achieved the proficiency levels. The initial performance on the simulator was better for Group I after basic skills training, and their suturing learning curve was shorter compared with Group II. In addition, Group I required less active instruction. Overall time required to finish the curriculum was similar for both groups; but the Group I training strategy cost less, with a savings of $148 per trainee. Teaching novices basic laparoscopic skills before a more complex laparoscopic task produces substantial cost savings. Additional studies are needed to assess the impact of such integrated curricula on ultimate educational benefit. Copyright (c) 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of internal limiting membrane peeling versus no peeling for patients with an idiopathic full-thickness macular hole: results from a randomised controlled trial.

Science.gov (United States)

Ternent, Laura; Vale, Luke; Boachie, Charles; Burr, Jennifer M; Lois, Noemi

2012-03-01

To determine whether internal limiting membrane (ILM) peeling is cost-effective compared with no peeling for patients with an idiopathic stage 2 or 3 full-thickness macular hole. A cost-effectiveness analysis was performed alongside a randomised controlled trial. 141 participants were randomly allocated to receive macular-hole surgery, with either ILM peeling or no peeling. Health-service resource use, costs and quality of life were calculated for each participant. The incremental cost per quality-adjusted life year (QALY) gained was calculated at 6 months. At 6 months, the total costs were on average higher (£424, 95% CI -182 to 1045) in the No Peel arm, primarily owing to the higher reoperation rate in the No Peel arm. The mean additional QALYs from ILM peel at 6 months were 0.002 (95% CI 0.01 to 0.013), adjusting for baseline EQ-5D and other minimisation factors. A mean incremental cost per QALY was not computed, as Peeling was on average less costly and slightly more effective. A stochastic analysis suggested that there was more than a 90% probability that Peeling would be cost-effective at a willingness-to-pay threshold of £20,000 per QALY. Although there is no evidence of a statistically significant difference in either costs or QALYs between macular hole surgery with or without ILM peeling, the balance of probabilities is that ILM Peeling is likely to be a cost-effective option for the treatment of macular holes. Further long-term follow-up data are needed to confirm these findings.

An empirical investigation into the changing visual identity of full service and low cost carriers, 2000 vs. 2012

Directory of Open Access Journals (Sweden)

Adam Taylor

2013-09-01

Full Text Available This paper reports on the findings of a semiotic content analysis of the visual branding of over 630 airline tail fins as they appeared in 2000 and 2012. Unlike existing studies of airlines’ visual identities that rely on a snap shot in time and examine all airlines, this paper focuses on changes that have occurred in the visual branding of full-service carriers (FSCs and low cost carriers (LCCs between 2000 and 2012. The results confirm that there have been significant changes in the visual content of FSC and LCC tail fins and the way in which these airlines portray non-price competitive characteristics. The research shows that while an increasing number of LCCs now use aircraft tail fins to display their corporate name, FSCs are increasingly employing icons of nationhood. This suggests that while LCCs are trying to appeal to a wide passenger demographic who value low fares over service, FSCs are responding to the competitive threat by explicitly drawing on the cultural rhetoric of symbols of sovereign national identity to differentiate themselves in an increasingly competitive market.

Which Triple Aim related measures are being used to evaluate population management initiatives? An international comparative analysis.

Science.gov (United States)

Hendrikx, Roy J P; Drewes, Hanneke W; Spreeuwenberg, Marieke; Ruwaard, Dirk; Struijs, Jeroen N; Baan, Caroline A

2016-05-01

Population management (PM) initiatives are introduced in order to create sustainable health care systems. These initiatives should focus on the continuum of health and well-being of a population by introducing interventions that integrate various services. To be successful they should pursue the Triple Aim, i.e. simultaneously improve population health and quality of care while reducing costs per capita. This study explores how PM initiatives measure the Triple Aim in practice. An exploratory search was combined with expert consultations to identify relevant PM initiatives. These were analyzed based on general characteristics, utilized measures and related selection criteria. In total 865 measures were used by 20 PM initiatives. All quality of care domains were included by at least 11 PM initiatives, while most domains of population health and costs were included by less than 7 PM initiatives. Although their goals showed substantial overlap, the measures applied showed few similarities between PM initiatives and were predominantly selected based on local priority areas and data availability. Most PM initiatives do not measure the full scope of the Triple Aim. Additionally, variety between measures limits comparability between PM initiatives. Consensus on the coverage of Triple Aim domains and a set of standardized measures could further both the inclusion of the various domains as well as the comparability between PM initiatives. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Intelligent transport systems deployment in Thessaloniki: Assessment of costs and benefits

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Mitsakis Evangelos

2015-01-01

Full Text Available Transportation projects often require large initial investments and are expected to generate benefits extending far into the future. Thus, there is a need to compare benefits and costs that occur at different periods over time. Since money has a time value, the same amount of money at different time periods does not have the same value. Therefore, it is important to convert costs and benefits into equivalent values when conducting a Cost-Benefit Analysis (CBA. A special category of transportation projects is that of Intelligent Transport Systems (ITS. ITS comprise innovative solutions for travel demand and traffic management, and it is expected to play a key role in future sustainable urban development plans. Compared to other transportation projects, ITS have a lower initial investment. In this paper a framework based on a CBA is presented, assessing costs and benefits of three ITS projects implemented in Thessaloniki, Greece. The paper refers to future developments of ITS in the city of Thessaloniki. The examined systems have already been developed as demonstration systems in various regions throughout Europe. The benefits of the systems have been transferred and scaled up, so as to be in line with the specific characteristics of the Greek environment.

Team training using full-scale reactor coolant pump seal mock-ups

International Nuclear Information System (INIS)

McDonald, T.J.; Hamill, R.W.

1987-01-01

The use of full-scale reactor coolant pump (RCP) seal mock-ups has greatly enhanced Northeast Utilities' ability to effectively utilize the team training approach to technical training. With the advent of the Institute of Nuclear Power Operations accreditation come a new emphasis and standards for the integrated training of plant engineering personnel, maintenance mechanics, quality control personnel, and health physics personnel. The results of purchasing full-scale RCP mock-ups to pilot the concept of team training have far exceeded expectations and cost-limiting factors. The initial training program analysis identified RCP seal maintenance as a task that required training for maintenance department personnel. Due to radiation exposure considerations and the unavailability of actual plant equipment for training purposes, the decision was made to procure a mock-up of an RCP seal assembly and housing. This mock-up was designed to facilitate seal cartridge removal, disassembly, assembly, and installation, duplicating all internal components of the seal cartridge and housing area in exact detail

The cost-effectiveness and budget impact of stepwise addition of bolus insulin in the treatment of type 2 diabetes: evaluation of the FullSTEP trial.

Science.gov (United States)

Saunders, Rhodri; Lian, Jean; Karolicki, Boris; Valentine, William

2014-12-01

Abstract Background and aims: Intensification of basal insulin-only therapy in type 2 diabetes is often achieved through addition of bolus insulin 3-times daily. The FullSTEP trial demonstrated that stepwise addition (SWA) of bolus insulin aspart was non-inferior to full basal-bolus (FBB) therapy and reduced the rate of hypoglycemia. Here the cost-effectiveness and budget impact of SWA is evaluated. Cost-effectiveness and budget impact models were developed to assess the cost and quality-of-life (QoL) implications of intensification using SWA compared with FBB in the US setting. At assessment, SWA patients added one bolus dose to their current regimen if the HbA1c target was not met. SWA patients reaching three bolus doses used FBB event rates. Outcomes were evaluated at trial end and projected annually up to 5 years. Models captured hypoglycemic events, the proportion meeting HbA1c target, and self-measured blood glucose. Event rates and QoL utilities were taken from trial data and published literature. Costs were evaluated from a healthcare-payer perspective, reported in 2013 USD, and discounted (like clinical outcomes) at 3.5% annually. This analysis applies to patients with HbA1c 7.0-9.0% and body mass index Budget impact analysis estimated that, by moving from FBB to SWA, a health plan with 77,000 patients with type 2 diabetes, of whom 7.8% annually intensified to basal-bolus therapy, would save USD 1304 per intensifying patient over the trial period. SWA of bolus insulin should be considered a beneficial and cost-saving alternative to FBB therapy for the intensification of treatment in type 2 diabetes.

Unilateral initiatives

International Nuclear Information System (INIS)

Anon.

1988-01-01

This paper reports on arms control which is generally thought of in terms of formal negotiations with an opponent, with the resulting agreements embodied in a treaty. This is not surprising, since arms control discussions between opponents are both important and politically visible. There are, however, strong reasons for countries to consider and frequently take unilateral initiatives. To do so is entirely consistent with the established major precepts of arms control which state that arms control is designed to reduce the risk of war, the costs of preparing for war, and the death and destruction if war should come. Unilateral initiatives on what weapons are purchased, which ones are eliminated and how forces are deployed can all relate to these objectives. There are two main categories of motives for unilateral initiatives in arms control. In one category, internal national objectives are the dominant, often sole, driving force; the initiative is undertaken for our own good

Cost-Effectiveness Evaluation of Etoricoxib versus Celecoxib and Nonselective NSAIDs in the Treatment of Ankylosing Spondylitis in Norway

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Jeroen P. Jansen

2011-01-01

Full Text Available Objectives. To evaluate the cost-effectiveness of etoricoxib (90 mg relative to celecoxib (200/400 mg, and the nonselective NSAIDs naproxen (1000 mg and diclofenac (150 mg in the initial treatment of ankylosing spondylitis in Norway. Methods. A previously developed Markov state-transition model was used to estimate costs and benefits associated with initiating treatment with the different competing NSAIDs. Efficacy, gastrointestinal and cardiovascular safety, and resource use data were obtained from the literature. Data from different studies were synthesized and translated into direct costs and quality adjusted life years by means of a Bayesian comprehensive decision modeling approach. Results. Over a 30-year time horizon, etoricoxib is associated with about 0.4 more quality adjusted life years than the other interventions. At 1 year, naproxen is the most cost-saving strategy. However, etoricoxib is cost and quality adjusted life year saving relative to celecoxib, as well as diclofenac and naproxen after 5 years of follow-up. For a willingness-to-pay ceiling ratio of 200,000 Norwegian krones per quality adjusted life year, there is a >95% probability that etoricoxib is the most-cost-effective treatment when a time horizon of 5 or more years is considered. Conclusions. Etoricoxib is the most cost-effective NSAID for initiating treatment of ankylosing spondylitis in Norway.

(20) Akinwole CORRECTED Cost (new art)

African Journals Online (AJOL)

Adeyinka Odunsi

Recirculating fish production technology re-‐uses water more than once by passing it through ... Within fixed costs input, interest payment on initial investment ranks the highest. While feed cost accounts for the highest among variable costs for fingerlings and growout systems. ... efforts geared towards obtaining information.

Evaluation of costs accrued through inadvertent continuation of hospital-initiated proton pump inhibitor therapy for stress ulcer prophylaxis beyond hospital discharge: a retrospective chart review

Directory of Open Access Journals (Sweden)

Shin S

2015-04-01

Full Text Available Sooyoung Shin Ajou University College of Pharmacy, Yeongtong-gu, Suwon-si, Gyeonggi-do, South Korea Background: Stress ulcers and related upper gastrointestinal bleeding are well-known complications in intensive care unit (ICU patients. Proton pump inhibitor (PPI-based stress ulcer prophylaxis (SUP has been widely prescribed in noncritically ill patients who are at low risk for clinically significant bleeding, which is then injudiciously continued after hospital discharge. This study aimed to evaluate the incidence of inappropriate prescribing of PPI-based preventative therapy in ICU versus non-ICU patients that subsequently continued postdischarge, and to estimate the costs incurred by the unwarranted outpatient continuation of PPI therapy.Methods: A retrospective review of patient data at a major teaching hospital in Korea was performed. During the 4-year study period, adult patients who were newly initiated on PPI-based SUP during hospital admission and subsequently discharged on a PPI without a medical indication for such therapy were captured for data analysis. The incidence rates of inappropriate prescribing of PPIs were compared between ICU and non-ICU patients, and the costs associated with such therapy were also examined.Results: A total of 4,410 patients, more than half of the inpatient-initiated PPI users, were deemed to have been inadvertently prescribed a PPI at discharge in the absence of a medical need for acid suppression. The incidence of inappropriate outpatient continuation of the prophylaxis was higher among ICU patients compared with non-ICU patients (57.7% versus 52.2%, respectively; P=0.001. The total expenditure accrued through the continuation of nonindicated PPI therapy was approximately US$40,175.Conclusion: This study confirmed that excess usage of PPIs for SUP has spread to low-risk, non-ICU patients. The overuse of unwarranted PPI therapy can incur large health care expenditure, as well as clinical complications

Economic analysis of the global polio eradication initiative.

Science.gov (United States)

Duintjer Tebbens, Radboud J; Pallansch, Mark A; Cochi, Stephen L; Wassilak, Steven G F; Linkins, Jennifer; Sutter, Roland W; Aylward, R Bruce; Thompson, Kimberly M

2010-12-16

The global polio eradication initiative (GPEI), which started in 1988, represents the single largest, internationally coordinated public health project to date. Completion remains within reach, with type 2 wild polioviruses apparently eradicated since 1999 and fewer than 2000 annual paralytic poliomyelitis cases of wild types 1 and 3 reported since then. This economic analysis of the GPEI reflects the status of the program as of February 2010, including full consideration of post-eradication policies. For the GPEI intervention, we consider the actual pre-eradication experience to date followed by two distinct potential future post-eradication vaccination policies. We estimate GPEI costs based on actual and projected expenditures and poliomyelitis incidence using reported numbers corrected for underreporting and model projections. For the comparator, which assumes only routine vaccination for polio historically and into the future (i.e., no GPEI), we estimate poliomyelitis incidence using a dynamic infection transmission model and costs based on numbers of vaccinated children. Cost-effectiveness ratios for the GPEI vs. only routine vaccination qualify as highly cost-effective based on standard criteria. We estimate incremental net benefits of the GPEI between 1988 and 2035 of approximately 40-50 billion dollars (2008 US dollars; 1988 net present values). Despite the high costs of achieving eradication in low-income countries, low-income countries account for approximately 85% of the total net benefits generated by the GPEI in the base case analysis. The total economic costs saved per prevented paralytic poliomyelitis case drive the incremental net benefits, which become positive even if we estimate the loss in productivity as a result of disability as below the recommended value of one year in average per-capita gross national income per disability-adjusted life year saved. Sensitivity analysis suggests that the finding of positive net benefits of the GPEI remains

Estimating the costs of human space exploration

Science.gov (United States)

Mandell, Humboldt C., Jr.

1994-01-01

The plan for NASA's new exploration initiative has the following strategic themes: (1) incremental, logical evolutionary development; (2) economic viability; and (3) excellence in management. The cost estimation process is involved with all of these themes and they are completely dependent upon the engineering cost estimator for success. The purpose is to articulate the issues associated with beginning this major new government initiative, to show how NASA intends to resolve them, and finally to demonstrate the vital importance of a leadership role by the cost estimation community.

Women's Initiative for Nonsmoking-VII: evaluation of health service utilization and costs among women smokers with cardiovascular disease.

Science.gov (United States)

Froelicher, Erika Sivarajan; Sohn, Min; Max, Wendy; Bacchetti, Peter

2004-01-01

The Women's Initiative for Nonsmoking (WINS), a randomized clinical trial of a smoking cessation intervention for women with cardiovascular disease, permitted an assessment of the types and costs of health services women used during the 30 months after their hospitalization with cardiovascular disease. A prospective design nested within WINS was used for this study. A structured telephone interview guide included questions about medical services and 15 categories of prevention services, including cardiac rehabilitation at 6, 12, 24, and 30 months. Costs were estimated from state and national databases. The 277 women studied had a mean age of 60.7 +/- 10 years. They had smoked approximately 40 +/- 11.4 years. More than 50% of the women had one or more risk factors for cardiovascular disease. During the first 6 months after the index hospitalization, 94% had a physician visit, 39% had an emergency-room visit, and 36% had a hospital admission. Prevention services used were home healthcare by nurse or home health aide (26%), a cardiac rehabilitation program, including Multifit and Heart Smart (19%), and physical therapy (14%). Usage decreased over the 30 months. For the women who used any service, the mean total monthly cost per woman was 913 dollars +/- 1204 dollars. This is the first report on health service use by women smokers with cardiovascular disease. Data collection using a telephone interview guide proved feasible for evaluating health service use. The greatest costs resulted from hospital admissions and physician and emergency-room visits. Considering the high prevalence of risk factors in this cohort, secondary prevention services were severely underutilized. By increasing referrals to such services, physicians and nurses might influence women to reduce their risk for subsequent cardiovascular disease.

IDC Reengineering Phase 2 & 3 Rough Order of Magnitude (ROM) Cost Estimate Summary (Leveraged NDC Case).

Energy Technology Data Exchange (ETDEWEB)

Harris, James M.; Prescott, Ryan; Dawson, Jericah M.; Huelskamp, Robert M.

2014-11-01

Sandia National Laboratories has prepared a ROM cost estimate for budgetary planning for the IDC Reengineering Phase 2 & 3 effort, based on leveraging a fully funded, Sandia executed NDC Modernization project. This report provides the ROM cost estimate and describes the methodology, assumptions, and cost model details used to create the ROM cost estimate. ROM Cost Estimate Disclaimer Contained herein is a Rough Order of Magnitude (ROM) cost estimate that has been provided to enable initial planning for this proposed project. This ROM cost estimate is submitted to facilitate informal discussions in relation to this project and is NOT intended to commit Sandia National Laboratories (Sandia) or its resources. Furthermore, as a Federally Funded Research and Development Center (FFRDC), Sandia must be compliant with the Anti-Deficiency Act and operate on a full-cost recovery basis. Therefore, while Sandia, in conjunction with the Sponsor, will use best judgment to execute work and to address the highest risks and most important issues in order to effectively manage within cost constraints, this ROM estimate and any subsequent approved cost estimates are on a 'full-cost recovery' basis. Thus, work can neither commence nor continue unless adequate funding has been accepted and certified by DOE.

Impact of Costing and Cost Analysis Methods on the Result of the Period: Methods Based on Partial Cost Theory

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Toma Maria

2017-01-01

Looking from this perspective, in the present paper we have proposed that objectives, to approach the full cost calculation methods based on partial costs (direct-costing on the product or direct-costing evolved, and comparing them to determine the effect they have on the outcome of the period.

Full cost accounting as a tool for the financial assessment of Pay-As-You-Throw schemes: a case study for the Panorama municipality, Greece.

Science.gov (United States)

Karagiannidis, Avraam; Xirogiannopoulou, Anna; Tchobanoglous, George

2008-12-01

In the present paper, implementation scenarios of a Pay-As-You-Throw program were developed and analyzed for the first time in Greece. Firstly, the necessary steps for implementing a Pay-As-You-Throw program were determined. A database was developed for the needs of the full cost accounting method, where all financial and waste-production data were inserted, in order to calculate the unit price of charging for four different implementation scenarios of the "polluter-pays" principle. For each scenario, the input in waste management cost was estimated, as well as the total waste charges for households. Finally, a comparative analysis of the results was performed.

Evaluation of caregiver-friendly workplace policy (CFWPs interventions on the health of full-time caregiver employees (CEs: implementation and cost-benefit analysis

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Allison M. Williams

2017-09-01

Full Text Available Abstract Background Current Canadian evidence illustrating the health benefits and cost-effectiveness of caregiver-friendly workplace policies is needed if Canadian employers are to adopt and integrate caregiver-friendly workplace policies into their employment practices. The goal of this three-year, three study research project is to provide such evidence for the auto manufacturing and educational services sectors. The research questions being addressed are: What are the impacts for employers (economic and workers (health of caregiver-friendly workplace policy intervention(s for full-time caregiver-employees? What are the impacts for employers, workers and society of the caregiver-friendly workplace policy intervention(s in each participating workplace? What contextual factors impact the successful implementation of caregiver-friendly workplace policy intervention(s? Methods Using a pre-post-test comparative case study design, Study A will determine the effectiveness of newly implemented caregiver-friendly workplace policy intervention(s across two workplaces to determine impacts on caregiver-employee health. A quasi-experimental pre-post design will allow the caregiver-friendly workplace policy intervention(s to be tested with respect to potential impacts on health, and specifically on caregiver employee mental, psychosocial, and physical health. Framed within a comparative case study design, Study B will utilize cost-benefit and cost-effectiveness analysis approaches to evaluate the economic impacts of the caregiver-friendly workplace policy intervention(s for each of the two participating workplaces. Framed within a comparative case study design, Study C will undertake an implementation analysis of the caregiver-friendly workplace policy intervention(s in each participating workplace in order to determine: the degree of support for the intervention(s (reflected in the workplace culture; how sex and gender are implicated; co

THEORETICAL AND PRACTICAL CONSIDERATIONS REGARDING THE COST CALCULATION USING DIRECT COSTING

Directory of Open Access Journals (Sweden)

Cristina Aurora, Bunea-Bontaş

2012-01-01

Full Text Available The definition of the cost of production as applied to inventories refers to the acquisition and production cost, and its determination involves many considerations. This article emphasizes a comparative approach of the calculation of production cost under direct costing and absorption costing, and examines the impact of using these calculation systems on the financial performance of the companies presented in the income statement.

COST MEASUREMENT AND COST MANAGEMENT IN TARGET COSTING

Directory of Open Access Journals (Sweden)

Moisello Anna Maria

2012-07-01

Full Text Available Firms are coping with a competitive scenario characterized by quick changes produced by internationalization, concentration, restructuring, technological innovation processes and financial market crisis. On the one hand market enlargement have increased the number and the segmentation of customers and have raised the number of competitors, on the other hand technological innovation has reduced product life cycle. So firms have to adjust their management models to this scenario, pursuing customer satisfaction and respecting cost constraints. In a context where price is a variable fixed by the market, firms have to switch from the cost measurement logic to the cost management one, adopting target costing methodology. The target costing process is a price driven, customer oriented profit planning and cost management system. It works, in a cross functional way, from the design stage throughout all the product life cycle and it involves the entire value chain. The process implementation needs a costing methodology consistent with the cost management logic. The aim of the paper is to focus on Activity Based Costing (ABC application to target costing process. So: -it analyzes target costing logic and phases, basing on a literary review, in order to highlight the costing needs related to this process; -it shows, through a numerical example, how to structure a flexible ABC model – characterized by the separation between variable, fixed in the short and fixed costs - that effectively supports target costing process in the cost measurement phase (drifting cost determination and in the target cost alignment; -it points out the effectiveness of the Activity Based Costing as a model of cost measurement applicable to the supplier choice and as a support for supply cost management which have an important role in target costing process. The activity based information allows a firm to optimize the supplier choice by following the method of minimizing the

Skilled Nursing Facility Partnerships May Decrease 90-Day Costs in a Total Joint Arthroplasty Episode Under the Bundled Payments for Care Improvement Initiative.

Science.gov (United States)

Behery, Omar A; Kouk, Shalen; Chen, Kevin K; Mullaly, Kathleen A; Bosco, Joseph A; Slover, James D; Iorio, Richard; Schwarzkopf, Ran

2018-03-01

The Bundled Payments for Care Improvement initiative was developed to reduce costs associated with total joint arthroplasty through a single payment for all patient care from index admission through a 90-day post-discharge period, including care at skilled nursing facilities (SNFs). The aim of this study is to investigate whether forming partnerships between hospitals and SNFs could lower the post-discharge costs. We hypothesize that institutionally aligned SNFs have lower post-discharge costs than non-aligned SNFs. A cohort of 615 elective, primary total hip and knee arthroplasty subjects discharged to an SNF under the Bundled Payments for Care Improvement from 2014 to 2016 were included in our analysis. Patients were grouped into one of the 3 categories of SNF alignment: group 1: non-partners; group 2: agreement-based partners; group 3: institution-owned partners. Demographics, comorbidities, length of stay (LOS) at SNF, and associated costs during the 90-day post-operative period were compared between the 3 groups. Mean index hospital LOS was statistically shortest in group 3 (mean 2.7 days vs 3.5 for groups 1 and 2, P = .001). SNF LOS was also shortest in group 3 (mean 11 days vs 19 and 21 days in groups 2 and 1 respectively, P Total SNF costs and total 90-day costs were both significantly lower in group 3 compared with groups 1 and 2 (P total 90-day costs, without increased risk of readmissions, compared with other SNFs. Copyright © 2017 Elsevier Inc. All rights reserved.

The Cost-Effectiveness of Treatment Modalities for Ureteral Stones

Directory of Open Access Journals (Sweden)

Justin Ji-Yuen Siu MD

2016-10-01

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

Initial evaluation of a full breast digital system

International Nuclear Information System (INIS)

Vano, E.; Fernandez, J.M.; Chevalier, M.; Moran, P.; Cepeda, T.; Fabra, A.; Alvarez Pedrosa, C.S.

2001-01-01

Full-field digital mammography systems have been developed for overcoming the limitations of the screen-film mammography. This work is focused on the system from GE Medical Systems (Senographe 2000) which has been recently installed in our institution. The imager consists of a thin Ics:Tl scintillator which is in narrow contact with an array of amorphous silicon detectors mounted in a single panel. The flat-panel detector is integrated in a x-ray system with a high-frequency generator Senographe DM and dual track anode of Mo and Rh with Mo and Rh filtration. The aim of this work is to analyse the defaults exposure factors set at the installation of the x-ray unit. The image quality has been evaluated by using one of the two phantoms recommended in the ACR Accreditation Program. Phantom images were obtained at each of the three available imaging modes: contrast (CNT), standard (STD) and DOSE. While maintaining the defaults of kilovoltage and anode/filter combination, phantom images were obtained at lower dose vales. The contrast noise ratio (CNR) was calculated for each of the low contrast objects (masses) of the phantom images and the detail visibility was also evaluated. The results obtained for both parameters reveal that similar image quality can be obtained with significant reductions of the average glandular dose. (author)

Tracking environmental costs

International Nuclear Information System (INIS)

Blahutova, Z.

2011-01-01

Tracking Environmental Costs and Investments in SAP will provide us with a managerial tool that will help us understand better the magnitude of the financial resources we are dedicating to environmental protection activities and investments. Environmental Cost Accounting is a new project in Slovenske Elektrarne that will be particularly valuable for the Company's environmental management initiatives, such as waste monitoring, cleaner production, eco-design and environmental management systems; its launch is expected in September. (author)

On the sensitivity of teleseismic full-waveform inversion to earth parametrization, initial model and acquisition design

Science.gov (United States)

Beller, S.; Monteiller, V.; Combe, L.; Operto, S.; Nolet, G.

2018-02-01

Full-waveform inversion (FWI) is not yet a mature imaging technology for lithospheric imaging from teleseismic data. Therefore, its promise and pitfalls need to be assessed more accurately according to the specifications of teleseismic experiments. Three important issues are related to (1) the choice of the lithospheric parametrization for optimization and visualization, (2) the initial model and (3) the acquisition design, in particular in terms of receiver spread and sampling. These three issues are investigated with a realistic synthetic example inspired by the CIFALPS experiment in the Western Alps. Isotropic elastic FWI is implemented with an adjoint-state formalism and aims to update three parameter classes by minimization of a classical least-squares difference-based misfit function. Three different subsurface parametrizations, combining density (ρ) with P and S wave speeds (Vp and Vs) , P and S impedances (Ip and Is), or elastic moduli (λ and μ) are first discussed based on their radiation patterns before their assessment by FWI. We conclude that the (ρ, λ, μ) parametrization provides the FWI models that best correlate with the true ones after recombining a posteriori the (ρ, λ, μ) optimization parameters into Ip and Is. Owing to the low frequency content of teleseismic data, 1-D reference global models as PREM provide sufficiently accurate initial models for FWI after smoothing that is necessary to remove the imprint of the layering. Two kinds of station deployments are assessed: coarse areal geometry versus dense linear one. We unambiguously conclude that a coarse areal geometry should be favoured as it dramatically increases the penetration in depth of the imaging as well as the horizontal resolution. This results because the areal geometry significantly increases local wavenumber coverage, through a broader sampling of the scattering and dip angles, compared to a linear deployment.

Full MOX core design in ABWR

International Nuclear Information System (INIS)

Ihara, Toshiteru; Mochida, Takaaki; Izutsu, Sadayuki; Fujimaki, Shingo

2003-01-01

Electric Power Development Co., Ltd. (EPDC) has been investigating an ABWR plant for construction at Oma-machi in Aomori Prefecture. The reactor, termed FULL MOX-ABWR will have its reactor core eventually loaded entirely with mixed-oxide (MOX) fuel. Extended use of MOX fuel in the plant is expected to play important roles in the country's nuclear fuel recycling policy. MOX fuel bundles will initially be loaded only to less than one-third of the reactor, but will be increased to cover its entire core eventually. The number of MOX fuel bundles in the core thus varies anywhere from 0 to 264 for the initial cycle and, 0 to 872 for equilibrium cycles. The safety design of the FULL MOX-ABWR briefly stated next considers any probable MOX loading combinations out of such MOX bundle usage scheme, starting from full UO 2 to full MOX cores. (author)

Melanoma costs: a dynamic model comparing estimated overall costs of various clinical stages.

Science.gov (United States)

Alexandrescu, Doru Traian

2009-11-15

The rapidly increasing incidence of melanoma occurs at the same time as an increase in general healthcare costs, particularly the expenses associated with cancer care. Previous cost estimates in melanoma have not utilized a dynamic model considering the evolution of the disease and have not integrated the multiple costs associated with different aspects of medical interventions and patient-related factors. Futhermore, previous calculations have not been updated to reflect the modern tendencies in healthcare costs. We designed a comprehensive model of expenses in melanoma that considers the dynamic costs generated by the natural progression of the disease, which produces costs associated with treatment, surveillance, loss of income, and terminal care. The complete range of initial clinical (TNM) stages of the disease and initial tumor stages were analyzed in this model and the total healthcare costs for the five years following melanoma presentation at each particular stage were calculated. We have observed dramatic incremental total costs associated with progressively higher initial stages of the disease, ranging from a total of $4,648.48 for in situ tumors to $159,808.17 for Stage IV melanoma. By stage, early lesions associate 30-55 percent of their costs for the treatment of the primary tumor, due to a low rate of recurrence (local, regional, or distant), which limits the need for additional interventions. For in situ melanoma, T1a, and T1b, surveillance is an important contributor to the medical costs, accounting for more than 25 percent of the total cost over 5 years. In contrast, late lesions incur a much larger proportion of their associated costs (up to 80-85%) from the diagnosis and treatment of metastatic disease because of the increased propensity of those lesions to disseminate. This cost increases with increasing tumor stage (from $2,442.17 for T1a to $6,678.00 for T4b). The most expensive items in the medical care of patients with melanoma consist of

Applying activity-based costing to healthcare settings.

Science.gov (United States)

Canby, J B

1995-02-01

Activity-based costing (ABC) focuses on processes that drive cost. By tracing healthcare activities back to events that generate cost, a more accurate measurement of financial performance is possible. This article uses ABC principles and techniques to determine costs associated with the x-ray process in a midsized outpatient clinic. The article also provides several tips for initiating an ABC cost system for an entire healthcare organization.

Costs and Benefits to Pregnant Male Pipefish Caring for Broods of Different Sizes.

Science.gov (United States)

Sagebakken, Gry; Ahnesjö, Ingrid; Kvarnemo, Charlotta

2016-01-01

Trade-offs between brood size and offspring size, offspring survival, parental condition or parental survival are classic assumptions in life history biology. A reduction in brood size may lessen these costs of care, but offspring mortality can also result in an energetic gain, if parents are able to utilize the nutrients from the demised young. Males of the broad-nosed pipefish (Syngnathus typhle) care for the offspring by brooding embryos in a brood pouch. Brooding males can absorb nutrients that emanate from embryos, and there is often a reduction in offspring number over the brooding period. In this study, using two experimentally determined brood sizes (partially and fully filled brood pouches), we found that full broods resulted in larger number of developing offspring, despite significantly higher absolute and relative embryo mortality, compared to partial broods. Male survival was also affected by brood size, with males caring for full broods having poorer survival, an effect that together with the reduced embryo survival was found to negate the benefit of large broods. We found that embryo mortality was lower when the brooding males were in good initial condition, that embryos in broods with low embryo mortality weighed more, and surprisingly, that males in higher initial condition had embryos of lower weight. Brood size, however, did not affect embryo weight. Male final condition, but not initial condition, correlated with higher male survival. Taken together, our results show costs and benefits of caring for large brood sizes, where the numerical benefits come with costs in terms of both embryo survival and survival of the brooding father, effects that are often mediated via male condition.

Full structure assignments of pyrrolizidine alkaloid DNA adducts and mechanism of tumor initiation.

Science.gov (United States)

Zhao, Yuewei; Xia, Qingsu; Gamboa da Costa, Gonçalo; Yu, Hongtao; Cai, Lining; Fu, Peter P

2012-09-17

Pyrrolizidine alkaloid-containing plants are widespread in the world and are probably the most common poisonous plants affecting livestock, wildlife, and humans. Pyrrolizidine alkaloids are among the first chemical carcinogens identified in plants. Previously, we determined that metabolism of pyrrolizidine alkaloids in vivo and in vitro generated a common set of DNA adducts that are responsible for tumor induction. Using LC-ESI/MS/MS analysis, we previously determined that four DNA adducts (DHP-dG-3, DHP-dG-4, DHP-dA-3, and DHP-dA-4) were formed in rats dosed with riddelliine, a tumorigenic pyrrolizidine alkaloid. Because of the lack of an adequate amount of authentic standards, the structures of DHP-dA-3 and DHP-dA-4 were not elucidated, and the structural assignment for DHP-dG-4 warranted further validation. In this study, we developed an improved synthetic methodology for these DNA adducts, enabling their full structural elucidation by mass spectrometry and NMR spectroscopy. We determined that DHP-dA-3 and DHP-dA-4 are a pair of epimers of 7-hydroxy-9-(deoxyadenosin-N(6)-yl) dehydrosupinidine, while DHP-dG-4 is 7-hydroxy-9-(deoxyguanosin-N(2)-yl)dehydrosupinidine, an epimer of DHP-dG-3. With the structures of these DNA adducts unequivocally elucidated, we conclude that cellular DNA preferentially binds dehydropyrrolizidine alkaloid, for example, dehydroriddelliine, at the C9 position of the necine base, rather than at the C7 position. We also determined that DHP-dA-3 and DHP-dA-4, as well as DHP-dG-3 and DHP-dG-4, are interconvertible. This study represents the first report with detailed structural assignments of the DNA adducts that are responsible for pyrrolizidine alkaloid tumor induction on the molecular level. A mechanism of tumor initiation by pyrrolizidine alkaloids is consequently fully determined.

Clinical and economic consequences of failure of initial antibiotic therapy for patients with community-onset complicated intra-abdominal infections.

Directory of Open Access Journals (Sweden)

Yong Pil Chong

Full Text Available Complicated intra-abdominal infection (cIAI is infection that extends beyond the hollow viscus of origin into the peritoneal space, and is associated with either abscess formation or peritonitis. There are few studies that have assessed the actual costs and outcomes associated with failure of initial antibiotic therapy for cIAI. The aims of this study were to evaluate risk factors and impact on costs and outcomes of failure of initial antibiotic therapy for community-onset cIAI.A retrospective study was performed at eleven tertiary-care hospitals. Hospitalized adults with community-onset cIAI who underwent an appropriate source control procedure between August 2008 and September 2011 were included. Failure of initial antibiotic therapy was defined as a change of antibiotics due to a lack of improvement of the clinical symptoms and signs associated with cIAI in the first week.A total of 514 patients hospitalized for community-onset cIAI were included in the analysis. The mean age of the patients was 53.3 ± 17.6 years, 72 patients (14% had health care-associated infection, and 48 (9% experienced failure of initial antibiotic therapy. Failure of initial antibiotic therapy was associated with increased costs and morbidity. After adjustment for covariates, patients with unsuccessful initial therapy received an additional 2.9 days of parenteral antibiotic therapy, were hospitalized for an additional 5.3 days, and incurred $3,287 in additional inpatient charges. Independent risk factors for failure of initial antibiotic therapy were health care-associated infection, solid cancer, and APACHE II ≥13.To improve outcomes and costs in patients with community-onset cIAI, rapid assessment of health care-associated risk factors and severity of disease, selection of an appropriate antibiotic regimen accordingly, and early infection source control should be performed.

An analysis of cost effective incentives for initial commercial deployment of advanced clean coal technologies

Energy Technology Data Exchange (ETDEWEB)

Spencer, D.F. [SIMTECHE, Half Moon Bay, CA (United States)

1997-12-31

This analysis evaluates the incentives necessary to introduce commercial scale Advanced Clean Coal Technologies, specifically Integrated Coal Gasification Combined Cycle (ICGCC) and Pressurized Fluidized Bed Combustion (PFBC) powerplants. The incentives required to support the initial introduction of these systems are based on competitive busbar electricity costs with natural gas fired combined cycle powerplants, in baseload service. A federal government price guarantee program for up to 10 Advanced Clean Coal Technology powerplants, 5 each ICGCC and PFBC systems is recommended in order to establish the commercial viability of these systems by 2010. By utilizing a decreasing incentives approach as the technologies mature (plants 1--5 of each type), and considering the additional federal government benefits of these plants versus natural gas fired combined cycle powerplants, federal government net financial exposure is minimized. Annual net incentive outlays of approximately 150 million annually over a 20 year period could be necessary. Based on increased demand for Advanced Clean Coal Technologies beyond 2010, the federal government would be revenue neutral within 10 years of the incentives program completion.

IDA 2004 Cost Research Symposium: Investments in, Use of, and Management of Cost Research

Science.gov (United States)

2004-09-01

E co no m ic s) 12% 7% 6% 3% 26% 4% 5% 6% 27% 4% ACDB/Cost Research ACEIT Commercial Parametric Software FCS Support Cost Management Performance...tools (e.g., ACEIT , OSMIS) is centralized at ODASA-CE • Licensing of commercial cost tools for Army centralized • Semi-formal process – ODASA-CE...os t & E co no m ic s) Current Research Initiatives (continued) • ACEIT – Enhancements • Major upgrade to COTS calculation/narrative engine

Cost Model Comparison: A Study of Internally and Commercially Developed Cost Models in Use by NASA

Science.gov (United States)

Gupta, Garima

2011-01-01

NASA makes use of numerous cost models to accurately estimate the cost of various components of a mission - hardware, software, mission/ground operations - during the different stages of a mission's lifecycle. The purpose of this project was to survey these models and determine in which respects they are similar and in which they are different. The initial survey included a study of the cost drivers for each model, the form of each model (linear/exponential/other CER, range/point output, capable of risk/sensitivity analysis), and for what types of missions and for what phases of a mission lifecycle each model is capable of estimating cost. The models taken into consideration consisted of both those that were developed by NASA and those that were commercially developed: GSECT, NAFCOM, SCAT, QuickCost, PRICE, and SEER. Once the initial survey was completed, the next step in the project was to compare the cost models' capabilities in terms of Work Breakdown Structure (WBS) elements. This final comparison was then portrayed in a visual manner with Venn diagrams. All of the materials produced in the process of this study were then posted on the Ground Segment Team (GST) Wiki.

Variability of Cost and Time Delivery of Educational Buildings in Nigeria

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Aghimien, Douglas Omoregie

2017-09-01

Full Text Available Cost and time overrun in construction projects has become a reoccurring problem in construction industries around the world especially in developing countries. This situation is unhealthy for public educational buildings which are executed with limited government funds, and are in most cases time sensitive, as they need to cater for the influx of students into the institutions. This study therefore assessed the variability of cost and time delivery of educational buildings in Nigeria, using a study of selected educational buildings within the country. A pro forma was used to gather cost and time data on selected building projects, while structured questionnaire was used to harness information on the possible measures for reducing the variability from the construction participants that were involved in the delivery of these projects. Paired sample t-test, percentage, relative importance index, and Kruskal-Walis test were adopted for data analyses. The study reveals that there is a significant difference between the initial and final cost of delivering educational buildings, as an average of 4.87% deviation, with a sig. p-value of 0.000 was experienced on all assessed projects. For time delivery, there is also a significant difference between the initial estimated time and final time of construction as a whopping 130% averaged deviation with a sig. p-value of 0.000 was discovered. To remedy these problems, the study revealed that prompt payment for executed works, predicting market price fluctuation and inculcating it into the initial estimate, and owner’s involvement at the planning and design phase are some of the possible measures to be adopted.

METHODOLOGICAL BACKGROUND OF EXPERT ESTIMATION OF INITIAL DATA COMPLETENESS AND QUALITY ACCORDING TO THE CERTIFIED INFORMATION SECURITY SYSTEM

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V. K. Fisenko

2015-01-01

Full Text Available Problem of information security systems certification is analyzed and the tasks of initial data analysis are carried out. The objectives, indices and decision making criteria, as well as the challenges to be addressed are formulated. It is shown that, in order to improve quality, reduce time and cost of preparation for certification, it is reasonable to use software system for automatization of the process of initial data analysis, presented by the owner of the information system.

Adoption of an activity based costing model in an Indian steel plant

Directory of Open Access Journals (Sweden)

Rishi Dwivedi

2016-10-01

Full Text Available In the age of relentless global competition, constantly improving technology and better information systems, managers are often compelled to devise new strategies to maintain sustained competitive advantage while adopting new business management approaches. So, in this paper, an activity based costing (ABC model is proposed for a raw material handling section of an Indian steel plant. The results obtained from ABC model application in the said department facilitates quantification of the unit cost of each process, analysis of various activities in order to identify inefficiency, setting-up of better budget allocation, initiation of cost minimization procedure and establishment of an efficient resource requirement plan. Moreover, the cost information derived from ABC model is compared with that extracted from the traditional costing system to demonstrate that ABC model can significantly minimize the product cost distortion resulting from unsystematic allocation of overhead costs. This paper also discusses the practical implication of the implemented ABC model with respect to its critical role in effective resource control, improved strategic and operational decision making, and aid in continuous improvement through internal cost minimization in the department.

Corruption Significantly Increases the Capital Cost of Power Plants in Developing Contexts

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Kumar Biswajit Debnath

2018-03-01

Full Text Available Emerging economies with rapidly growing population and energy demand, own some of the most expensive power plants in the world. We hypothesized that corruption has a relationship with the capital cost of power plants in developing countries such as Bangladesh. For this study, we analyzed the capital cost of 61 operational and planned power plants in Bangladesh. Initial comparison study revealed that the mean capital cost of a power plant in Bangladesh is twice than that of the global average. Then, the statistical analysis revealed a significant correlation between corruption and the cost of power plants, indicating that higher corruption leads to greater capital cost. The high up-front cost can be a significant burden on the economy, at present and in the future, as most are financed through international loans with extended repayment terms. There is, therefore, an urgent need for the review of the procurement and due diligence process of establishing power plants, and for the implementation of a more transparent system to mitigate adverse effects of corruption on megaprojects.

Comparison and Evaluation of Large-Scale and On-Site Recycling Systems for Food Waste via Life Cycle Cost Analysis

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Kyoung Hee Lee

2017-11-01

Full Text Available The purpose of this study was to evaluate the cost-benefit of on-site food waste recycling system using Life-Cycle Cost analysis, and to compare with large-scale treatment system. For accurate evaluation, the cost-benefit analysis was conducted with respect to local governments and residents, and qualitative environmental improvement effects were quantified. As for the local governments, analysis results showed that, when large-scale treatment system was replaced with on-site recycling system, there was significant cost reduction from the initial stage depending on reduction of investment, maintenance, and food wastewater treatment costs. As for the residents, it was found that the cost incurred from using the on-site recycling system was larger than the cost of using large-scale treatment system due to the cost of producing and installing the on-site treatment facilities at the initial stage. However, analysis showed that with continuous benefits such as greenhouse gas emission reduction, compost utilization, and food wastewater reduction, cost reduction would be obtained after 6 years of operating the on-site recycling system. Therefore, it was recommended for local governments and residents to consider introducing an on-site food waste recycling system if they are to replace an old treatment system or need to establish a new one.

Expensive blood safety initiatives may offer less benefit than we think

DEFF Research Database (Denmark)

Kamper-Jørgensen, Mads; Hjalgrim, Henrik; Edgren, Gustaf

2010-01-01

Various blood safety initiatives have ensured a historically low risk of infection transmission through blood transfusion. Although further prevention of infection transmission is possible through, for example, nucleic acid testing and future introduction of pathogen inactivation, such initiative...... are very costly in relation to the benefit they offer. Although estimation of the cost-effectiveness requires detailed information about the survival of transfusion recipients, previous cost-effectiveness analyses have relied on incorrect survival assumptions....

OPTIMIZATION OF TIMES AND COSTS OF PROJECT OF HORIZONTAL LAMINATOR PRODUCTION USING PERT/CPM TECHNICAL

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Fernando Henrique Lermen

2016-09-01

Full Text Available The PERT/CPM is a technique widely used in both the scheduling and in the project feasibility in terms of cost control and time.  In order to optimize time and costs involved in production, the work presented here aims to apply the PERT/CPM technique in the production project of the Horizontal Laminator, a machine used to cut polyurethane foam blocks in the mattresses industries. For the application of PERT/CPM technique in the project of Horizontal Laminator production were identified the activities that compose the project, the dependence between them, the normal and accelerated durations and the normal and accelerated costs. In this study, deterministic estimates for the duration of the activities were considered. The results show that the project can be completed in 520 hours at a total cost of R$7,042.50, when all activities are performed in their normal durations.  When all the activities that compose the critical path are accelerated, the project can be completed in 333.3 hours at a total cost of R$9,263.01. If the activities slacks have been exploited, it can obtain a final total cost of R$6,157.8, without changing the new duration of the project. It is noteworthy that the final total cost of the project if the slacks are used, will be lower than the initial cost. Regarding the initial cost of the project, after the application of the PERT/CPM technique, it presents a decrease of 12.56% of the total project cost.

Impact of omalizumab on medical cost of childhood asthma in Japan.

Science.gov (United States)

Yoshikawa, Hideki; Iwata, Mihoko; Matsuzaki, Hiroshi; Ono, Rintaro; Murakami, Yoko; Taba, Naohiko; Honjo, Satoshi; Motomura, Chikako; Odajima, Hiroshi

2016-05-01

Omalizumab is effective in children with severe asthma, but its impact on medical cost in Japan is not clear. We evaluated the impact of omalizumab on medical cost by comparing the pre- vs post-omalizumab-initiation medical costs of 12 children with severe asthma who received omalizumab for 2 years, and calculating incremental cost-effectiveness ratio for omalizumab therapy. Health outcome was measured as hospital-free days (HFD). The median total medical costs and medication fee per patient increased significantly after omalizumab initiation because of the high cost of omalizumab. The median hospitalization fee per patient, however, decreased significantly after omalizumab initiation due to reduction in hospitalization. Omalizumab led to an estimated increase of 40.8 HFD per omalizumab responder patient per 2 years. The cost was JPY 20 868 per additional HFD. Omalizumab can therefore reduce hospitalization cost in children with severe asthma in Japan. © 2016 Japan Pediatric Society.

Capital and Operating Costs of Full-Scale Fecal Sludge Management and Wastewater Treatment Systems in Dakar, Senegal

Science.gov (United States)

2012-01-01

A financial comparison of a parallel sewer based (SB) system with activated sludge, and a fecal sludge management (FSM) system with onsite septic tanks, collection and transport (C&T) trucks, and drying beds was conducted. The annualized capital for the SB ($42.66 capita–1 year–1) was ten times higher than the FSM ($4.05 capita–1 year–1), the annual operating cost for the SB ($11.98 capita–1 year–1) was 1.5 times higher than the FSM ($7.58 capita–1 year–1), and the combined capital and operating for the SB ($54.64 capita–1 year–1) was five times higher than FSM ($11.63 capita–1 year–1). In Dakar, costs for SB are almost entirely borne by the sanitation utility, with only 6% of the annualized cost borne by users of the system. In addition to costing less overall, FSM operates with a different business model, with costs spread among households, private companies, and the utility. Hence, SB was 40 times more expensive to implement for the utility than FSM. However, the majority of FSM costs are borne at the household level and are inequitable. The results of the study illustrate that in low-income countries, vast improvements in sanitation can be affordable when employing FSM, whereas SB systems are prohibitively expensive. PMID:22413875

Capital and operating costs of full-scale fecal sludge management and wastewater treatment systems in Dakar, Senegal.

Science.gov (United States)

Dodane, Pierre-Henri; Mbéguéré, Mbaye; Sow, Ousmane; Strande, Linda

2012-04-03

A financial comparison of a parallel sewer based (SB) system with activated sludge, and a fecal sludge management (FSM) system with onsite septic tanks, collection and transport (C&T) trucks, and drying beds was conducted. The annualized capital for the SB ($42.66 capita(-1) year(-1)) was ten times higher than the FSM ($4.05 capita(-1) year(-1)), the annual operating cost for the SB ($11.98 capita(-1) year(-1)) was 1.5 times higher than the FSM ($7.58 capita(-1) year(-1)), and the combined capital and operating for the SB ($54.64 capita(-1) year(-1)) was five times higher than FSM ($11.63 capita(-1) year(-1)). In Dakar, costs for SB are almost entirely borne by the sanitation utility, with only 6% of the annualized cost borne by users of the system. In addition to costing less overall, FSM operates with a different business model, with costs spread among households, private companies, and the utility. Hence, SB was 40 times more expensive to implement for the utility than FSM. However, the majority of FSM costs are borne at the household level and are inequitable. The results of the study illustrate that in low-income countries, vast improvements in sanitation can be affordable when employing FSM, whereas SB systems are prohibitively expensive.

The costs of turnover in nursing homes.

Science.gov (United States)

Mukamel, Dana B; Spector, William D; Limcangco, Rhona; Wang, Ying; Feng, Zhanlian; Mor, Vincent

2009-10-01

Turnover rates in nursing homes have been persistently high for decades, ranging upwards of 100%. To estimate the net costs associated with turnover of direct care staff in nursing homes. DATA AND SAMPLE: Nine hundred two nursing homes in California in 2005. Data included Medicaid cost reports, the Minimum Data Set, Medicare enrollment files, Census, and Area Resource File. We estimated total cost functions, which included in addition to exogenous outputs and wages, the facility turnover rate. Instrumental variable limited information maximum likelihood techniques were used for estimation to deal with the endogeneity of turnover and costs. The cost functions exhibited the expected behavior, with initially increasing and then decreasing returns to scale. The ordinary least square estimate did not show a significant association between costs and turnover. The instrumental variable estimate of turnover costs was negative and significant (P = 0.039). The marginal cost savings associated with a 10% point increase in turnover for an average facility was $167,063 or 2.9% of annual total costs. The net savings associated with turnover offer an explanation for the persistence of this phenomenon over the last decades, despite the many policy initiatives to reduce it. Future policy efforts need to recognize the complex relationship between turnover and costs.

48 CFR 31.205-42 - Termination costs.

Science.gov (United States)

2010-10-01

... nonrecurring labor, material, and related overhead costs incurred in the early part of production and result... the settlement proposal as a direct charge, such costs shall not also be included in overhead. Initial... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Termination costs. 31.205...

Direct cost associated with acquired brain injury in Ontario

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Chen Amy

2012-08-01

Full Text Available Abstract Background Acquired Brain Injury (ABI from traumatic and non traumatic causes is a leading cause of disability worldwide yet there is limited research summarizing the health system economic burden associated with ABI. The objective of this study was to determine the direct cost of publicly funded health care services from the initial hospitalization to three years post-injury for individuals with traumatic (TBI and non-traumatic brain injury (nTBI in Ontario Canada. Methods A population-based cohort of patients discharged from acute hospital with an ABI code in any diagnosis position in 2004 through 2007 in Ontario was identified from administrative data. Publicly funded health care utilization was obtained from several Ontario administrative healthcare databases. Patients were stratified according to traumatic and non-traumatic causes of brain injury and whether or not they were discharged to an inpatient rehabilitation center. Health system costs were calculated across a continuum of institutional and community settings for up to three years after initial discharge. The continuum of settings included acute care emergency departments inpatient rehabilitation (IR complex continuing care home care services and physician visits. All costs were calculated retrospectively assuming the government payer’s perspective. Results Direct medical costs in an ABI population are substantial with mean cost in the first year post-injury per TBI and nTBI patient being $32132 and $38018 respectively. Among both TBI and nTBI patients those discharged to IR had significantly higher treatment costs than those not discharged to IR across all institutional and community settings. This tendency remained during the entire three-year follow-up period. Annual medical costs of patients hospitalized with a brain injury in Ontario in the first follow-up year were approximately $120.7 million for TBI and $368.7 million for nTBI. Acute care cost accounted for 46

VISIBLE COSTS AND HIDDEN COSTS IN THE BAKING INDUSTRY

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Criveanu Maria

2013-04-01

Full Text Available Hidden costs are present in the activity of any company, hardly identified in the traditional administrative accounting. The high levels of the hidden costs and their unknown presence have serious consequences on the decisions made by the managers. This paper aims at presenting some aspects related to the hidden costs that occur in the activity of the companies in the baking industry and the possibilities to reduce their level.

A Comparative Study on Evaluating the Service Quality Attributes based on Kano Model: A Case of Low-cost Carrier and Full-service Carrier

Directory of Open Access Journals (Sweden)

Byun Hyojeong

2014-01-01

Full Text Available The emergence and development of low-cost carriers(LCC with competitive price is heating up the competition in the aviation market more, especially between low-cost carriers(LCC and full-service carriers(FSC. Therefore, it became more important than ever to implement service differentiation strategies of each airline for securing customers and competitiveness. In this sense, the purpose of this study is to compare and assess the different expectations of the customers for airline service attributes pursued by FSCs and LCCs. Three main dimensions of airline service quality attributes (physical, human, and system service, were selected and this study clarified the service quality attributes of each airline carrier using Kano Model. Data were collected from Korean passengers who experienced both LCCs and FSCs for international or domestic flights. As results, this study demonstrated several differences in airline service quality attributes between FSCs and LCCs, which imply that each airline needs to adopt differential strategies to be more competitive. In particular, most physical-related attributes for FSCs were a ‘must-be’ dimension while the majority of attributes for LCCs was clarified ‘one-dimensional’ attribute. The current study also presented implications to be helpful in developing the quality of service and establishing marketing strategies for improvement in customer satisfaction.

Methodological issues in assessing changes in costs pre- and post-medication switch: a schizophrenia study example

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Nyhuis Allen W

2009-05-01

Full Text Available Abstract Background Schizophrenia is a severe, chronic, and costly illness that adversely impacts patients' lives and health care payer budgets. Cost comparisons of treatment regimens are, therefore, important to health care payers and researchers. Pre-Post analyses ("mirror-image", where outcomes prior to a medication switch are compared to outcomes post-switch, are commonly used in such research. However, medication changes often occur during a costly crisis event. Patients may relapse, be hospitalized, have a medication change, and then spend a period of time with intense use of costly resources (post-medication switch. While many advantages and disadvantages of Pre-Post methodology have been discussed, issues regarding the attributability of costs incurred around the time of medication switching have not been fully investigated. Methods Medical resource use data, including medications and acute-care services (hospitalizations, partial hospitalizations, emergency department were collected for patients with schizophrenia who switched antipsychotics (n = 105 during a 1-year randomized, naturalistic, antipsychotic cost-effectiveness schizophrenia trial. Within-patient changes in total costs per day were computed during the pre- and post-medication change periods. In addition to the standard Pre-Post analysis comparing costs pre- and post-medication change, we investigated the sensitivity of results to varying assumptions regarding the attributability of acute care service costs occurring just after a medication switch that were likely due to initial medication failure. Results Fifty-six percent of all costs incurred during the first week on the newly initiated antipsychotic were likely due to treatment failure with the previous antipsychotic. Standard analyses suggested an average increase in cost-per-day for each patient of $2.40 after switching medications. However, sensitivity analyses removing costs incurred post-switch that were potentially

Implementing Patient Safety Initiatives in Rural Hospitals

Science.gov (United States)

Klingner, Jill; Moscovice, Ira; Tupper, Judith; Coburn, Andrew; Wakefield, Mary

2009-01-01

Implementation of patient safety initiatives can be costly in time and energy. Because of small volumes and limited resources, rural hospitals often are not included in nationally driven patient safety initiatives. This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for…

Cost minimization in a full-scale conventional wastewater treatment plant: associated costs of biological energy consumption versus sludge production.

Science.gov (United States)

Sid, S; Volant, A; Lesage, G; Heran, M

2017-11-01

Energy consumption and sludge production minimization represent rising challenges for wastewater treatment plants (WWTPs). The goal of this study is to investigate how energy is consumed throughout the whole plant and how operating conditions affect this energy demand. A WWTP based on the activated sludge process was selected as a case study. Simulations were performed using a pre-compiled model implemented in GPS-X simulation software. Model validation was carried out by comparing experimental and modeling data of the dynamic behavior of the mixed liquor suspended solids (MLSS) concentration and nitrogen compounds concentration, energy consumption for aeration, mixing and sludge treatment and annual sludge production over a three year exercise. In this plant, the energy required for bioreactor aeration was calculated at approximately 44% of the total energy demand. A cost optimization strategy was applied by varying the MLSS concentrations (from 1 to 8 gTSS/L) while recording energy consumption, sludge production and effluent quality. An increase of MLSS led to an increase of the oxygen requirement for biomass aeration, but it also reduced total sludge production. Results permit identification of a key MLSS concentration allowing identification of the best compromise between levels of treatment required, biological energy demand and sludge production while minimizing the overall costs.

Early appendectomy reduces costs in children with perforated appendicitis.

Science.gov (United States)

Church, Joseph T; Klein, Edwin J; Carr, Benjamin D; Bruch, Steven W

2017-12-01

Perforated appendicitis can be managed with early appendectomy, or nonoperative management followed by interval appendectomy. We aimed to identify the strategy with the lowest health care utilization and cost. We retrospectively reviewed the medical records of all children ≤18 years old with perforated appendicitis admitted to a single institution between January 2009 and March 2016. After excluding immunosuppressed patients and transfers from outside hospitals, we grouped the remaining patients by early or interval appendectomy. Cost accounting data were obtained from our institutional database. The primary outcome was total hospital cost over 2 y from initial admission for appendicitis. Other outcomes analyzed included initial admission costs, number of admissions, emergency room and clinic visits, percutaneous procedures, cross-sectional and overall imaging studies, and length of stay. A total of 203 children with perforated appendicitis were identified. After exclusion of immunosuppressed patients and outside hospital transfers, 94 patients were included in the study. Thirty-nine underwent early appendectomy and 55 initial nonoperative management; of these, 54 underwent elective interval appendectomy. Five of 55 patients (9%) failed initial nonoperative management and required earlier-than-planned appendectomy. Total cost over 2 y was significantly lower with early appendectomy than initial nonoperative management ($19,300 ± 14,300 versus $26,000 ± 17,500; P = 0.05). Early appendectomy resulted in fewer hospital admissions, clinic visits, invasive procedures, and imaging studies. Early appendectomy results in lower hospital costs and less health care utilization compared with initial nonoperative management with elective interval appendectomy. A prospective study will shed more light on this question and can assess the role of nonoperative management without interval appendectomy in children with perforated appendicitis. Copyright © 2017 Elsevier

Restoration ecology: two-sex dynamics and cost minimization.

Science.gov (United States)

Molnár, Ferenc; Caragine, Christina; Caraco, Thomas; Korniss, Gyorgy

2013-01-01

We model a spatially detailed, two-sex population dynamics, to study the cost of ecological restoration. We assume that cost is proportional to the number of individuals introduced into a large habitat. We treat dispersal as homogeneous diffusion in a one-dimensional reaction-diffusion system. The local population dynamics depends on sex ratio at birth, and allows mortality rates to differ between sexes. Furthermore, local density dependence induces a strong Allee effect, implying that the initial population must be sufficiently large to avert rapid extinction. We address three different initial spatial distributions for the introduced individuals; for each we minimize the associated cost, constrained by the requirement that the species must be restored throughout the habitat. First, we consider spatially inhomogeneous, unstable stationary solutions of the model's equations as plausible candidates for small restoration cost. Second, we use numerical simulations to find the smallest rectangular cluster, enclosing a spatially homogeneous population density, that minimizes the cost of assured restoration. Finally, by employing simulated annealing, we minimize restoration cost among all possible initial spatial distributions of females and males. For biased sex ratios, or for a significant between-sex difference in mortality, we find that sex-specific spatial distributions minimize the cost. But as long as the sex ratio maximizes the local equilibrium density for given mortality rates, a common homogeneous distribution for both sexes that spans a critical distance yields a similarly low cost.

Designer's unified cost model

Science.gov (United States)

Freeman, William T.; Ilcewicz, L. B.; Swanson, G. D.; Gutowski, T.

1992-01-01

A conceptual and preliminary designers' cost prediction model has been initiated. The model will provide a technically sound method for evaluating the relative cost of different composite structural designs, fabrication processes, and assembly methods that can be compared to equivalent metallic parts or assemblies. The feasibility of developing cost prediction software in a modular form for interfacing with state of the art preliminary design tools and computer aided design programs is being evaluated. The goal of this task is to establish theoretical cost functions that relate geometric design features to summed material cost and labor content in terms of process mechanics and physics. The output of the designers' present analytical tools will be input for the designers' cost prediction model to provide the designer with a data base and deterministic cost methodology that allows one to trade and synthesize designs with both cost and weight as objective functions for optimization. The approach, goals, plans, and progress is presented for development of COSTADE (Cost Optimization Software for Transport Aircraft Design Evaluation).

Quality of Security Service Costing Demonstration for the MSHN Project

National Research Council Canada - National Science Library

Spyropoulou, Evdoxia

2000-01-01

.... Each service has two costs: an initialization cost and a run-time cost. The demonstration illustrates the costs incurred as network modes and security levels are changed. High level and detailed specifications are provided.

Low-cost high purity production

Science.gov (United States)

Kapur, V. K.

1978-01-01

Economical process produces high-purity silicon crystals suitable for use in solar cells. Reaction is strongly exothermic and can be initiated at relatively low temperature, making it potentially suitable for development into low-cost commercial process. Important advantages include exothermic character and comparatively low process temperatures. These could lead to significant savings in equipment and energy costs.

Estimating Maintenance Cost for Web Applications

Directory of Open Access Journals (Sweden)

Ion IVAN

2016-01-01

Full Text Available The current paper tackles the issue of determining a method for estimating maintenance costs for web applications. The current state of research in the field of web application maintenance is summarized and leading theories and results are highlighted. The cost of web maintenance is determined by the number of man-hours invested in maintenance tasks. Web maintenance tasks are categorized into content maintenance and technical maintenance. Research is centered on analyzing technical maintenance tasks. The research hypothesis is formulated on the assumption that the number of man-hours invested in maintenance tasks can be assessed based on the web application’s user interaction level, complexity and content update effort. Data regarding the costs of maintenance tasks is collected from 24 maintenance projects implemented by a web development company that tackles a wide area of web applications. Homogeneity and diversity of collected data is submitted for debate by presenting a sample of the data and depicting the overall size and comprehensive nature of the entire dataset. A set of metrics dedicated to estimating maintenance costs in web applications is defined based on conclusions formulated by analyzing the collected data and the theories and practices dominating the current state of research. Metrics are validated with regards to the initial research hypothesis. Research hypothesis are validated and conclusions are formulated on the topic of estimating the maintenance cost of web applications. The limits of the research process which represented the basis for the current paper are enunciated. Future research topics are submitted for debate.

Initial investment to 3D printing technologies in a construction company

Directory of Open Access Journals (Sweden)

Cernohorsky, Zdenek

2017-06-01

Full Text Available This article deals with an initial investment to 3D printing technologies in a construction company. The investment refers to the use of building information models and their integration with 3D printing technology within a construction company. In the first part, there will be discussed an introduction of 3D printing scheme in a construction company from a lifecycle perspective in general. As a part of this scheme, the ideal variant of an initial investment will be considered a.k.a a pilot project. In the second part, there will be a more detailed discussion of the pilot project, more about each activities which should be its parts and which should analyze cost categories. These categories will be about particular lifecycle stages of the pilot project. In the third part, a summary is done. This article could be a handout for a construction company in a term of an initial investment to 3D printing.

Initial measurement of assets produced in Bulgarian companies – current state and ways for improvement

Directory of Open Access Journals (Sweden)

Mincho Minev

2017-10-01

Full Text Available The initial evaluation of the production is one of the most complex tasks that accounting specialists face in their practice. The quality of the accounting information provided to the various internal and external users depends to a great extent on the way in which this task is resolved. In this article, using the results of an undertaken research, the practice of leading Bulgarian companies will be analyzed with regard to the costing of their production. The main purpose is to make recommendations for optimizing the process of costing in Bulgarian companies and to increase the quality of the accounting information produced as a result of this process.

Documenting costs and yield of crops of organic origin

Directory of Open Access Journals (Sweden)

J.P. Melnychuk

2016-06-01

Full Text Available The article focuses on the study of primary cost accounting and output of organic crop production. The article has also agreed the key issues that ensure in the primary accounting of organic crop production. For the survey we have used such general scientific methods as induction and deduction, dialectic, historical and systematic methods and some specific methods of accounting which include documentation, inventory, assessment, calculation, accounting records, double entry, balance sheet and financial statements. . As for the documentation of costs and yield of crops of organic origin, it should be noted that documentation is an important method of accounting as it’s the basis of initial observation of commercial operations and it’s a prerequisite for their reflection in accounting. The article has highlighted the features of documenting the posting of production costs and crop production of organic origin, and has also studied the order of registration of land in the operating lease for the production of organic products. The author submits the suggestions for improvement of documenting costs and yields of organic crop production in order to develop reliable information about the costs of production and the grown crop of organic origin for management decision-making.

Methodology of social and environmental external costs estimation in the Ukraine’s energy sector

Directory of Open Access Journals (Sweden)

Karaieva Nataliia Veniaminivna

2016-09-01

Full Text Available Paper objective is analysis of the external costs assessment model for the eco-social damage, and/or human capital losses caused by environmental pollution from the energy enterprises in Ukraine. Using the given method, necessary initial socio-economic parameters were defined and used for calculating the social costs of capital health losses in Ukraine due to deterioration of the environment, and due to the negative impact of energy sector on the air quality for the period 2002-2013. On the proposed technique determines the range value of social losses due to the negative impact of energy on air quality in Ukraine excluding future external costs for years 2002 – 2013 ranges from 1.6 – 4.5% of GDP, and the range of values of taking into account future costs is 2.0 – 6.2% of GDP.

Open vs Laparoscopic Simple Prostatectomy: A Comparison of Initial Outcomes and Cost.

Science.gov (United States)

Demir, Aslan; Günseren, Kadir Ömür; Kordan, Yakup; Yavaşçaoğlu, İsmet; Vuruşkan, Berna Aytaç; Vuruşkan, Hakan

2016-08-01

We compared the cost-effectiveness of laparoscopic simple prostatectomy (LSP) vs open prostatectomy (OP). A total of 73 men treated for benign prostatic hyperplasia were enrolled for OP and LSP in groups 1 and 2, respectively. The findings were recorded perioperative, including operation time (OT), blood lost, transfusion rate, conversion to the open surgery, and the complications according to the Clavien Classification. The postoperative findings, including catheterization and drainage time, the amount of analgesic used, hospitalization time, postoperative complications, international prostate symptom score (IPSS) and International Index of Erectile Function (IIEF) scores, the extracted prostate weight, the uroflowmeter, as well as postvoiding residual (PVR) and quality of life (QoL) score at the postoperative third month, were analyzed. The cost of both techniques was also compared statistically. No statistical differences were found in the preoperative parameters, including age, IPSS and QoL score, maximum flow rate (Qmax), PVR, IIEF score, and prostate volumes, as measured by transabdominal ultrasonography. No statistical differences were established in terms of the OT and the weight of the extracted prostate. No differences were established with regard to complications according to Clavien's classification in groups. However, the bleeding rate was significantly lower in group 2. The drainage, catheterization, and hospitalization times and the amount of analgesics were significantly lower in the second group. The postoperative third month findings were not different statistically. Only the Qmax values were significantly greater in group 2. While there was only a $52 difference between groups with regard to operation cost, this difference was significantly different. The use of LSP for the prostates over 80 g is more effective than the OP in terms of OT, bleeding amount, transfusion rates, catheterization time, drain removal time, hospitalization time

Advanced Fuel Cycle Cost Basis

Energy Technology Data Exchange (ETDEWEB)

D. E. Shropshire; K. A. Williams; W. B. Boore; J. D. Smith; B. W. Dixon; M. Dunzik-Gougar; R. D. Adams; D. Gombert; E. Schneider

2009-12-01

This report, commissioned by the U.S. Department of Energy (DOE), provides a comprehensive set of cost data supporting a cost analysis for the relative economic comparison of options for use in the Advanced Fuel Cycle Initiative (AFCI) Program. The report describes the AFCI cost basis development process, reference information on AFCI cost modules, a procedure for estimating fuel cycle costs, economic evaluation guidelines, and a discussion on the integration of cost data into economic computer models. This report contains reference cost data for 25 cost modules—23 fuel cycle cost modules and 2 reactor modules. The cost modules were developed in the areas of natural uranium mining and milling, conversion, enrichment, depleted uranium disposition, fuel fabrication, interim spent fuel storage, reprocessing, waste conditioning, spent nuclear fuel (SNF) packaging, long-term monitored retrievable storage, near surface disposal of low-level waste (LLW), geologic repository and other disposal concepts, and transportation processes for nuclear fuel, LLW, SNF, transuranic, and high-level waste.

Advanced Fuel Cycle Cost Basis

Energy Technology Data Exchange (ETDEWEB)

D. E. Shropshire; K. A. Williams; W. B. Boore; J. D. Smith; B. W. Dixon; M. Dunzik-Gougar; R. D. Adams; D. Gombert

2007-04-01

This report, commissioned by the U.S. Department of Energy (DOE), provides a comprehensive set of cost data supporting a cost analysis for the relative economic comparison of options for use in the Advanced Fuel Cycle Initiative (AFCI) Program. The report describes the AFCI cost basis development process, reference information on AFCI cost modules, a procedure for estimating fuel cycle costs, economic evaluation guidelines, and a discussion on the integration of cost data into economic computer models. This report contains reference cost data for 26 cost modules—24 fuel cycle cost modules and 2 reactor modules. The cost modules were developed in the areas of natural uranium mining and milling, conversion, enrichment, depleted uranium disposition, fuel fabrication, interim spent fuel storage, reprocessing, waste conditioning, spent nuclear fuel (SNF) packaging, long-term monitored retrievable storage, near surface disposal of low-level waste (LLW), geologic repository and other disposal concepts, and transportation processes for nuclear fuel, LLW, SNF, and high-level waste.

Advanced Fuel Cycle Cost Basis

Energy Technology Data Exchange (ETDEWEB)

D. E. Shropshire; K. A. Williams; W. B. Boore; J. D. Smith; B. W. Dixon; M. Dunzik-Gougar; R. D. Adams; D. Gombert; E. Schneider

2008-03-01

This report, commissioned by the U.S. Department of Energy (DOE), provides a comprehensive set of cost data supporting a cost analysis for the relative economic comparison of options for use in the Advanced Fuel Cycle Initiative (AFCI) Program. The report describes the AFCI cost basis development process, reference information on AFCI cost modules, a procedure for estimating fuel cycle costs, economic evaluation guidelines, and a discussion on the integration of cost data into economic computer models. This report contains reference cost data for 25 cost modules—23 fuel cycle cost modules and 2 reactor modules. The cost modules were developed in the areas of natural uranium mining and milling, conversion, enrichment, depleted uranium disposition, fuel fabrication, interim spent fuel storage, reprocessing, waste conditioning, spent nuclear fuel (SNF) packaging, long-term monitored retrievable storage, near surface disposal of low-level waste (LLW), geologic repository and other disposal concepts, and transportation processes for nuclear fuel, LLW, SNF, transuranic, and high-level waste.

The costs of turnover in nursing homes

Science.gov (United States)

Mukamel, Dana B.; Spector, William D.; Limcangco, Rhona; Wang, Ying; Feng, Zhanlian; Mor, Vincent

2009-01-01

Background Turnover rates in nursing homes have been persistently high for decades, ranging upwards of 100%. Objectives To estimate the net costs associated with turnover of direct care staff in nursing homes. Data and sample 902 nursing homes in California in 2005. Data included Medicaid cost reports, the Minimum Data Set (MDS), Medicare enrollment files, Census and Area Resource File (ARF). Research Design We estimated total cost functions, which included in addition to exogenous outputs and wages, the facility turnover rate. Instrumental variable (IV) limited information maximum likelihood techniques were used for estimation to deal with the endogeneity of turnover and costs. Results The cost functions exhibited the expected behavior, with initially increasing and then decreasing returns to scale. The ordinary least square estimate did not show a significant association between costs and turnover. The IV estimate of turnover costs was negative and significant (p=0.039). The marginal cost savings associated with a 10 percentage point increase in turnover for an average facility was $167,063 or 2.9% of annual total costs. Conclusion The net savings associated with turnover offer an explanation for the persistence of this phenomenon over the last decades, despite the many policy initiatives to reduce it. Future policy efforts need to recognize the complex relationship between turnover and costs. PMID:19648834

Financing Preference Behaviour for Private Finance Initiative (PFI Projects

Directory of Open Access Journals (Sweden)

Yati Md Lasa

2016-01-01

Full Text Available Project Financing Initiative (PFI projects require the private sector to invest an enormous amount of capital for the development of public projects. The private sector has to seek cost-effective financing sources for their survival in the long-term concession. Conventional financing uses widely; however, Islamic financing promises better financing through profit and loss sharing. This paper reviews financing preferences for PFI projects and the factors influencing the choice of funding. The results show that religious perspective, quality of services, financing facilities and reputation are the factors that are expected will influence the financing preference behaviour, either Islamic or conventional finance.

Reduction of initial shock in decadal predictions using a new initialization strategy

Science.gov (United States)

He, Yujun; Wang, Bin; Liu, Mimi; Liu, Li; Yu, Yongqiang; Liu, Juanjuan; Li, Ruizhe; Zhang, Cheng; Xu, Shiming; Huang, Wenyu; Liu, Qun; Wang, Yong; Li, Feifei

2017-08-01

A novel full-field initialization strategy based on the dimension-reduced projection four-dimensional variational data assimilation (DRP-4DVar) is proposed to alleviate the well-known initial shock occurring in the early years of decadal predictions. It generates consistent initial conditions, which best fit the monthly mean oceanic analysis data along the coupled model trajectory in 1 month windows. Three indices to measure the initial shock intensity are also proposed. Results indicate that this method does reduce the initial shock in decadal predictions by Flexible Global Ocean-Atmosphere-Land System model, Grid-point version 2 (FGOALS-g2) compared with the three-dimensional variational data assimilation-based nudging full-field initialization for the same model and is comparable to or even better than the different initialization strategies for other fifth phase of the Coupled Model Intercomparison Project (CMIP5) models. Better hindcasts of global mean surface air temperature anomalies can be obtained than in other FGOALS-g2 experiments. Due to the good model response to external forcing and the reduction of initial shock, higher decadal prediction skill is achieved than in other CMIP5 models.

Marketable pollution permits with uncertainty and transaction costs

International Nuclear Information System (INIS)

Montero, Juan-Pablo

1998-01-01

Increasing interest in the use of marketable permits for pollution control has become evident in recent years. Concern regarding their performance still remains because empirical evidence has shown transaction costs and uncertainty to be significant in past and existing marketable permits programs. In this paper we develop theoretical and numerical models that include transaction costs and uncertainty (in trade approval) to show their effects on market performance (i.e., equilibrium price of permits and trading volume) and aggregate control costs. We also show that in the presence of transaction costs and uncertainty the initial allocation of permits may not be neutral in terms of efficiency. Furthermore, using a numerical model for a hypothetical NO x trading program in which participants have discrete control technology choices, we find that aggregate control costs and the equilibrium price of permits are sensitive to the initial allocation of permits, even for constant marginal transaction costs and certainty

Cost Reporting at a Navy Branch Clinic

Science.gov (United States)

1993-03-01

John Wiley & Sons, 1991. 15 Horngren , Charles, Cost Accounting -=A Managerial Emphasis, 5th Edition, Prentice Hall, Inc., Englewood Cliffs, N.J., 1982...traditionally reported under a partial cost reporting system. By applying basic principles of managerial accounting , a full cost reporting system is...traditionally reported under a partial cost reporting system. By applying basic principles of managerial accounting , a proposed full cost reporting

CAD/CAM monolithic restorations and full-mouth adhesive rehabilitation to restore a patient with a past history of bulimia: the modified three-step technique.

Science.gov (United States)

Vailati, Francesca; Carciofo, Sylvain

2016-01-01

Due to an increasing awareness about dental erosion, many clinicians would like to propose treatments even at the initial stages of the disease. However, when the loss of tooth structure is visible only to the professional eye, and it has not affected the esthetics of the smile, affected patients do not usually accept a full-mouth rehabilitation. Reducing the cost of the therapy, simplifying the clinical steps, and proposing noninvasive adhesive techniques may promote patient acceptance. In this article, the treatment of an ex-bulimic patient is illustrated. A modified approach of the three-step technique was followed. The patient completed the therapy in five short visits, including the initial one. No tooth preparation was required, no anesthesia was delivered, and the overall (clinical and laboratory) costs were kept low. At the end of the treatment, the patient was very satisfied from a biologic and functional point of view.

Comparison of hospitalizations, emergency department visits, and costs in a historical cohort of Texas Medicaid patients with chronic obstructive pulmonary disease, by initial medication regimen.

Science.gov (United States)

Rascati, Karen L; Akazawa, Manabu; Johnsrud, Michael; Stanford, Richard H; Blanchette, Christopher M

2007-06-01

Limited information is available on the relative outcomes and treatment costs of various pharmacotherapies for chronic obstructive pulmonary disease (COPD) in a Medicaid population. This study compared the effects of initial medication regimens for COPD on COPD-related and all-cause events (hospitalizations and/or emergency department [ED] visits) and COPD-related and all-cause costs. The study population was a historical cohort of Texas Medicaid beneficiaries aged 40 to 64 years with COPD-related medical costs (International Classification of Diseases, Ninth Revision, Clinical Modification codes 491.xx, 492.xx, 496.xx), 24 months of continuous Medicaid enrollment (12 months before and after the index prescription), and at least 1 prescription claim (index) for a combination product containing fluticasone propionate + salmeterol, an inhaled corticosteroid, salmeterol, or ipratropium between April 1, 2001, and March 31, 2003. The analyses of events employed Cox proportional hazards regression, controlling for baseline factors and preindex events. The analyses of costs used a 2-part model with logistic regression and generalized linear model to adjust for baseline characteristics and preindex utilization and costs. The study population included 6793 patients (1211 combination therapy, 968 inhaled corticosteroid, 401 salmeterol, and 4213 ipratropium). Only combination therapy was associated with a significantly lower risk for any COPD-related event (hazard ratio [HR] = 0.733; 95% CI, 0.650-0.826) and any all-cause event (HR = 0.906; 95% CI, 0.844-0.972) compared with ipratropium. COPD-related prescription costs were higher in all cohorts compared with the ipratropium cohort, but COPD-related medical costs were lower, offsetting the increase in prescription costs. For all-cause costs, prescription costs were higher in the combination-therapy cohort (+$415; P costs in the combination-therapy cohort (-$1735; P costs. In this historical population of Texas Medicaid

Cost-minimization analysis of subcutaneous abatacept in the treatment of rheumatoid arthritis in Spain

Directory of Open Access Journals (Sweden)

R. Ariza

2014-07-01

Full Text Available Objective: To compare the cost of treating rheumatoid arthritis patients that have failed an initial treatment with methotrexate, with subcutaneous aba - tacept versus other first-line biologic disease-modifying antirheumatic drugs. Method: Subcutaneous abatacept was considered comparable to intravenous abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab and tocilizumab, based on indirect comparison using mixed treatment analysis. A cost-minimization analysis was therefore considered appropriate. The Spanish Health System perspective and a 3 year time horizon were selected. Pharmaceutical and administration costs (, 2013 of all available first-line biological disease-modifying antirheumatic drugs were considered. Administration costs were obtained from a local costs database. Patients were considered to have a weight of 70 kg. A 3% annual discount rate was applied. Deterministic and probabilistic sensitivity analyses were performed. Results: Subcutaneous abatacept proved in the base case to be less costly than all other biologic antirrheumatic drugs (ranging from -831.42 to -9,741.69 versus infliximab and tocilizumab, respectively. Subcutaneous abatacept was associated with a cost of 10,760.41 per patient during the first year of treatment and 10,261.29 in subsequent years. The total 3-year cost of subcutaneous abatacept was 29,953.89 per patient. Sensitivity analyses proved the model to be robust. Subcutaneous abatacept remained cost-saving in 100% of probabilistic sensitivity analysis simulations versus adalimumab, certolizumab, etanercept and golimumab, in more than 99.6% versus intravenous abatacept and tocilizumab and in 62.3% versus infliximab. Conclusions: Treatment with subcutaneous abatacept is cost-saving versus intravenous abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab and tocilizumab in the management of rheumatoid arthritis patients initiating

The direct cost of "Thriasio" school screening program

Directory of Open Access Journals (Sweden)

Maziotou Christina

2007-05-01

Full Text Available Abstract Background There is great diversity in the policies for scoliosis screening worldwide. The initial enthusiasm was succeeded by skepticism and the worth of screening programs has been challenged. The criticisms of school screening programs cite mainly the negative psychological impact on children and their families and the increased financial cost of visits and follow-up radiographs. The purpose of this report is to evaluate the direct cost of performing the school screening in a district hospital. Methods A cost analysis was performed for the estimation of the direct cost of the "Thriasio" school-screening program between January 2000 and May 2006. The analysis involved all the 6470 pupils aged 6–18 years old who were screened at schools for spinal deformities during this period. The factors which were taken into consideration in order to calculate the direct cost of the screening program were a the number of the examiners b the working hours, c the examiners' salary, d the cost of transportation and finally e the cost of examination per child. Results During the examined period 20 examiners were involved in the program and worked for 1949 working hours. The hourly salary for the trainee doctors was 6.80 euro, for the Health Visitors 6.70 euro and for the Physiotherapists 5.50 euro in current prices. The cost of transportation was 32 euro per year. The direct cost for the examination of each child for the above studied period was calculated to be 2.04 euro. Conclusion The cost of our school-screening program is low. The present study provides a strong evidence for the continuation of the program when looking from a financial point of view.

Cost-effectiveness and budget impact analyses of a long-term hypertension detection and control program for stroke prevention.

Science.gov (United States)

Yamagishi, Kazumasa; Sato, Shinichi; Kitamura, Akihiko; Kiyama, Masahiko; Okada, Takeo; Tanigawa, Takeshi; Ohira, Tetsuya; Imano, Hironori; Kondo, Masahide; Okubo, Ichiro; Ishikawa, Yoshinori; Shimamoto, Takashi; Iso, Hiroyasu

2012-09-01

The nation-wide, community-based intensive hypertension detection and control program, as well as universal health insurance coverage, may well be contributing factors for helping Japan rank near the top among countries with the longest life expectancy. We sought to examine the cost-effectiveness of such a community-based intervention program, as no evidence has been available for this issue. The hypertension detection and control program was initiated in 1963 in full intervention and minimal intervention communities in Akita, Japan. We performed comparative cost-effectiveness and budget-impact analyses for the period 1964-1987 of the costs of public health services and treatment of patients with hypertension and stroke on the one hand, and incidence of stroke on the other in the full intervention and minimal intervention communities. The program provided in the full intervention community was found to be cost saving 13 years after the beginning of program in addition to the fact of effectiveness that; the prevalence and incidence of stroke were consistently lower in the full intervention community than in the minimal intervention community throughout the same period. The incremental cost was minus 28,358 yen per capita over 24 years. The community-based intensive hypertension detection and control program was found to be both effective and cost saving. The national government's policy to support this program may have contributed in part to the substantial decline in stroke incidence and mortality, which was largely responsible for the increase in Japanese life expectancy.

The Cost of Blindness in the Republic of Ireland 2010–2020

Directory of Open Access Journals (Sweden)

D. Green

2016-01-01

Full Text Available Aims. To estimate the prevalence of blindness in the Republic of Ireland and the associated financial and total economic cost between 2010 and 2020. Methods. Estimates for the prevalence of blindness in the Republic of Ireland were based on blindness registration data from the National Council for the Blind of Ireland. Estimates for the financial and total economic cost of blindness were based on the sum of direct and indirect healthcare and nonhealthcare costs. Results. We estimate that there were 12,995 blind individuals in Ireland in 2010 and in 2020 there will be 17,997. We estimate that the financial and total economic costs of blindness in the Republic of Ireland in 2010 were €276.6 million and €809 million, respectively, and will increase in 2020 to €367 million and €1.1 billion, respectively. Conclusions. Here, ninety-eight percent of the cost of blindness is borne by the Departments of Social Protection and Finance and not by the Department of Health as might initially be expected. Cost of illness studies should play a role in public policy making as they help to quantify the indirect or “hidden” costs of disability and so help to reveal the true cost of illness.

Realistic generation cost of solar photovoltaic electricity

International Nuclear Information System (INIS)

Singh, Parm Pal; Singh, Sukhmeet

2010-01-01

Solar photovoltaic (SPV) power plants have long working life with zero fuel cost and negligible maintenance cost but requires huge initial investment. The generation cost of the solar electricity is mainly the cost of financing the initial investment. Therefore, the generation cost of solar electricity in different years depends on the method of returning the loan. Currently levelized cost based on equated payment loan is being used. The static levelized generation cost of solar electricity is compared with the current value of variable generation cost of grid electricity. This improper cost comparison is inhibiting the growth of SPV electricity by creating wrong perception that solar electricity is very expensive. In this paper a new method of loan repayment has been developed resulting in generation cost of SPV electricity that increases with time like that of grid electricity. A generalized capital recovery factor has been developed for graduated payment loan in which capital and interest payment in each installment are calculated by treating each loan installment as an independent loan for the relevant years. Generalized results have been calculated which can be used to determine the cost of SPV electricity for a given system at different places. Results show that for SPV system with specific initial investment of 5.00 cents /kWh/year, loan period of 30 years and loan interest rate of 4% the levelized generation cost of SPV electricity with equated payment loan turns out to be 28.92 cents /kWh, while the corresponding generation cost with graduated payment loan with escalation in annual installment of 8% varies from 9.51 cents /kWh in base year to 88.63 cents /kWh in 30th year. So, in this case, the realistic current generation cost of SPV electricity is 9.51 cents /kWh and not 28.92 cents /kWh. Further, with graduated payment loan, extension in loan period results in sharp decline in cost of SPV electricity in base year. Hence, a policy change is required

Managing Hidden Costs of Offshoring

DEFF Research Database (Denmark)

Larsen, Marcus M.; Pedersen, Torben

2014-01-01

This chapter investigates the concept of the ‘hidden costs’ of offshoring, i.e. unexpected offshoring costs exceeding the initially expected costs. Due to the highly undefined nature of these costs, we position our analysis towards the strategic responses of firms’ realisation of hidden costs....... In this regard, we argue that a major response to the hidden costs of offshoring is the identification and utilisation of strategic mechanisms in the organisational design to eventually achieving system integration in a globally dispersed and disaggregated organisation. This is heavily moderated by a learning......-by-doing process, where hidden costs motivate firms and their employees to search for new and better knowledge on how to successfully manage the organisation. We illustrate this thesis based on the case of the LEGO Group....

An Analysis Of Activity Based Costing Between Benefit And Cost For Its Implementation

Directory of Open Access Journals (Sweden)

Dadan Soekardan

2015-08-01

Full Text Available This research discusses how the importance of adopting activity-based costing for the company in order to carry out its business strategy. One objective is to implement activity based costing cost efficiency by cutting costs incurred for non-value added activity. But the phenomenon shows that there are still many companies organizations are not interested in adopting the activity based costing. This article also outlines the advantages and limitations in adopting activity based costing for the company.

Cost-benefit analysis of telehealth in pre-hospital care.

Science.gov (United States)

Langabeer, James R; Champagne-Langabeer, Tiffany; Alqusairi, Diaa; Kim, Junghyun; Jackson, Adria; Persse, David; Gonzalez, Michael

2017-09-01

Objective There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative. Methods Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost-benefit analysis (CBA) comparing costs with potential savings associated with patients treated through a telehealth-enabled intervention. The intervention consisted of telehealth-based consultation between the 911 patient and an EMS physician, to evaluate and triage the necessity for patient transport to a hospital emergency department (ED). Patients with non-urgent, primary care-related conditions were then scheduled and transported by alternative means to an affiliated primary care clinic. We measured CBA as both total cost savings and cost per ED visit averted, in US Dollars ($USD). Results In total, 5570 patients were treated over the first full 12 months with a telehealth-enabled care model. We found a 6.7% absolute reduction in potentially medically unnecessary ED visits, and a 44-minute reduction in total ambulance back-in-service times. The average cost for a telehealth patient was $167, which was a statistically significantly $103 less than the control group ( p cost savings from the societal perspective, or $2468 cost savings per ED visit averted (benefit). Conclusion Patient care enabled by telehealth in a pre-hospital environment, is a more cost effective alternative compared to the traditional EMS 'treat and transport to ED' model.

Cost Accounting for Decision Makers.

Science.gov (United States)

Kaneklides, Ann L.

1985-01-01

Underscores the importance of informed decision making through accurate anticipation of cost incurrence in light of changing economic and environmental conditions. Explains the concepts of cost accounting, full allocation of costs, the selection of an allocation base, the allocation of indirect costs, depreciation, and implications for community…

Designers' unified cost model

Science.gov (United States)

Freeman, W.; Ilcewicz, L.; Swanson, G.; Gutowski, T.

1992-01-01

The Structures Technology Program Office (STPO) at NASA LaRC has initiated development of a conceptual and preliminary designers' cost prediction model. The model will provide a technically sound method for evaluating the relative cost of different composite structural designs, fabrication processes, and assembly methods that can be compared to equivalent metallic parts or assemblies. The feasibility of developing cost prediction software in a modular form for interfacing with state-of-the-art preliminary design tools and computer aided design programs is being evaluated. The goal of this task is to establish theoretical cost functions that relate geometric design features to summed material cost and labor content in terms of process mechanics and physics. The output of the designers' present analytical tools will be input for the designers' cost prediction model to provide the designer with a database and deterministic cost methodology that allows one to trade and synthesize designs with both cost and weight as objective functions for optimization. This paper presents the team members, approach, goals, plans, and progress to date for development of COSTADE (Cost Optimization Software for Transport Aircraft Design Evaluation).

CT colonography and cost-effectiveness

Energy Technology Data Exchange (ETDEWEB)

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

2008-11-15

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

CT colonography and cost-effectiveness

International Nuclear Information System (INIS)

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

2008-01-01

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

Quality Cost in the Construction Industry ' Preliminary Findings in Malaysia

Directory of Open Access Journals (Sweden)

Mukhtar Che Ali

2010-06-01

Full Text Available One of the key areas being emphasis in ISO 9001 Quality Management System (QMS is performance measurement towards continual improvement. Among the primary measuring tools is quality cost approach. Quality cost has been well practice in manufacturing sector but slowly gain its importance in construction industry. In fact Project Management Body of Knowledge (PMBOK has reckoned quality cost as one of the tool and technique in few of its management processes. In view of such circumstances that has prompted an effort to undertake a study to ascertain the level of knowledge and practice on quality cost in Malaysian construction landscape. The targeted group of respondents was the personnel in the project management team. Capitalizing Construction Industry Development Board (CIDB National Electronic Tendering Initiatives (NETI road shows which were held in year 2007 throughout the country, the author was able to garner 263 respondents representing the project management team. Subsequently the data gathered from the completed forms were analyzed using Statistical Package for Social Science (SPSS software. General findings indicated that the level of knowledge and practice on quality cost among the project management team were relatively low. One of the main contributing factors was poor knowledge in the area related to quality cost. Despite of such scenario most of the respondents showed their interest in acquiring knowledge in the field of quality cost. Hence quality cost approach is at the infancy stage in Malaysian construction industry.

REDUCTION OF THE PRODUCTION COST. EXPERIENCE OF THE COSTS REDUCTION AT RUP “BMZ”

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S. S. Sereda

2004-01-01

Full Text Available The method of the daily operative monitoring of the costs for reduction of net cost and reinforcement of control on the costs has been applied for the first time in 2003 in RB at RUP “BMZ”, that allowed for the enterprise to control the costs in regime of real time.

Thoracic surgical resident education: a costly endeavor.

Science.gov (United States)

Calhoon, John H; Baisden, Clint; Holler, Ben; Hicks, George L; Bove, Ed L; Wright, Cameron D; Merrill, Walter H; Fullerton, Dave A

2014-12-01

We sought to define an accurate measure of thoracic surgical education costs. Program directors from six distinct and differently sized and geographically located thoracic surgical training programs used a common template to provide estimates of resident educational costs. These data were reviewed, clarifying questions or discrepancies when noted and using best estimates when exact data were unavailable. Subsequently, a composite of previously published cost-estimation products was used to capture accurate cost data. Data were then compiled and averaged to provide an accurate picture of all costs associated with thoracic surgical education. Before formal accounting was performed, the estimated average for all programs was approximately $250,000 per year per resident. However, when formal evaluations by the six programs were performed, the annual cost of resident education ranged from $330,000 to $667,000 per year per resident. The average cost of $483,000 per year was almost double the initial estimates. Variability was noted by region and size of program. Faculty teaching costs varied from $208,000 to $346,000 per year. Simulation costs ranged from $0 to $80,000 per year. Resident savings to program ranged from $0 to $135,000 per year and averaged $37,000 per year per resident. Thoracic surgical education costs are considerably higher than initial estimates from program directors and probably represent an unappreciated source of financial burden for cardiothoracic surgical educational programs. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Costing in Radiotherapy. Chapter 18

International Nuclear Information System (INIS)

Zubizarreta, E.; Lievens, Y.; Levin, V.C.; Van Der Merwe, D.

2017-01-01

The available literature on the cost of radiotherapy yields a large variation in data related to the specifics of the methodology used (the viewpoint of the analysis, time frame, health care system, etc.) and to the cost components and radiotherapy activities included. To overcome this difficulty, the reimbursement paid by medical insurance is commonly used as a proxy for the actual radiotherapy costs. Costs, however, generally bear little or no resemblance to charges, as the latter also include allowances for non-capacity use and profit margins. Accurate resource cost data are therefore more valid and should ideally be used in the context of economic evaluations and public health provisions. In addition to the theoretical problems related to obtaining accurate costs, it is difficult to interpret cost data across country borders because of differences in economics. If this is already the case for high income countries, using these cost data for low and middle income countries (LMICs) is even more problematic. Thus, there clearly is a need for calculations performed from the viewpoint of LMICs to prevent misapprehensions based on conclusions derived from data from their high income counterparts. The IAEA endeavours to assist Member States in accumulating appropriate and sufficient cost data for the initiation or expansion of radiation oncology services. Although relatively simple and easy to understand, the IAEA has found that in many countries where it has been involved in the establishment of new radiotherapy departments, the basic principles of cost calculation for radiotherapy facilities were not followed by the local planners. Radiotherapy needs careful planning, organization and a strong quality assurance (QA) programme in order to deliver safe treatments, due to the complexity of the planning and treatment process and the possibility of systematic errors. Administrators should be aware that the cost of building a radiotherapy facility and buying machines

Teachers’ perceptions of their own initiative: Collective initiative vs. personal initiative

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Džinović Vladimir

2013-01-01

Full Text Available Current trends in education demand from teachers to exhibit proactive behaviour and assume responsibility for the implementation of changes in school practice. In that sense, it is important to study how teachers perceive their own initiative and to gain insight into the activities where such initiative is demonstrated. This study has been conceived as a mixed-methods research. The qualitative study implied forming four focus groups with subject teachers and class teachers (N=38, while the quantitative study entailed surveying 1441 teachers in forty primary schools in Serbia using the questionnaire constructed based on qualitative data. Data from focus groups were processed by qualitative thematic analysis, while the questionnaire data were processed by principal component analysis and univariate analysis of variance. The findings of the study have shown that teachers mostly demonstrate initiative through co­operative activities that include planning of joint teaching as well as conducting joint projects within school and with the local community actors. Teachers are least ready to demonstrate personal initiative and the initiative aimed at accomplishing considerable changes in school work. The concluding part includes the recommendations for encouraging teachers’ personal initiative and building organizational culture that would support such initiative. [Projekat Ministarstva nauke Republike Srbije, br. br. 47008: Unapređivanje kvaliteta i dostupnosti obrazovanja u procesima modernizacije Srbije i br. 179034: Od podsticanja inicijative, saradnje i stvaralaštva u obrazovanju do novih uloga i identiteta u društvu

Costs involved in using a cochlear implant in South Africa

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Gillian Robyn Kerr

2012-12-01

Full Text Available Cochlear implantation is an expensive but effective lifelong intervention for individuals with a severe-to-profound hearing loss. The primary aim of this study was to survey the short- and long-term costs of cochlear implantation. Individuals (N=154 using cochlear implants obtained from the University of Stellenbosch-Tygerberg Hospital Cochlear Implant Unit in Cape Town, South Africa were surveyed using a questionnaire and patient record review. The questionnaire used a combination of closed and open-ended questions to gather both quantitative and qualitative information. Costs were categorised as short- and long-term costs. All costs were converted to constant rands (June 2010 using the Consumer Price Index to allow for comparison in real terms over time. In the first 10 years of implantation the average estimated costs incurred by adults totalled R379 626, and by children R455 225. The initial purchase of the implant system was the most substantial cost, followed by upgrading of the processor. Travel and accommodation costs peaked in the first 2 years. On average the participants spent R2 550 per year on batteries and spares. Rehabilitation for children cost an average of R7 200. Insurance costs averaged R4 040 per year, and processor repairs R3 000 each. In addition to the upfront expense of obtaining the cochlear implant system, individuals using a cochlear implant in South Africa should be prepared for the long-term costs of maintenance, accessing the unit, support services and additional costs associated with use. Knowledge of these costs is important to ensure that individuals are successful users of their cochlear implants in the long term.

Costs and Benefits of a Shared Digital Long-Term Preservation System

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Esa-Pekka Keskitalo

2011-10-01

Full Text Available This paper describes the cost-benefit analysis of digital long-term preservation (LTP that was carried out in the context of the Finnish National Digital Library Project (NDL in 2010. The analysis was based on the assumption that as many as 200 archives, libraries, and museums will share an LTP system. The term ‘system’ shall be understood as encompassing not only information technology, but also human resources, organizational structures, policies and funding mechanisms. The cost analysis shows that an LTP system will incur, over the first 12 years, cumulative costs of €42 million, i.e. an average of €3.5 million per annum. Human resources and investments in information technology are the major cost factors. After the initial stages, the analysis predicts annual costs of circa €4 million. The analysis compared scenarios with and without a shared LTP system. The results indicate that a shared system will have remarkable benefits. At the development and implementation stages, a shared system shows an advantage of €30 million against the alternative scenario consisting of five independent LTP solutions. During the later stages, the advantage is estimated at €10 million per annum. The cumulative cost benefit over the first 12 years would amount to circa €100 million.

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

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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

Improving Library Management by Using Cost Analysis Tools: A Case Study for Cataloguing Processes

Directory of Open Access Journals (Sweden)

Lorena Siguenza-Guzman

2014-02-01

Full Text Available TTDABC is a relatively new costing management technique, initially developed for manufacturing processes, which is gaining attention in libraries. This is because TDABC is a fast and simple method that only requires two parameters, an estimation of time required to perform an activity and the unit cost per time of supplying capacity. A few case studies have been documented with regard to TDABC in libraries; all of them being oriented to analyse specific library activities such as inter-library loan, acquisition and circulation processes. The primary focus of this paper is to describe TDABC implementation in one of the most important library processes, namely cataloguing. In particular, original and copy cataloguing are analysed through a case study to demonstrate the applicability and usefulness of TDABC to perform cost analysis of cataloguing processes.

The costs and benefits to participants in community partnerships: a paradox?

Science.gov (United States)

El Ansari, Walid; Phillips, Ceri J

2004-01-01

This article examines the degree of stakeholder participation in health and social partnership schemes in relation to their perceptions of benefits, costs, satisfaction, commitment, and ownership. The findings suggest that (a) involvement, commitment, and sense of ownership were invariably associated with high benefits and mostly with low costs; (b) benefits, commitment, and ownership might be more sensitive monitors of involvement than costs and satisfaction; (c) an increase in involvement was initially associated with decreased costs and increased satisfaction up to a point beyond which costs increased and satisfaction decreased despite increasing benefits; and (d) favorable cost-benefit ratios were perceived when the benefits were at least 1.6 times the costs. Partnership initiatives need to explore the involvement "cut-off" point at which the costs (and satisfaction) might change direction. For favorable cost-benefit ratios, benefits need to be at least 60% more than costs (Ansari's paradox).

Activity- Based Costing: An Application In The Olive Sector

OpenAIRE

Bekçioğlu, Selim; Gürel, Eymen; Kızılyalçın, D. Ali

2014-01-01

The purpose of the study named as “The Activity Based Costing: An Application in the Olive Sector” is the implementation of activity based costing in olive sector and the statement of the differences as regards to the traditional costing. The accepted basic hypothesis in the thesis is that the activity-based costing provides more accurate cost information than the traditional costing process. In this study initially comprehensive information about activity based costing is given and after th...

Defining the value of magnetic resonance imaging in prostate brachytherapy using time-driven activity-based costing.

Science.gov (United States)

Thaker, Nikhil G; Orio, Peter F; Potters, Louis

Magnetic resonance imaging (MRI) simulation and planning for prostate brachytherapy (PBT) may deliver potential clinical benefits but at an unknown cost to the provider and healthcare system. Time-driven activity-based costing (TDABC) is an innovative bottom-up costing tool in healthcare that can be used to measure the actual consumption of resources required over the full cycle of care. TDABC analysis was conducted to compare patient-level costs for an MRI-based versus traditional PBT workflow. TDABC cost was only 1% higher for the MRI-based workflow, and utilization of MRI allowed for cost shifting from other imaging modalities, such as CT and ultrasound, to MRI during the PBT process. Future initiatives will be required to follow the costs of care over longer periods of time to determine if improvements in outcomes and toxicities with an MRI-based approach lead to lower resource utilization and spending over the long-term. Understanding provider costs will become important as healthcare reform transitions to value-based purchasing and other alternative payment models. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

SunShot Initiative Fact Sheet

Energy Technology Data Exchange (ETDEWEB)

DOE Solar Energy Technologies Office

2015-04-01

The U.S. Department of Energy (DOE) SunShot Initiative is a collaborative national effort launched in 2011 that aggressively drives innovation to make solar energy fully cost competitive with traditional energy sources before the end of the decade. The SunShot fact sheet outlines goals and successes of the program as it works with private companies, universities, non-profit organizations, state and local governments, and national laboratories to drive down the cost of solar electricity to $0.06 per kilowatt-hour, without incentives, by the year 2020.

Full-automatic Special Drill Hydraulic System and PLC Control

Directory of Open Access Journals (Sweden)

Tian Xue Jun

2016-01-01

Full Text Available A hydraulic-driven and PLC full-automatic special drill is introduced, working principle of the hydraulic system and PLC control system are analyzed and designed, this equipment has the advantages of high efficiency, superior quality and low cost etc.

Medical Cost Trajectories and Onsets of Cancer and NonCancer Diseases in US Elderly Population

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Igor Akushevich

2011-01-01

Full Text Available Time trajectories of medical costs-associated with onset of twelve aging-related cancer and chronic noncancer diseases were analyzed using the National Long-Term Care Survey data linked to Medicare Service Use files. A special procedure for selecting individuals with onset of each disease was developed and used for identification of the date at disease onset. Medical cost trajectories were found to be represented by a parametric model with four easily interpretable parameters reflecting: (i prediagnosis cost (associated with initial comorbidity, (ii cost of the disease onset, (iii population recovery representing reduction of the medical expenses associated with a disease since diagnosis was made, and (iv acquired comorbidity representing the difference between post- and pre diagnosis medical cost levels. These parameters were evaluated for the entire US population as well as for the subpopulation conditional on age, disability and comorbidity states, and survival (2.5 years after the date of onset. The developed approach results in a family of new forecasting models with covariates.

Biogas Initiative from Swine Farm in Southern Thailand

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Damrongsak Det

2016-01-01

Full Text Available First biogas pipeline network has been well established in southern Thailand. About 1,273 households, accountable for about 87% of the total of 1,466 households in the district, get the benefits from biogas energy in many ways. Key success to this initiative is the collaboration between all parties, i.e., swine farm owners, households, and government officials. Swine farm owners are responsible for the design and construction of the biogas plants. Households pay some contributions regarding labor work and maintenance cost on biogas system and its pipeline network. Government officials are responsible for financial and technical supports to both parties. Indeed biogas energy offers an alternative source of heat energy for cooking fuel in this region.

Quality Improvement Initiatives in Inflammatory Bowel Disease.

Science.gov (United States)

Berry, Sameer K; Siegel, Corey A; Melmed, Gil Y

2017-08-01

This article serves as an overview of several quality improvement initiatives in inflammatory bowel disease (IBD). IBD is associated with significant variation in care, suggesting poor quality of care. There have been several efforts to improve the quality of care for patients with IBD. Quality improvement (QI) initiatives in IBD are intended to be patient-centric, improve outcomes for individuals and populations, and reduce costs-all consistent with "the triple aim" put forth by the Institute for Healthcare Improvement (IHI). Current QI initiatives include the development of quality measure sets to standardize processes and outcomes, learning health systems to foster collaborative improvement, and patient-centered medical homes specific to patients with IBD in shared risk models of care. Some of these programs have demonstrated early success in improving patient outcomes, reducing costs, improving patient satisfaction, and facilitating patient engagement. However, further studies are needed to evaluate and compare the effects of these programs over time on clinical outcomes in order to demonstrate long-term value and sustainability.

Transitional orientation: a cost-effective alternative to traditional RN residency programs.

Science.gov (United States)

Guthrie, Kimberly; Tyrna, Jaime; Giannuzzi, Donna

2013-01-01

Recruitment, orientation, and development costs, particularly for inexperienced RNs, challenge hospitals to find cost-effective methods to assure patients receive competent nursing care. Nurse leaders at the Lee Memorial Health System (LMHS) initiated a multifaceted development methodology called the Transitional Orientation Program, designed to develop and retain competent RNs. To assist in the intensive development needs required by the transitional unit interns and for other inexperienced RNs assigned initially to their unit of hire, LMHS established new clinical educator positions called intern development specialists (IDS). Results of this initiative showed a significant decrease in total orientation times and costs, and a dramatic increase in retention rates of inexperienced RNs.

Estimating the cost of blood: past, present, and future directions.

Science.gov (United States)

Shander, Aryeh; Hofmann, Axel; Gombotz, Hans; Theusinger, Oliver M; Spahn, Donat R

2007-06-01

Understanding the costs associated with blood products requires sophisticated knowledge about transfusion medicine and is attracting the attention of clinical and administrative healthcare sectors worldwide. To improve outcomes, blood usage must be optimized and expenditures controlled so that resources may be channeled toward other diagnostic, therapeutic, and technological initiatives. Estimating blood costs, however, is a complex undertaking, surpassing simple supply versus demand economics. Shrinking donor availability and application of a precautionary principle to minimize transfusion risks are factors that continue to drive the cost of blood products upward. Recognizing that historical accounting attempts to determine blood costs have varied in scope, perspective, and methodology, new approaches have been initiated to identify all potential cost elements related to blood and blood product administration. Activities are also under way to tie these elements together in a comprehensive and practical model that will be applicable to all single-donor blood products without regard to practice type (e.g., academic, private, multi- or single-center clinic). These initiatives, their rationale, importance, and future directions are described.

The CRINE initiative -- Education and training

International Nuclear Information System (INIS)

Littlewood, S.K.

1995-01-01

CRINE's aim is to have everyone in the industry working in new ways and doing so because it is second nature. CRINE is an acronym for Cost Reduction Initiative for the New Era, is an industry-wide program now under way in the UK continental shelf oil and gas fields whose main objective is to achieve thirty percent or more savings in capital costs and to half the operating costs over the next few years. Such a culture change is only feasible through an extensive program of education and training. This is under way, helped in many organizations by CRINE 'champions' driving the courses and training aids

Cost/efficacy analysis of preferred Spanish AIDS study group regimens and the dual therapy with lopinavir/ritonavir plus lamivudine for initial ART in HIV infected adults.

Science.gov (United States)

Gatell Artigas, Josep María; Arribas López, José Ramón; Lázaro Y de Mercado, Pablo; Blasco Bravo, Antonio Javier

2016-01-01

The National AIDS Plan and the Spanish AIDS study group (GESIDA) proposes "preferred regimens" (PR) of antiretroviral treatment (ART) as initial therapy in HIV-infected patients. In 2013, the recommended regimens were all triple therapy regimens. The Gardel Study assessed the efficacy of a dual therapy (DT) combination of lopinavir/ritonavir (LPV/r) plus lamivudine (3TC). Our objective is to evaluate the GESIDA PR and the DT regimen LPV/r+3TC cost/efficacy ratios. Decision tree models were built. probability of having viral load cost: costs of ART, adverse effects, and drug resistance tests during the first 48 weeks. Cost/efficacy ratios varied between 5,817 and 13,930 euros per responder at 48 weeks, for the DT of LPV/r+3TC and tenofovir DF/emtricitabine+raltegravir, respectively. Taking into account the official Spanish prices of ART, the most efficient regimen was DT of LPV/r+3TC, followed by the triple therapy with non-nucleoside containing regimens. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Evaluation of caregiver-friendly workplace policy (CFWPs) interventions on the health of full-time caregiver employees (CEs): implementation and cost-benefit analysis.

Science.gov (United States)

Williams, Allison M; Tompa, Emile; Lero, Donna S; Fast, Janet; Yazdani, Amin; Zeytinoglu, Isik U

2017-09-20

Current Canadian evidence illustrating the health benefits and cost-effectiveness of caregiver-friendly workplace policies is needed if Canadian employers are to adopt and integrate caregiver-friendly workplace policies into their employment practices. The goal of this three-year, three study research project is to provide such evidence for the auto manufacturing and educational services sectors. The research questions being addressed are: What are the impacts for employers (economic) and workers (health) of caregiver-friendly workplace policy intervention(s) for full-time caregiver-employees? What are the impacts for employers, workers and society of the caregiver-friendly workplace policy intervention(s) in each participating workplace? What contextual factors impact the successful implementation of caregiver-friendly workplace policy intervention(s)? Using a pre-post-test comparative case study design, Study A will determine the effectiveness of newly implemented caregiver-friendly workplace policy intervention(s) across two workplaces to determine impacts on caregiver-employee health. A quasi-experimental pre-post design will allow the caregiver-friendly workplace policy intervention(s) to be tested with respect to potential impacts on health, and specifically on caregiver employee mental, psychosocial, and physical health. Framed within a comparative case study design, Study B will utilize cost-benefit and cost-effectiveness analysis approaches to evaluate the economic impacts of the caregiver-friendly workplace policy intervention(s) for each of the two participating workplaces. Framed within a comparative case study design, Study C will undertake an implementation analysis of the caregiver-friendly workplace policy intervention(s) in each participating workplace in order to determine: the degree of support for the intervention(s) (reflected in the workplace culture); how sex and gender are implicated; co-workers' responses to the chosen intervention(s), and

Pengaruh Activity Based Costing terhadap Peningkatan Kinerja Keuangan

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Erni Suryandari F

2016-01-01

Full Text Available This research was done to identify the influence of Activity-Based Costing toward the development of financial performance (Empirical Study in Stock Exchange of Jakarta. The respondents of this research are internal auditors in manufacturing companies whose names are registered in Indonesian Capital Market Directory in 2004. The obtained primary data in this research was from questionnaires that was sent to the respondents by using cross-sectional survey method. The data was processed by using Structural Equation Modeling (SEM through goodness of fit index, confirmatory model and structural similarities experiments. The three tested factors in this research are ABC success, other initiative and enabler are listed in hypothesis that influence toward financial performance. The result of the research shows there is significant influence between ABC success toward the development of financial performance; on the other hand, other initiative and enablers don’t have significant influence toward the development of financial performance.

The Distributed Wind Cost Taxonomy

Energy Technology Data Exchange (ETDEWEB)

Forsyth, Trudy; Jimenez, Tony; Preus, Robert; Tegen, Suzanne; Baring-Gould, Ian

2017-03-28

To date, there has been no standard method or tool to analyze the installed and operational costs for distributed wind turbine systems. This report describes the development of a classification system, or taxonomy, for distributed wind turbine project costs. The taxonomy establishes a framework to help collect, sort, and compare distributed wind cost data that mirrors how the industry categorizes information. The taxonomy organizes costs so they can be aggregated from installers, developers, vendors, and other sources without losing cost details. Developing a peer-reviewed taxonomy is valuable to industry stakeholders because a common understanding the details of distributed wind turbine costs and balance of station costs is a first step to identifying potential high-value cost reduction opportunities. Addressing cost reduction potential can help increase distributed wind's competitiveness and propel the U.S. distributed wind industry forward. The taxonomy can also be used to perform cost comparisons between technologies and track trends for distributed wind industry costs in the future. As an initial application and piloting of the taxonomy, preliminary cost data were collected for projects of different sizes and from different regions across the contiguous United States. Following the methods described in this report, these data are placed into the established cost categories.

Uncertainty in decision models analyzing cost-effectiveness : The joint distribution of incremental costs and effectiveness evaluated with a nonparametric bootstrap method

NARCIS (Netherlands)

Hunink, Maria; Bult, J.R.; De Vries, J; Weinstein, MC

1998-01-01

Purpose. To illustrate the use of a nonparametric bootstrap method in the evaluation of uncertainty in decision models analyzing cost-effectiveness. Methods. The authors reevaluated a previously published cost-effectiveness analysis that used a Markov model comparing initial percutaneous

Cost of treatment for breast cancer in central Vietnam

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Nguyen Hoang Lan

2013-02-01

Full Text Available Background: In recent years, cases of breast cancer have been on the rise in Vietnam. To date, there has been no study on the financial burden of the disease. This study estimates the direct medical cost of a 5-year treatment course for women with primary breast cancer in central Vietnam. Methods: Retrospective patient-level data from medical records at the Hue Central Hospital between 2001 and 2006 were analyzed. Cost analysis was conducted from the health care payers’ perspective. Various direct medical cost categories were computed for a 5-year treatment course for patients with breast cancer. Costs, in US dollars, discounted at a 3% rate, were converted to 2010 after adjusting for inflation. For each cost category, the mean, standard deviation, median, and cost range were estimated. Median regression was used to investigate the relationship between costs and the stage, age at diagnosis, and the health insurance coverage of the patients. Results: The total direct medical cost for a 5-year treatment course for breast cancer in central Vietnam was estimated at $975 per patient (range: $11.7–$3,955. The initial treatment cost, particularly the cost of chemotherapy, was found to account for the greatest proportion of total costs (64.9%. Among the patient characteristics studied, stage at diagnosis was significantly associated with total treatment costs. Patients at later stages of breast cancer did not differ significantly in their total costs from those at earlier stages however, but their survival time was much shorter. The absence of health insurance was the main factor limiting service uptake. Conclusion: From the health care payers’ perspective, the Government subsidization of public hospital charges lowered the direct medical costs of a 5-year treatment course for primary breast cancer in central Vietnam. However, the long treatment course was significantly influenced by out-of-pocket payments for patients without health insurance.

Performance of initial full-length RHIC [Relativistic Heavy Ion Collider] dipoles

International Nuclear Information System (INIS)

Dahl, P.; Cottingham, J.; Garber, M.

1987-01-01

The first four full-length (9.7 m) R and D dipoles for the proposed Relativistic Heavy Ion Collider (RHIC) have been successfully tested. The magnets reached a quench plateau of approximately 4.5 T with very reasonable training - a field level comfortably above the design field of 3.45 T required for operation with beams of 100 GeV/amu gold nuclei. Measured field multipoles are considered to be quite acceptable for this series of R and D magnets

Application Of The Work Breakdown Structure In Determining Cost Buffers In Construction Schedules

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Połoński M.

2015-03-01

Full Text Available The paper presents methods of determining the location of cost buffers and corresponding contingency costs in the CPM schedule based on its work breakdown structure. Application of correctly located cost buffers with appropriately established reserve costs is justified by the common overrunning of scheduled costs in construction projects. Interpolated cost buffers (CB as separate tasks have been combined with relevant summary tasks by the start–to–start (SS relationship, whereas the time of their execution has been dynamically connected with the time of accomplishment of particular summary tasks using the “paste connection” option. Besides cost buffers linked with the group of tasks assigned to summary tasks, a definition of the cost buffer for the entire project (PCB has been proposed, i.e. as one initial task of the entire project. Contingency costs corresponding to these buffers, depending on the data that the planner has at his disposal, can be determined using different methods, but always depend on the costs of all tasks protected by each buffer. The paper presents an exemplary schedule for a facility and the method of determining locations and cost for buffers CB and PCB, as well as their influence on the course of the curve illustrating the budgeted cost of work scheduled (BCWS. The proposed solution has been adjusted and presented with consideration of the possibilities created by the scheduling software MS Project, though its general assumptions may be implemented with application of other similar specialist tools.

Hawadith Street Initiative: A unique Sudanese childhood charity experience.

Science.gov (United States)

Ahmed, Awad Mohamed; A-Rahman, Nada Hassan Ahmed

2015-01-01

Due to escalating conflicts and resultant economic constraints, different social services in low income and low-middle income countries have witnessed a decline in its standards, and increase in the costs. This situation has led to emergence of large numbers of patients and their families who cannot afford the costs of health services provided by public hospitals. On this background, and the old heritage of the Sudanese to help the needy, the Hawadith Street Initiative (HSI) was established. Named after the street on which it was founded - which translates indirectly to "Accidents Lane", HSI was established in 2012 by a group of youths, most of them in their twenties of age, and recently graduated. The main activity of the initiative is helping the needy hospital patients, especially with regards to their treatment costs, in Khartoum and other cities in Sudan. Starting with recreational programs for cancer patients, and public campaigns for donation of blood, the initiative's youths changed their activities. Using the social media, Facebook, they adopted the strategy of communication with potential donors, after sending posts containing brief anonymous presentations and call of help for needy cases. Currently HSI includes more than 2000 volunteers in Khartoum and 17 other cities. The most important achievement of HSI is the establishment of an intensive care unit at a children hospital in Omdurman city costing 435,880 US dollars. HSI demonstrates the possibility of delivering great services with minimum resources, and constitutes a unique organization, worldwide, in a new wave of Internet-based initiatives.

Cost-effectiveness analysis of endoscopic ultrasound versus magnetic resonance cholangiopancreatography in patients with suspected common bile duct stones.

Directory of Open Access Journals (Sweden)

Stephen Morris

Full Text Available Patients with suspected common bile duct (CBD stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP, an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS or Magnetic Resonance CholangioPancreatography (MRCP first to detect CBD stones can reduce the risk of unnecessary procedures, cut complications and may save costs.This study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones.This study is a model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs per patient from the perspective of the UK National Health Service (NHS over a 1 year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources, including one-way and probabilistic sensitivity analyses.Using MRCP to select patients for ERCP was less costly than using EUS to select patients or proceeding directly to ERCP ($1299 versus $1753 and $1781, respectively, with similar QALYs accruing to each option (0.998, 0.998 and 0.997 for EUS, MRCP and direct ERCP, respectively. Initial MRCP was the most cost-effective option with the highest monetary net benefit, and this result was not sensitive to model parameters. MRCP had a 61% probability of being cost-effective at $29,000, the maximum willingness to pay for a QALY commonly used in the UK.From the perspective of the UK NHS, MRCP was the most cost-effective test in the diagnosis of CBD stones.

A model for evaluating the institutional costs and benefits of ICT initiatives in teaching and learning in higher education

Directory of Open Access Journals (Sweden)

David Nicol

2003-12-01

Full Text Available Significant investments are being made in the application of new information and communications technologies (ICT to teaching and learning in higher education. However, until recently, there has been little progress in devising an integrated costbenefit model that decision-makers can use to appraise ICT investment options from the wider institutional perspective. This paper describes and illustrates a model that has been developed to enable evaluations of the costs and benefits of the use of ICT. The strengths and limitations of the model are highlighted and discussed

Cost estimation and management over the life cycle of metallurgical ...

African Journals Online (AJOL)

This study investigates whether all expected costs over the life cycle of metallurgical research projects are included in initial, normal and fi nal cost estimates, and whether these costs are managed throughout a project's life cycle since there is not enough emphasis on the accurate estimation of costs and their management ...

Green Composites Reinforced with Plant-Based Fabrics: Cost and Eco-Impact Assessment

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Georgios Koronis

2018-02-01

Full Text Available This study considers a green composite under a twofold assessment; evaluating its process-based cost and environmental footprint profile. The initial objective was to project the manufacturing cost and allow for an additional material comparison of alternative scenarios in the resin transfer molding processes. The additional aim is to have an intermediate environmental assessment to assist in selecting materials and adjust manufacturing parameters which would minimize the energy spent and the CO2 emissions. As it has been noted in numerous applications, the incorporation of natural fiber fabrics, as opposed to glass fabrics, bring together weight savings and consequently cost savings. However, the economic analysis suggests that a glass reinforced composite is marginally cheaper at the production volume of 300 parts (1.9% lower cost in contrast to a possible green solution (ramie. Considering jute instead of ramie as a reinforcement, the cost gets immediately lower, and further decreases with proposed improvements to the manufacturing process. Additional reduction of up to 10% in the production cost can be achieved by process upgrade. As indicated by the Eco-Audit analysis, 36% less energy and 44% CO2 per kilo will be generated, respectively when swapping from glass to ramie fabrics in the production of the automotive hood.

The Ethos of Cost Management

Directory of Open Access Journals (Sweden)

Sorinel Capusneanu

2008-05-01

Full Text Available This article describes the ethos of cost management, distinguishing the definition, functions and principles governing cost management. I have emphasized the efforts made by the specialists in the field towards finding a much more complete definition of cost management. The description of cost management principles reveals the current interest of the specialists in this extremely important domain of company management.

The Reduction of Faculty Reassigned Time as a Community College Cost Containment Initiative: A Case Study of the Maricopa County Community College District.

Science.gov (United States)

Petrowsky, Michael C.

This paper argues that community colleges can contain costs by reducing faculty reassigned time, defined as a conscious or deliberate management action, either discretionary or mandated, that releases full-time faculty from teaching duties in order to perform other tasks. According to the paper, standard financial accounting systems have a…

Life-cycle cost assessment of seismically base-isolated structures in nuclear power plants

International Nuclear Information System (INIS)

Wang, Hao; Weng, Dagen; Lu, Xilin; Lu, Liang

2013-01-01

Highlights: • The life-cycle cost of seismic base-isolated nuclear power plants is modeled. • The change law of life-cycle cost with seismic fortification intensity is studied. • The initial cost of laminated lead rubber bearings can be expressed as the function of volume. • The initial cost of a damper can be expressed as the function of its maximum displacement and tonnage. • The use of base-isolation can greatly reduce the expected damage cost, which leads to the reduction of the life-cycle cost. -- Abstract: Evaluation of seismically base-isolated structural life-cycle cost is the key problem in performance based seismic design. A method is being introduced to address the life-cycle cost of base-isolated reinforced concrete structures in nuclear power plants. Each composition of life-cycle cost is analyzed including the initial construction cost, the isolators cost and the excepted damage cost over life-cycle of the structure. The concept of seismic intensity is being used to estimate the expected damage cost, greatly simplifying the calculation. Moreover, French Cruas nuclear power plant is employed as an example to assess its life-cycle cost, compared to the cost of non-isolated plant at the same time. The results show that the proposed method is efficient and the expected damage cost is enormously reduced because of the application of isolators, which leads to the reduction of the life-cycle cost of nuclear power plants

Cost analysis for the implementation of a medication review with follow-up service in Spain.

Science.gov (United States)

Noain, Aranzazu; Garcia-Cardenas, Victoria; Gastelurrutia, Miguel Angel; Malet-Larrea, Amaia; Martinez-Martinez, Fernando; Sabater-Hernandez, Daniel; Benrimoj, Shalom I

2017-08-01

Background Medication review with follow-up (MRF) is a professional pharmacy service proven to be cost-effective. Its broader implementation is limited, mainly due to the lack of evidence-based implementation programs that include economic and financial analysis. Objective To analyse the costs and estimate the price of providing and implementing MRF. Setting Community pharmacy in Spain. Method Elderly patients using poly-pharmacy received a community pharmacist-led MRF for 6 months. The cost analysis was based on the time-driven activity based costing model and included the provider costs, initial investment costs and maintenance expenses. The service price was estimated using the labour costs, costs associated with service provision, potential number of patients receiving the service and mark-up. Main outcome measures Costs and potential price of MRF. Results A mean time of 404.4 (SD 232.2) was spent on service provision and was extrapolated to annual costs. Service provider cost per patient ranged from €196 (SD 90.5) to €310 (SD 164.4). The mean initial investment per pharmacy was €4594 and the mean annual maintenance costs €3,068. Largest items contributing to cost were initial staff training, continuing education and renting of the patient counselling area. The potential service price ranged from €237 to €628 per patient a year. Conclusion Time spent by the service provider accounted for 75-95% of the final cost, followed by initial investment costs and maintenance costs. Remuneration for professional pharmacy services provision must cover service costs and appropriate profit, allowing for their long-term sustainability.

Cost management in the internal value chain of integrated application of activity-based costing, Kaizen concept and target costing

Directory of Open Access Journals (Sweden)

Pešić-Tomić Vesna

2014-01-01

Full Text Available The objective of this paper is an effort to view the possibilities of integrated use of target costing, activity based costing and Kaizen concept in the internal value chain as the central link of the entire chain. The idea is to stimulate the company management to think about the costs, position they take in the structure of price cost and their influence on forming the sales price since it is very important to produce right product for the consumer, of desired quality and functionality but along with as low production costs as possible. It is therefore needed to construct the right design of a product and provide its production at the shortest possible time along with as low costs as possible which will impact the efficiency of the entire value chain.

Total life cycle cost model for electric power stations

International Nuclear Information System (INIS)

Cardullo, M.W.

1995-01-01

The Total Life Cycle Cost (TLCC) model for electric power stations was developed to provide a technology screening model. The TLCC analysis involves normalizing cost estimates with respect to performance standards and financial assumptions and preparing a profile of all costs over the service life of the power station. These costs when levelized present a value in terms of a utility electricity rate. Comparison of cost and the pricing of the electricity for a utility shows if a valid project exists. Cost components include both internal and external costs. Internal costs are direct costs associated with the purchase, and operation of the power station and include initial capital costs, operating and maintenance costs. External costs result from societal and/or environmental impacts that are external to the marketplace and can include air quality impacts due to emissions, infrastructure costs, and other impacts. The cost stream is summed (current dollars) or discounted (constant dollars) to some base year to yield a overall TLCC of each power station technology on a common basis. While minimizing life cycle cost is an important consideration, it may not always be a preferred method for some utilities who may prefer minimizing capital costs. Such consideration does not always result in technology penetration in a marketplace such as the utility sector. Under various regulatory climates, the utility is likely to heavily weigh initial capital costs while giving limited consideration to other costs such as societal costs. Policy makers considering external costs, such as those resulting from environmental impacts, may reach significantly different conclusions about which technologies are most advantageous to society. The TLCC analysis model for power stations was developed to facilitate consideration of all perspectives

Cost-effectiveness of a ROPS social marketing campaign.

Science.gov (United States)

Sorensen, J A; Jenkins, P; Bayes, B; Clark, S; May, J J

2010-01-01

Tractor rollovers are the most frequent cause of death in the farm community. Rollover protection structures (ROPS) can prevent the injuries and fatalities associated with these events; however, almost half of U.S. farms lack these essential devices. One promising strategy for increasing ROPS use is social marketing. The purpose of this study was to assess the costs associated with the New York ROPS Social Marketing Campaign in relation to the cost of fatalities and injuries averted as a result of the campaign to determine whether cost savings could be demonstrated in the initial years of program implementation. A total of 524 farmers who had retrofitted a tractor through the program were mailed a survey to assess the number of rollovers or close calls that occurred since ROPS installation. Responses were obtained from 382 farmers, two of whom indicated that they had a potential fatality/injury scenario since retrofitting their tractor through the program. The cost savings associated with the intervention was estimated using a decision-tree analysis adapted from Myers and Pana-Cryan with appropriate consumer price index adjustments. The data were compared to the cost of the New York ROPS Social Marketing Campaign to arrive at an associated cost-savings estimate relative to the intervention. This study indicates that a net savings will likely be demonstrated within the third year of the New York ROPS Social Marketing initiative. These data may provide evidence for researchers hoping to generate support from state and private agencies for similar initiatives.

Long-Term Cost-Effectiveness of Transanal Irrigation in Patients with Neurogenic Bowel Dysfunction.

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Anton Emmanuel

Full Text Available People suffering from neurogenic bowel dysfunction (NBD and an ineffective bowel regimen often suffer from fecal incontinence (FI and related symptoms, which have a huge impact on their quality of life. In these situations, transanal irrigation (TAI has been shown to reduce these symptoms and improve quality of life.To investigate the long-term cost-effectiveness of initiating TAI in patients with NBD who have failed standard bowel care (SBC.A deterministic Markov decision model was developed to project the lifetime health economic outcomes, including quality-adjusted life years (QALYs, episodes of FI, urinary tract infections (UTIs, and stoma surgery when initiating TAI relative to continuing SBC. A data set consisting of 227 patients with NBD due to spinal cord injury (SCI, multiple sclerosis, spina bifida and cauda equina syndrome was used in the analysis. In the model a 30-year old individual with SCI was used as a base-case. A probabilistic sensitivity analysis was applied to evaluate the robustness of the model.The model predicts that a 30-year old SCI patient with a life expectancy of 37 years initiating TAI will experience a 36% reduction in FI episodes, a 29% reduction in UTIs, a 35% reduction in likelihood of stoma surgery and a 0.4 improvement in QALYs, compared with patients continuing SBC. A lifetime cost-saving of £21,768 per patient was estimated for TAI versus continuing SBC alone.TAI is a cost-saving treatment strategy reducing risk of stoma surgery, UTIs, episodes of FI and improving QALYs for NBD patients who have failed SBC.

Costs of employee turnover

Directory of Open Access Journals (Sweden)

Jiří Duda

2013-01-01

Full Text Available The aim of this paper is to establish a general methodology for calculating the costs incurred by employee turnover. This paper deals with identification of costs incurred by the departure of an employee, and does not deal with the cost of recruitment of a new employee. Economic calculations are adjusted to the tax policy in the Czech Republic. The costs of employee turnover (according to Bliss, 2012 include the costs of substitution of the unoccupied position, costs of conducting the exit interview and termination of the contract. The cost of an executive’s time to understand the causes of leaving and costs of the leaving employee’s training were also determined. Important factors in the costs of employee turnover also include the loss of knowledge and possibly also a loss of customers. Costs of lost employee and department productiveness represent an important part of the costs of employee turnover, as well. For all of these costs there have been proposed general calculations formulas.

Calculation of direct antiretroviral treatment costs and potential cost savings by using generics in the German HIV ClinSurv cohort.

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Matthias Stoll

Full Text Available UNLABELLED: BACKGROUND/AIM OF THE STUDY: The study aimed to determine the cost impacts of antiretroviral drugs by analysing a long-term follow-up of direct costs for combined antiretroviral therapy, cART, -regimens in the nationwide long-term observational multi-centre German HIV ClinSurv Cohort. The second aim was to develop potential cost saving strategies by modelling different treatment scenarios. METHODS: Antiretroviral regimens (ART from 10,190 HIV-infected patients from 11 participating ClinSurv study centres have been investigated since 1996. Biannual data cART-initiation, cART-changes, surrogate markers, clinical events and the Centre of Disease Control- (CDC-stage of HIV disease are reported. Treatment duration was calculated on a daily basis via the documented dates for the beginning and end of each antiretroviral drug treatment. Prices were calculated for each individual regimen based on actual office sales prices of the branded pharmaceuticals distributed by the license holder including German taxes. RESULTS: During the 13-year follow-up period, 21,387,427 treatment days were covered. Cumulative direct costs for antiretroviral drugs of €812,877,356 were determined according to an average of €42.08 per day (€7.52 to € 217.70. Since cART is widely used in Germany, the costs for an entire regimen increased by 13.5%. Regimens are more expensive in the advanced stages of HIV disease. The potential for cost savings was calculated using non-nucleotide-reverse-transcriptase-inhibitor, NNRTI, more frequently instead of ritonavir-boosted protease inhibitor, PI/r, in first line therapy. This calculation revealed cumulative savings of 10.9% to 19.8% of daily treatment costs (50% and 90% substitution of PI/r, respectively. Substituting certain branded drugs by generic drugs showed potential cost savings of between 1.6% and 31.8%. CONCLUSIONS: Analysis of the data of this nationwide study reflects disease-specific health services research

Operations and support cost modeling of conceptual space vehicles

Science.gov (United States)

Ebeling, Charles

1994-01-01

The University of Dayton is pleased to submit this annual report to the National Aeronautics and Space Administration (NASA) Langley Research Center which documents the development of an operations and support (O&S) cost model as part of a larger life cycle cost (LCC) structure. It is intended for use during the conceptual design of new launch vehicles and spacecraft. This research is being conducted under NASA Research Grant NAG-1-1327. This research effort changes the focus from that of the first two years in which a reliability and maintainability model was developed to the initial development of an operations and support life cycle cost model. Cost categories were initially patterned after NASA's three axis work breakdown structure consisting of a configuration axis (vehicle), a function axis, and a cost axis. A revised cost element structure (CES), which is currently under study by NASA, was used to established the basic cost elements used in the model. While the focus of the effort was on operations and maintenance costs and other recurring costs, the computerized model allowed for other cost categories such as RDT&E and production costs to be addressed. Secondary tasks performed concurrent with the development of the costing model included support and upgrades to the reliability and maintainability (R&M) model. The primary result of the current research has been a methodology and a computer implementation of the methodology to provide for timely operations and support cost analysis during the conceptual design activities.

Applying the net-benefit framework for analyzing and presenting cost-effectiveness analysis of a maternal and newborn health intervention.

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Sennen Hounton

Full Text Available BACKGROUND: Coverage of maternal and newborn health (MNH interventions is often influenced by important determinants and decision makers are often concerned with equity issues. The net-benefit framework developed and applied alongside clinical trials and in pharmacoeconomics offers the potential for exploring how cost-effectiveness of MNH interventions varies at the margin by important covariates as well as for handling uncertainties around the ICER estimate. AIM: We applied the net-benefit framework to analyze cost-effectiveness of the Skilled Care Initiative and assessed relative advantages over a standard computation of incremental cost effectiveness ratios. METHODS: Household and facility surveys were carried out from January to July 2006 in Ouargaye district (where the Skilled Care Initiative was implemented and Diapaga (comparison site district in Burkina Faso. Pregnancy-related and perinatal mortality were retrospectively assessed and data were collected on place of delivery, education, asset ownership, place, and distance to health facilities, costs borne by households for institutional delivery, and cost of standard provision of maternal care. Descriptive and regression analyses were performed. RESULTS: There was a 30% increase in institutional births in the intervention district compared to 10% increase in comparison district, and a significant reduction of perinatal mortality rates (OR 0.75, CI 0.70-0.80 in intervention district. The incremental cost for achieving one additional institutional delivery in Ouargaye district compared to Diapaga district was estimated to be 170 international dollars and varied significantly by covariates. However, the joint probability distribution (net-benefit framework of the effectiveness measure (institutional delivery, the cost data and covariates indicated distance to health facilities as the single most important determinant of the cost-effectiveness analysis with implications for policy making

Low-cost carriers fare competition effect

NARCIS (Netherlands)

Carmona Benitez, R.B.; Lodewijks, G.

2010-01-01

This paper examines the effects that low-cost carriers (LCC’s) produce when entering new routes operated only by full-service carriers (FSC’s) and routes operated by low-cost carriers in competition with full-service carriers. A mathematical model has been developed to determine what routes should

GCP 1.0: A Tool for Cost Management in Micro and Small Textile Manufacturing Companies in Bucaramanga

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Ofelia Gómez Niño

2015-11-01

Full Text Available This article presents the results of a diagnostic study in which 52 textile manufacturing companies were observed in Bucaramanga to characterize the needs of these productive units. Based on the results, three strategic options were formulated to improve performance: a To consolidate the productive system by tools that facilitate production processes, b to strengthen cost structure by designing systems and tools; and c to share technological initiatives, knowledge and experience to improve resource management. From this perspective, the second phase of the research was oriented to develop the software GCP 1.0 for micro and small companies of children’s confection in Bucaramanga, a production cost information system that would facilitate cost management and the fixation of sale prices.

Motivation for a near term gun launch to space demonstration and a variable induction power supply concept to minimize initial demonstration costs

International Nuclear Information System (INIS)

Palmer, M.R.

1993-01-01

The history of the Gun Launch to Space (GLTS) concept is briefly reviewed along with recent progress and motivations for a near term launch demonstration. A current multiplying reconfigurable inductor design is developed which could couple to an existing battery system to power a GLTS railgun demonstration at the 300 megajoule muzzle energy level. The design is developed using proven approaches and performance levels and appears capable of reducing the power supply cost for an initial GLTS demonstration below that of a simple battery charged inductor system. Possible uses are (1) launching of space weapons; (2) launching of communication satellites; (3) and launching of satellites for space disposal of radioactive wastes

Estimating the cost of healthcare delivery in three hospitals in ...

African Journals Online (AJOL)

Objective: The cost burden (called full cost) of providing health services at a referral, a district and a mission hospital in Ghana were determined. Methods: Standard cost-finding and cost analysis tools recommended by World Health Organization are used to analyse 2002 and 2003 hospital data. Full cost centre costs were ...

Misinterpretation of the strategic significance of cost driver analysis: evidence from management accounting theory and practice

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Henry T Palowski

2011-06-01

Full Text Available This paper traces the development of cost driver theory in the Strategy literature and reflects on misinterpretations of the strategic significance of the theory in related academic disciplines, notably Management Accounting. Management Accounting has largely been responsible for informing costing practice in a wide range of organizational settings. The paper considers one such application- i.e. the case of the Higher Education Funding Council’s (HEFC costing and pricing initiative for UK universities. The project was completed just under five years ago, although details of implementation are still ongoing, to a degree. The systems in place incorporate most of the theoretical flaws outlined in this paper. Rather than providing cost driver analysis to aid the strategic management process in universities, the system appears to represent little more than a compliance and reporting framework between university central administrations and the funding provider, HEFC.

Resource use and costs of exenatide bid or insulin in clinical practice: the European CHOICE study

Directory of Open Access Journals (Sweden)

Kiiskinen U

2013-07-01

Full Text Available Urpo Kiiskinen,1 Stephan Matthaei,2 Matthew Reaney,3 Chantal Mathieu,4 Claes-Göran Östenson,5 Thure Krarup,6 Michael Theodorakis,7,* Jacek Kiljanski,8 Carole Salaun-Martin,9 Hélène Sapin,9 Bruno Guerci10 1Eli Lilly, Helsinki, Finland; 2Quakenbrück Diabetes Center, Quakenbrück, Germany; 3Eli Lilly, Windlesham, Surrey, UK; 4Department of Endocrinology, UZ Gasthuisberg, Leuven, Belgium; 5Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 6Department of Endocrinology, Bispebjerg Hospital, Copenhagen, Denmark; 7Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; 8Eli Lilly, Warsaw, Poland; 9Eli Lilly, Neuilly Cedex, France; 10Department of Diabetes, Metabolic Diseases, and Nutrition, Hôpital Brabois, Vandoeuvre-Lès-Nancy, France *Michael Theodorakis was affiliated with the institution shown above at the time of the study, but has since left this institution Purpose: CHOICE (CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy assessed patterns of exenatide bid and initial insulin therapy usage in clinical practice in six European countries and evaluated outcomes during the study. Methods: CHOICE was a 24-month, prospective, noninterventional observational study. Clinical and resource use data were collected at initiation of first injectable therapy (exenatide bid or insulin and at regular intervals for 24 months. Costs were evaluated from the national health care system perspective at 2009 prices. Results: A total of 2515 patients were recruited. At the 24-month analysis, significant treatment change had occurred during the study in 42.2% of 1114 eligible patients in the exenatide bid cohort and 36.0% of 1274 eligible patients in the insulin cohort. Improvements in glycemic control were observed over the course of the study in both cohorts (P < 0.001 for both, but mean weight was reduced in the exenatide bid cohort (P < 0

48 CFR 9903.302-2 - Change to a cost accounting practice.

Science.gov (United States)

2010-10-01

... Disclosure Statement, except for the following: (a) The initial adoption of a cost accounting practice for... accounting practice. 9903.302-2 Section 9903.302-2 Federal Acquisition Regulations System COST ACCOUNTING... AND COST ACCOUNTING STANDARDS CONTRACT COVERAGE CAS Rules and Regulations 9903.302-2 Change to a cost...

A life cycle cost economics model for automation projects with uniformly varying operating costs. [applied to Deep Space Network and Air Force Systems Command

Science.gov (United States)

Remer, D. S.

1977-01-01

The described mathematical model calculates life-cycle costs for projects with operating costs increasing or decreasing linearly with time. The cost factors involved in the life-cycle cost are considered, and the errors resulting from the assumption of constant rather than uniformly varying operating costs are examined. Parameters in the study range from 2 to 30 years, for project life; 0 to 15% per year, for interest rate; and 5 to 90% of the initial operating cost, for the operating cost gradient. A numerical example is presented.

Project Cost Estimation for Planning

Science.gov (United States)

2010-02-26

For Nevada Department of Transportation (NDOT), there are far too many projects that ultimately cost much more than initially planned. Because project nominations are linked to estimates of future funding and the analysis of system needs, the inaccur...

The Role of Logistics in Practical Levelized Cost of Energy Reduction Implementation and Government Sponsored Cost Reduction Studies: Day and Night in Offshore Wind Operations and Maintenance Logistics

DEFF Research Database (Denmark)

Poulsen, Thomas; Hasager, Charlotte Bay; Jensen, Christian Munk

2017-01-01

This paper reveals that logistics make up at least 17% of annual operational expenditure costs for offshore wind farms. Annual operational expenditure is found to vary by a factor of 9.5, making its share of levelized cost of energy for offshore wind range from 13% to 57%. These are key findings...... contrast to the shore-based office personnel who develop studies directing cost reduction efforts. This paper details the company motivation to join industry-wide cost reduction initiatives. A business case for offshore wind operations and maintenance logistics yielding 1% savings in levelized cost...... of a 20-month research project targeting cost reduction initiatives for offshore wind systems. The findings reveal that cost-out measures are difficult to implement due to cultural differences. Implementation efforts are rendered by personnel located offshore in a harsh sea environment which is in stark...

24 CFR 941.304 - Full proposal content.

Science.gov (United States)

2010-04-01

... with all applicable Federal relocation requirements; (j) Life-cycle analysis. For new construction and... cooling systems, and which shall include a life-cycle cost analysis of the installation, maintenance and... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Full proposal content. 941.304...

Cost effectiveness analysis of HLA-B*58:01 genotyping prior to initiation of allopurinol for gout.

Science.gov (United States)

Plumpton, Catrin O; Alfirevic, Ana; Pirmohamed, Munir; Hughes, Dyfrig A

2017-10-01

To determine whether prospective testing for HLA-B*58:01, as a strategy to prevent serious adverse reactions to allopurinol in patients with gout, is cost-effective from the perspective of the National Health Service in the UK. A systematic review and meta-analysis for the association of HLA-B*58:01 with cutaneous and hypersensitivity adverse drug reactions informed a decision analytic and Markov model to estimate lifetime costs and outcomes associated with testing vs standard care (with febuxostat prescribed for patients who test positive). Scenario analyses assessed alternative treatment assumptions and patient populations. The number of patients needed to test to prevent one case of adverse drug reaction was 11 286 (95% central range (CR): 2573, 53 594). Cost and quality-adjusted life-year (QALY) gains were small, £103 (95% CR: £98, £106) and 0.0023 (95% CR: -0.0006, 0.0055), respectively, resulting in an incremental cost-effectiveness ratio (ICER) of £44 954 per QALY gained. The probability of testing being cost-effective at a threshold of £30 000 per QALY was 0.25. Reduced costs of testing or febuxostat resulted in an ICER below £30 000 per QALY gained. The ICER for patients with chronic renal insufficiency was £38 478 per QALY gained. Routine testing for HLA-B*58:01 in order to reduce the incidence of adverse drug reactions in patients being prescribed allopurinol for gout is unlikely to be cost-effective in the UK; however testing is expected to become cost-effective with reductions in the cost of genotyping, and with the future availability of cheaper, generic febuxostat. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Trastuzumab in early stage breast cancer: a cost-effectiveness analysis for Belgium.

Science.gov (United States)

Neyt, Mattias; Huybrechts, Michel; Hulstaert, Frank; Vrijens, France; Ramaekers, Dirk

2008-08-01

Although trastuzumab is traditionally used in metastatic breast cancer treatment, studies reported on the efficacy and safety of trastuzumab in adjuvant setting for the treatment of early stage breast cancer in HER2+ tumors. We estimated the cost-effectiveness and budget impact of reimbursing trastuzumab in this indication from a payer's perspective. We constructed a health economic model. Long-term consequences of preventing patients to progress to metastatic breast cancer and side effects such as congestive heart failure were taken into account. Uncertainty was handled applying probabilistic modeling and through probabilistic sensitivity analyses. In the HERA scenario, applying an arbitrary threshold of euro30000 per life-year gained, early stage breast cancer treatment with trastuzumab is cost-effective for 9 out of 15 analyzed subgroups (according to age and stage). In contrast, treatment according to the FinHer scenario is cost-effective in 14 subgroups. Furthermore, the FinHer regimen is most of the times cost saving with an average incremental cost of euro668, euro-1045, and euro-6869 for respectively stages I, II and III breast cancer patients whereas the HERA regimen is never cost saving due to the higher initial treatment costs. The model shows better cost-effectiveness for the 9-week initial treatment (FinHer) compared to no trastuzumab treatment than for the 1-year post-chemotherapy treatment (HERA). Both from a medical and an economic point of view, the 9-week initial treatment regimen with trastuzumab shows promising results and justifies the initiation of a large comparative trial with a 1-year regimen.

Review of the cost of venous thromboembolism

Science.gov (United States)

Fernandez, Maria M; Hogue, Susan; Preblick, Ronald; Kwong, Winghan Jacqueline

2015-01-01

Background Venous thromboembolism (VTE) is the second most common medical complication and a cause of excess length of hospital stay. Its incidence and economic burden are expected to increase as the population ages. We reviewed the recent literature to provide updated cost estimates on VTE management. Methods Literature search strategies were performed in PubMed, Embase, Cochrane Collaboration, Health Economic Evaluations Database, EconLit, and International Pharmaceutical Abstracts from 2003–2014. Additional studies were identified through searching bibliographies of related publications. Results Eighteen studies were identified and are summarized in this review; of these, 13 reported data from the USA, four from Europe, and one from Canada. Three main cost estimations were identified: cost per VTE hospitalization or per VTE readmission; cost for VTE management, usually reported annually or during a specific period; and annual all-cause costs in patients with VTE, which included the treatment of complications and comorbidities. Cost estimates per VTE hospitalization were generally similar across the US studies, with a trend toward an increase over time. Cost per pulmonary embolism hospitalization increased from $5,198–$6,928 in 2000 to $8,764 in 2010. Readmission for recurrent VTE was generally more costly than the initial index event admission. Annual health plan payments for services related to VTE also increased from $10,804–$16,644 during the 1998–2004 period to an estimated average of $15,123 for a VTE event from 2008 to 2011. Lower costs for VTE hospitalizations and annualized all-cause costs were estimated in European countries and Canada. Conclusion Costs for VTE treatment are considerable and increasing faster than general inflation for medical care services, with hospitalization costs being the primary cost driver. Readmissions for VTE are generally more costly than the initial VTE admission. Further studies evaluating the economic impact of new

Analysing initial attack on wildland fires using stochastic simulation.

Science.gov (United States)

Jeremy S. Fried; J. Keith Gilless; James. Spero

2006-01-01

Stochastic simulation models of initial attack on wildland fire can be designed to reflect the complexity of the environmental, administrative, and institutional context in which wildland fire protection agencies operate, but such complexity may come at the cost of a considerable investment in data acquisition and management. This cost may be well justified when it...

Systematization of Cost Factors for Cost Management at Industrial Enterprises

Directory of Open Access Journals (Sweden)

N. Y.

2017-12-01

Full Text Available Identification and structuring of factors determining the cost level has significant importance in cost analysis and control. Cost factors need to be systematized for more effective cost management. The objective of the study is to identify and structure the factors with impact on the enterprise costs. The external and internal factors with impact on the enterprise costs in industry are highlighted. For cost management purposes, it is proposed to group the cost factors into the two categories: structural and functional. The essence of structural and functional factors is shown; a classification of functional factors is given. The effect of a structural factor such as products range (complexity is illustrated. As the factor of complexity, combined with cost analysis systems and innovative tools of analysis (ABC and XYZ methods, has been increasingly in focus of analysts, three problems are described which, once dealt with, will enable ABC method to fit into the cost management system. The importance of another structural factor of costs, technology selection, in cost management is shown. The analysis allows for the following conclusions: for purposes of current cost management, including one based on operational analysis, the output needs to be addressed as the central factor determining the cost level; in the strategic perspective, an enterprise needs to concentrate on calculating the costs for the structural alternatives that are supposed to determine its competitive position; for cost management purposes, the cost factors should be broken into two categories, structural and functional; a specific management system exists for each cost factor, which is greatly important for the positioning of an enterprise.

Grid-connected polymer solar panels: initial considerations of cost, lifetime, and practicality.

Science.gov (United States)

Medford, Andrew J; Lilliedal, Mathilde R; Jørgensen, Mikkel; Aarø, Dennis; Pakalski, Heinz; Fyenbo, Jan; Krebs, Frederik C

2010-09-13

Large solar panels were constructed from polymer solar cell modules prepared using full roll-to-roll (R2R) manufacture based on the previously published ProcessOne. The individual flexible polymer solar modules comprising multiple serially connected single cell stripes were joined electrically and laminated between a 4 mm tempered glass window and black Tetlar foil using two sheets of 0.5 mm thick ethylene vinyl acetate (EVA). The panels produced up to 8 W with solar irradiance of ~960 Wm⁻², and had outer dimensions of 1 m x 1.7 m with active areas up to 9180 cm². Panels were mounted on a tracking station and their output was grid connected between testing. Several generations of polymer solar cells and panel constructions were tested in this context to optimize the production of polymer solar panels. Cells lacking a R2R barrier layer were found to degrade due to diffusion of oxygen after less than a month, while R2R encapsulated cells showed around 50% degradation after 6 months but suffered from poor performance due to de-lamination during panel production. A third generation of panels with various barrier layers was produced to optimize the choice of barrier foil and it was found that the inclusion of a thin protective foil between the cell and the barrier foil is critical. The findings provide a preliminary foundation for the production and optimization of large-area polymer solar panels and also enabled a cost analysis of solar panels based on polymer solar cells.

Cost benchmarking of railway projects in Europe – dealing with uncertainties in cost estimates

DEFF Research Database (Denmark)

Trabo, Inara

Past experiences in the construction of high-speed railway projects demontrate either positive or negative financial outcomes of the actual project’s budget. Usually some uncertainty value is included into initial budget calculations. Uncertainty is related to the increase of material prices...... per main cost drivers were compared and analyzed. There were observed nine railway projects, comparable to the Copenhagen-Ringsted project. The results of this comparison provided a certain overview on the cost range in different budget disciplines. The Copenhagen-Ringsted project is positioned right...

Cost estimating for CERCLA remedial alternatives a unit cost methodology

International Nuclear Information System (INIS)

Brettin, R.W.; Carr, D.J.; Janke, R.J.

1995-06-01

The United States Environmental Protection Agency (EPA) Guidance for Conducting Remedial Investigations and Feasibility Studies Under CERCLA, Interim Final, dated October 1988 (EPA 1988) requires a detailed analysis be conducted of the most promising remedial alternatives against several evaluation criteria, including cost. To complete the detailed analysis, order-of-magnitude cost estimates (having an accuracy of +50 percent to -30 percent) must be developed for each remedial alternative. This paper presents a methodology for developing cost estimates of remedial alternatives comprised of various technology and process options with a wide range of estimated contaminated media quantities. In addition, the cost estimating methodology provides flexibility for incorporating revisions to remedial alternatives and achieves the desired range of accuracy. It is important to note that the cost estimating methodology presented here was developed as a concurrent path to the development of contaminated media quantity estimates. This methodology can be initiated before contaminated media quantities are estimated. As a result, this methodology is useful in developing cost estimates for use in screening and evaluating remedial technologies and process options. However, remedial alternative cost estimates cannot be prepared without the contaminated media quantity estimates. In the conduct of the feasibility study for Operable Unit 5 at the Fernald Environmental Management Project (FEMP), fourteen remedial alternatives were retained for detailed analysis. Each remedial alternative was composed of combinations of remedial technologies and processes which were earlier determined to be best suited for addressing the media-specific contaminants found at the FEMP site, and achieving desired remedial action objectives

Cost-benefit and cost-savings analyses of antiarrhythmic medication monitoring.

Science.gov (United States)

Snider, Melissa; Carnes, Cynthia; Grover, Janel; Davis, Rich; Kalbfleisch, Steven

2012-09-15

The economic impact of pharmacist-managed antiarrhythmic drug therapy monitoring on an academic medical center's electrophysiology (EP) program was investigated. Data were collected for the initial two years of patient visits (n = 816) to a pharmacist-run clinic for antiarrhythmic drug therapy monitoring. A retrospective cost analysis was conducted to assess the direct costs associated with three appointment models: (1) a clinic office visit only, (2) a clinic visit involving electrocardiography and basic laboratory tests, and (3) a clinic visit including pulmonary function testing and chest x-rays in addition to electrocardiography and laboratory testing. A subset of patient cases (n = 18) were included in a crossover analysis comparing pharmacist clinic care and usual care in an EP physician clinic. The primary endpoints were the cost benefits and cost savings associated with pharmacy-clinic care versus usual care. A secondary endpoint was improvement of overall EP program efficiency. The payer mix was 61.6% (n = 498) Medicare, 33.2% (n = 268) managed care, and 5.2% (n = 42) other. Positive contribution margins were demonstrated for all appointment models. The pharmacist-managed clinic also yielded cost savings by reducing overall patient care charges by 21% relative to usual care. By the second year, the pharmacy clinic improved EP program efficiency by scheduling an average of 24 patients per week, in effect freeing up one day per week of EP physician time to spend on other clinical activities. Pharmacist monitoring of antiarrhythmic drug therapy in an out-patient clinic provided cost benefits, cost savings, and improved overall EP program efficiency.

COST QUALITY MANAGEMENT

Directory of Open Access Journals (Sweden)

Vitanova Gordana

2009-05-01

Full Text Available Within the contemporary economic conditions, enterprises might achieve a competitive advantage if only they sell goods and services with high quality and lower prices. Customers, usually, prefer quality goods with acceptable prices, while such goods create reputation with the particular brand. The perfect control system is necessary to achieve a high quality product, which the cost quality management is considered to be an indispensable part in. The cost quality is nevertheless created to ensure that customers’ requirements are being appropriately attained. The most important objective of quality costs controlling is to assist the management in enhancing the product’s value permanently. The superior cost quality control system helps the management to achieve other strategic objectives, such as: producing goods with acceptable costs and deliver the products to their customers in time.

Analisis Unit Cost Sectio Caesaria dengan Metode Activity Based Costing di Rumah Sakit Bhayangkara Yogyakarta

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Tsalisah Damayanti

2017-01-01

Full Text Available This study aims to analyze the unit cost of sectio Caesaria by ABC method, second to analyze the differences between the unit cost calculation of Sectio Caesaria by ABC method with applied cost. Unit cost analysis was conducted at Sectio Caesaria procedure without comorbidities or complications. Data that used in the form of primary data interviews with specialists Obgyn and secondary data financial data and hospitals profiles. The result of the calculation of unit cost of Sectio Caesaria service through Activity Based Costing approach is still lower than INA CBG’s tariff.

Successful integration of ergonomics into continuous improvement initiatives.

Science.gov (United States)

Monroe, Kimberly; Fick, Faye; Joshi, Madina

2012-01-01

Process improvement initiatives are receiving renewed attention by large corporations as they attempt to reduce manufacturing costs and stay competitive in the global marketplace. These initiatives include 5S, Six Sigma, and Lean. These programs often take up a large amount of available time and budget resources. More often than not, existing ergonomics processes are considered separate initiatives by upper management and struggle to gain a seat at the table. To effectively maintain their programs, ergonomics program managers need to overcome those obstacles and demonstrate how ergonomics initiatives are a natural fit with continuous improvement philosophies.

Crude costs: a framework for a full-cost accounting analysis of oil and gas exploration off Cape Breton, Nova Scotia

International Nuclear Information System (INIS)

Landon, L.; Pannozzo, L.

2001-12-01

Defined as the total quantity of all goods and services produced and the total money earned and spent, the Gross Domestic Product (GDP) is a measure used to determine how well an economy is doing. For its part, the Genuine Progress Index (GPI) measures 26 variables and was first developed in 1995. In Nova Scotia, a set of 20 social, economic and environmental indicators are examined to obtain a better picture of the well-being of the region and determine if the development is sustainable over time. The authors explained their approach based on the use of GPI analysis to assist decision makers in identifying the real costs and benefits of different options applied to the oil and gas exploration situation off Cape Breton, Nova Scotia. The document is divided into five parts as follows: (1) Part 1: introduction, (2) Part 2: natural capital and the impacts of oil and gas development, (3) Part 3: social capital and the economic value of fishing and tourism, (4) Part 4: the real cost of oil and gas, and (5) Part 5: recommendations. Some of the recommendations call for the further study of cumulative and sub-lethal effects from petroleum development, the establishment of Marine Protected Areas preceded by a moratorium on oil and gas exploration in the Southern Gulf of St. Lawrence and Sydney Bight areas until the establishment of the Areas is made, and that future environmental assessments concerning oil and gas development to address the impacts on species and ecosystems as a whole. 209 refs., 11 tabs., 4 figs

Allocation base of general production costs as optimization of prime costs

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Levytska I.O.

2017-03-01

Full Text Available Qualified management aimed at optimizing financial results is the key factor in today's society. Effective management decisions depend on the necessary information about the costs of production process in all its aspects – their structure, types, accounting policies of reflecting costs. General production costs, the so-called indirect costs that are not directly related to the production process, but provide its functioning in terms of supporting structural divisions and create the necessary conditions of production, play a significant role in calculating prime costs of goods (works, services. However, the accurate estimate of prime costs of goods (works, services should be determined with the value of indirect costs (in other words, general production costs, and properly determined with the base of their allocation. The choice of allocation base of general production costs is the significant moment, depending on the nature of business, which must guarantee fair distribution regarding to the largest share of direct expenses in the total structure of production costs. The study finds the essence of general production costs based on the analysis of key definitions of leading Ukrainian economists. The optimal allocation approach of general production costs is to calculate these costs as direct production costs within each subsidiary division (department separately without selecting a base as the main one to the their total amount.

26 CFR 1.181-1T - Deduction for qualified film and television production costs (temporary).

Science.gov (United States)

2010-04-01

... incurred to distribute or exploit a production (including advertising and print costs). (iii) Production costs do not include the costs to prepare a new release or new broadcast of an existing film or video after the initial release or initial broadcast of the film or video (for instance, the preparation of a...

An assessment of monitoring requirements and costs of 'Reduced Emissions from Deforestation and Degradation'

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McCallum Ian

2009-08-01

Full Text Available Abstract Background Negotiations on a future climate policy framework addressing Reduced Emissions from Deforestation and Degradation (REDD are ongoing. Regardless of how such a framework will be designed, many technical solutions of estimating forest cover and forest carbon stock change exist to support policy in monitoring and accounting. These technologies typically combine remotely sensed data with ground-based inventories. In this article we assess the costs of monitoring REDD based on available technologies and requirements associated with key elements of REDD policy. Results We find that the design of a REDD policy framework (and specifically its rules can have a significant impact on monitoring costs. Costs may vary from 0.5 to 550 US$ per square kilometre depending on the required precision of carbon stock and area change detection. Moreover, they follow economies of scale, i.e. single country or project solutions will face relatively higher monitoring costs. Conclusion Although monitoring costs are relatively small compared to other cost items within a REDD system, they should be shared not only among countries but also among sectors, because an integrated monitoring system would have multiple benefits for non-REDD management. Overcoming initialization costs and unequal access to monitoring technologies is crucial for implementation of an integrated monitoring system, and demands for international cooperation.

Tobacco litter costs and public policy: a framework and methodology for considering the use of fees to offset abatement costs.

Science.gov (United States)

Schneider, John E; Peterson, N Andrew; Kiss, Noemi; Ebeid, Omar; Doyle, Alexis S

2011-05-01

Growing concern over the costs, environmental impact and safety of tobacco product litter (TPL) has prompted states and cities to undertake a variety of policy initiatives, of which litter abatement fees are part. The present work describes a framework and methodology for calculating TPL costs and abatement fees. Abatement is associated with four categories of costs: (1) mechanical and manual abatement from streets, sidewalks and public places, (2) mechanical and manual abatement from storm water and sewer treatment systems, (3) the costs associated with harm to the ecosystem and harm to industries dependent on clean and healthy ecosystems, and (4) the costs associated with direct harm to human health. The experiences of the City of San Francisco's recently proposed tobacco litter abatement fee serve as a case study. City and municipal TPL costs are incurred through manual and mechanical clean-up of surfaces and catchment areas. According to some studies, public litter abatement costs to US cities range from US$3 million to US$16 million. TPL typically comprises between 22% and 36% of all visible litter, implying that total public TPL direct abatement costs range from about US$0.5 million to US$6 million for a city the size of San Francisco. The costs of mitigating the negative externalities of TPL in a city the size of San Francisco can be offset by implementing a fee of approximately US$0.20 per pack. Tobacco litter abatement costs to cities can be substantial, even when the costs of potential environmental pollution and tourism effects are excluded. One public policy option to address tobacco litter is levying of fees on cigarettes sold. The methodology described here for calculating TPL costs and abatement fees may be useful to state and local authorities who are considering adoption of this policy initiative.

The global cost of eliminating avoidable blindness

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Kirsten L Armstrong

2012-01-01

Full Text Available Aims : To complete an initial estimate of the global cost of eliminating avoidable blindness, including the investment required to build ongoing primary and secondary health care systems, as well as to eliminate the ′backlog′ of avoidable blindness. This analysis also seeks to understand and articulate where key data limitations lie. Materials and Methods : Data were collected in line with a global estimation approach, including separate costing frameworks for the primary and secondary care sectors, and the treatment of backlog. Results : The global direct health cost to eliminate avoidable blindness over a 10-year period from 2011 to 2020 is estimated at $632 billion per year (2009 US$. As countries already spend $592 billion per annum on eye health, this represents additional investment of $397.8 billion over 10 years, which is $40 billion per year or $5.80 per person for each year between 2010 and 2020. This is concentrated in high-income nations, which require 68% of the investment but comprise 16% of the world′s inhabitants. For all other regions, the additional investment required is $127 billion. Conclusions : This costing estimate has identified that low- and middle-income countries require less than half the additional investment compared with high-income nations. Low- and middle-income countries comprise the greater investment proportion in secondary care whereas high-income countries require the majority of investment into the primary sector. However, there is a need to improve sector data. Investment in better data will have positive flow-on effects for the eye health sector.

The effect of span length and girder type on bridge costs

Directory of Open Access Journals (Sweden)

Batikha Mustafa

2017-01-01

Full Text Available Bridges have an important role in impacting the civilization, growth and economy of cities from ancient time until these days due to their function in reducing transportation cost and time. Therefore, development of bridges has been a knowledge domain in civil engineering studies in terms of their types and construction materials to confirm a reliable, safe, economic design and construction. Girder-bridge of concrete deck and I-beam girder has been used widely for short and medium span bridges because of ease and low-cost of fabrication. However, many theoretical and practical investigations are still undertaken regarding the type of beam girder; i.e steel composite or prestressed concrete. This paper evaluates the effect of bridge span and the type of girder on the capital cost and life cycle costs of bridges. Three types of girders were investigated in this research: steel composite, pre-tensioned pre-stressed concrete and post-tensioned pre-stressed concrete. The structural design was analyzed for 5 span lengths: 20, 25, 30, 35 and 40m. Then, the capital construction cost was accounted for 15 bridges according to each span and construction materials. Moreover, the maintenance required for 50 years of bridge life was evaluated and built up as whole life costs for each bridge. As a result of this study, the influence of both span length and type of girder on initial construction cost and maintenance whole life costs were assessed to support the decision makers and designers in the selection process for the optimum solution of girder bridges.

Palliative and low cost radiotherapy in developing countries

International Nuclear Information System (INIS)

Allen, Barry; Hussein, S.M.A.

2011-01-01

Full text: The International Agency for Research on Cancer predicts that cancer incidence in developing countries will increase dramatically in the first two decades of this millennium. Already some 80% of cancer patients in developing countries present with incurable disease. In many cases pain is a severe problem and palliation is needed to improve quality of life as well as extending survival. This paper will consider the physical and clinical aspects of palliative radiotherapy (PRT), choice of radiation modality, alternative approaches to imaging and therapy and cost-benefit considerations. The potential benefits of a dedicated palliative care centre include lower cost and therefore more centres, enabling more patients access to regional palliative care. Simple curative treatments could also be managed. Co60 radiotherapy has important advantages in developing countries, because of the higher initial cost of a linear accelerator, as well as the need for reliable power supply and the level of skill required by linac technicians and physicists. The beam characteristics of both Co60 units and low energy linacs are compared and both are found to be acceptable for palliation. The role of palliative and low cost radiotherapy in Bangladesh is reviewed. The concept of telemedicine is also discussed, using mobile phones and internet communication to allow rural clinics to receive support from specialists based in the cities, to send images for remote diagnosis and remote dose planning for radiotherapy.

Low technology tissue culture materials for initiation and ...

African Journals Online (AJOL)

Low technology tissue culture materials for initiation and multiplication of banana plants. ... African Crop Science Journal ... locally available macronutrients, micronutrients, sugar, equipment and facility reduced the cost of consumable material

Do Canadian electricity prices reflect costs?

International Nuclear Information System (INIS)

Jaccard, M.

1993-01-01

In an article by Cairns and Heyes (1993), it is argued that electricity pricing in Canada diverges from cost due to inter-class rate design that results in cross-subsidies, subsidized cost of capital, intra-class rate design that lacks time-of-use pricing, and failure to collect differential rent. Some problems with the key components of the initial assumption that prices diverge from cost are examined. The premise that inter-class rate design results in cross-subsidies may be correct, but is difficult to test since unregulated crown utilities are not required to make the necessary information public. Cairns and Heyes are on firmer ground in their assertion that provincial government backing of utility debts leads to lower costs of capital than would otherwise occur. Quebec and British Columbia governments have recently undertaken revenue collection initiatives justified under the rationale of addressing this situation. However, there are problems with the assumption that lack of time-of-use pricing indicates cost/price divergence, since such pricing is especially relevant in capacity-critical systems. Most hydroelectric systems are energy-critical and time-of-use differentials are not appropriate. Finally, recent evidence suggests reassessing the differential rent assumptions of the 1980s. The economic rents estimated in that period may be more accurately described as windfall rents existing in the short term while markets adjust to erratic fuel prices and cost changes in nuclear and hydro energy. There may be good economic efficiency arguments against short-term rent collection strategies involving erratic price adjustments. 1 ref

Cost Calculation Model for Logistics Service Providers

Directory of Open Access Journals (Sweden)

Zoltán Bokor

2012-11-01

Full Text Available The exact calculation of logistics costs has become a real challenge in logistics and supply chain management. It is essential to gain reliable and accurate costing information to attain efficient resource allocation within the logistics service provider companies. Traditional costing approaches, however, may not be sufficient to reach this aim in case of complex and heterogeneous logistics service structures. So this paper intends to explore the ways of improving the cost calculation regimes of logistics service providers and show how to adopt the multi-level full cost allocation technique in logistics practice. After determining the methodological framework, a sample cost calculation scheme is developed and tested by using estimated input data. Based on the theoretical findings and the experiences of the pilot project it can be concluded that the improved costing model contributes to making logistics costing more accurate and transparent. Moreover, the relations between costs and performances also become more visible, which enhances the effectiveness of logistics planning and controlling significantly

Improving Maternal Care through a State-Wide Health Insurance Program: A Cost and Cost-Effectiveness Study in Rural Nigeria.

Directory of Open Access Journals (Sweden)

Gabriela B Gomez

Full Text Available While the Nigerian government has made progress towards the Millennium Development Goals, further investments are needed to achieve the targets of post-2015 Sustainable Development Goals, including Universal Health Coverage. Economic evaluations of innovative interventions can help inform investment decisions in resource-constrained settings. We aim to assess the cost and cost-effectiveness of maternal care provided within the new Kwara State Health Insurance program (KSHI in rural Nigeria.We used a decision analytic model to simulate a cohort of pregnant women. The primary outcome is the incremental cost effectiveness ratio (ICER of the KSHI scenario compared to the current standard of care. Intervention cost from a healthcare provider perspective included service delivery costs and above-service level costs; these were evaluated in a participating hospital and using financial records from the managing organisations, respectively. Standard of care costs from a provider perspective were derived from the literature using an ingredient approach. We generated 95% credibility intervals around the primary outcome through probabilistic sensitivity analysis (PSA based on a Monte Carlo simulation. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the base case separately through a scenario analysis. Finally, we assessed the sustainability and feasibility of this program's scale up within the State's healthcare financing structure through a budget impact analysis. The KSHI scenario results in a health benefit to patients at a higher cost compared to the base case. The mean ICER (US$46.4/disability-adjusted life year averted is considered very cost-effective compared to a willingness-to-pay threshold of one gross domestic product per capita (Nigeria, US$ 2012, 2,730. Our conclusion was robust to uncertainty in parameters estimates (PSA: median US$49.1, 95% credible

Cost-benefit and regulatory decision making

International Nuclear Information System (INIS)

Harvie, J.

1996-01-01

The Atomic Energy Control Board is investigating the feasibility of developing methods for factoring cost-benefit considerations into its regulatory decision-making. This initiative results, in part, from the federal government policy requiring cost-benefit considerations to be taken into account in regulatory processes, and from the recommendations of an Advisory Panel on Regulatory Review in 1993, submitted to the Minister of Natural Resources Canada. One of these recommendations stated: 'that mechanisms be developed to examine cost benefit issues and work towards some consensus of opinion among stake holders: a task force on the subject could be an appropriate starting point'. (author)

Are PES connection costs too high?

International Nuclear Information System (INIS)

Scott, N.

1998-01-01

Windfarm developers often have good reason to question the costs they are quoted by their local distribution company for connection to the system, and these costs can now be challenged under the 'Competition in Connection' initiative. Econnect Ltd specialise in electrical connections for renewable generation throughout the UK and Europe, and have worked on many projects where alternative connections have been designed at more competitive prices. This paper provides some examples which illustrate the importance of acquiring a thorough understanding of all power system issues and PES concerns if the most cost-effective connection is to be realised. (Author)

Nuclear generation cost management and economic benefits

International Nuclear Information System (INIS)

Horton, E.P.; Sepa, T.R.

1989-01-01

The CANDU-Pressurized Heavy Water (CANDU-PHW) type of nuclear generating station has been developed jointly by Atomic Energy of Canada Limited and Ontario Hydro. This report discusses the cost management principles used for Ontario Hydro's CANDU-PHW program, current cost management initiatives, and the economic benefits of nuclear power to the provinces of Ontario and New Brunswick, in Canada

Cost Control and Performance Review of Software Projects by Using the Earned Value Management

Directory of Open Access Journals (Sweden)

Felician ALECU

2014-08-01

Full Text Available EVM (Earned Value Management is a method that can be successfully used to measure the performance of a project from the cost and schedule points of view. Initially developed for the US government programs in the 60s, it later becomes an important feature of any modern project management practice thanks to its simplicity and efficiency in signaling project anomalies in time. EVM become extremely popular because it can be equally applied for any project in any industry.

An innovative multivariate tool for fuel consumption and costs estimation of agricultural operations

Directory of Open Access Journals (Sweden)

Mirko Guerrieri

2016-12-01

Full Text Available The estimation of operating costs of agricultural and forestry machineries is a key factor in both planning agricultural policies and farm management. Few works have tried to estimate operating costs and the produced models are normally based on deterministic approaches. Conversely, in the statistical model randomness is present and variable states are not described by unique values, but rather by probability distributions. In this study, for the first time, a multivariate statistical model based on Partial Least Squares (PLS was adopted to predict the fuel consumption and costs of six agricultural operations such as: ploughing, harrowing, fertilization, sowing, weed control and shredding. The prediction was conducted on two steps: first of all few initial selected parameters (time per surface-area unit, maximum engine power, purchase price of the tractor and purchase price of the operating machinery were used to estimate the fuel consumption; then the predicted fuel consumption together with the initial parameters were used to estimate the operational costs. Since the obtained models were based on an input dataset very heterogeneous, these resulted to be extremely efficient and so generalizable and robust. In details the results show prediction values in the test with r always ≥ 0.91. Thus, the approach may results extremely useful for both farmers (in terms of economic advantages and at institutional level (representing an innovative and efficient tool for planning future Rural Development Programmes and the Common Agricultural Policy. In light of these advantages the proposed approach may as well be implemented on a web platform and made available to all the stakeholders.

INITIATION AND CONDUCT OF ADMINISTRATIVE PROCEDURE

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Milan Stipic

2013-12-01

Full Text Available General administrative procedure act contains legal norms that are valid for all identical cases. In addition to the general, there are special administrative procedures, customized to the specific administrative areas. Procedure initiation is regulated. Administrative procedure can be initiated at the request of the proponent and ex officio. When the official determines that the conditions for the conduct of administrative procedure are met, before making a decision, all the facts and circumstances relevant to the resolution of administrative matter have to be identified. When there are no legal requirements for the initiation of procedures, the official shall make a decision to reject the application of the party. The procedure is initiated ex officio when stipulated by law or when protection of public interest requires it. When initiating procedure ex officio, the public authority shall take into consideration the petition or other information that indicate the need to protect the public interest. In such cases the applicant is not a party, and the official is obliged to notify the applicant, if initiation of procedures is not accepted ex officio. Based on the notification, the applicant has a right to complain, including the situation when there is no response within the prescribed period of 30 days. Public authority may, therefore it is not obliged to, initiate administrative procedure by public announcement only in a situation where the parties are unknown, while it is obliged to initiate procedure by public announcement when this method of initiating the procedure is prescribed by law. Initiation of procedure with public announcement occurs in rare cases. Due to the application of efficiency and cost-effectiveness principle, two or more administrative procedures can be merged into one procedure by a conclusion. The condition for this is that the rights or obligations of the parties are based on the same legal basis and on the same or

How space design and technology can support the Pharmacy Practice Model Initiative through interprofessional collaboration

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Lindsay Hahn

2014-01-01

Full Text Available Purpose: The Pharmacy Practice Model Initiative (PPMI calls pharmacists to more direct patient care and increased responsibility for medication-related outcomes, as a means of achieving greater safety, improving outcomes and reducing costs. This article acknowledges the value of interprofessional collaboration to the PPMI and identifies the implications of the Initiative for space design and technology, both of which stand to help the Initiative gather additional support. Summary: The profession of pharmacy has for some time now become increasingly vocal about its desire to take on greater responsibility for patient outcomes. With drug costs representing the largest portion of a hospital's pharmacy budget and reimbursements becoming more contingent on readmission avoidance, the pharmacy's influence on a hospital's bottom line is significant. More importantly, study after study is showing that with greater pharmacist intervention, patient outcomes improve. This article addresses the ways in which developments in the fields of technology and facility design can assist in the deployment of the PPMI. Conclusion: As the PPMI achieves a critical level of support from inside and outside the pharmacy, and more empirical research emerges regarding the improved outcomes and cost savings of increasing the roles of both clinical pharmacists and pharmacy technicians, the industry sectors of healthcare technology and healthcare design stand ready to assist in the execution of this new model. By encouraging pharmacists, doctors and nurses to work together - and all caregivers to work with facility designers, biomedical engineers and IT specialists, there is the increased likelihood of these fields turning to each other to problem-solve together, all for the ultimate benefit to patients and their families.   Type: Commentary

The value of confirmatory testing in early infant HIV diagnosis programmes in South Africa: A cost-effectiveness analysis.

Directory of Open Access Journals (Sweden)

Lorna Dunning

2017-11-01

Full Text Available The specificity of nucleic acid amplification tests (NAATs used for early infant diagnosis (EID of HIV infection is <100%, leading some HIV-uninfected infants to be incorrectly identified as HIV-infected. The World Health Organization recommends that infants undergo a second NAAT to confirm any positive test result, but implementation is limited. Our objective was to determine the impact and cost-effectiveness of confirmatory HIV testing for EID programmes in South Africa.Using the Cost-effectiveness of Preventing AIDS Complications (CEPAC-Pediatric model, we simulated EID testing at age 6 weeks for HIV-exposed infants without and with confirmatory testing. We assumed a NAAT cost of US$25, NAAT specificity of 99.6%, NAAT sensitivity of 100% for infants infected in pregnancy or at least 4 weeks prior to testing, and a mother-to-child transmission (MTCT rate at 12 months of 4.9%; we simulated guideline-concordant rates of testing uptake, result return, and antiretroviral therapy (ART initiation (100%. After diagnosis, infants were linked to and retained in care for 10 years (false-positive or lifelong (true-positive. All parameters were varied widely in sensitivity analyses. Outcomes included number of infants with false-positive diagnoses linked to ART per 1,000 ART initiations, life expectancy (LE, in years and per-person lifetime HIV-related healthcare costs. Both without and with confirmatory testing, LE was 26.2 years for HIV-infected infants and 61.4 years for all HIV-exposed infants; clinical outcomes for truly infected infants did not differ by strategy. Without confirmatory testing, 128/1,000 ART initiations were false-positive diagnoses; with confirmatory testing, 1/1,000 ART initiations were false-positive diagnoses. Because confirmatory testing averted costly HIV care and ART in truly HIV-uninfected infants, it was cost-saving: total cost US$1,790/infant tested, compared to US$1,830/infant tested without confirmatory testing

CALCULATION OF LASER CUTTING COSTS

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Bogdan Nedic

2016-09-01

Full Text Available The paper presents description methods of metal cutting and calculation of treatment costs based on model that is developed on Faculty of mechanical engineering in Kragujevac. Based on systematization and analysis of large number of calculation models of cutting with unconventional methods, mathematical model is derived, which is used for creating a software for calculation costs of metal cutting. Software solution enables resolving the problem of calculating the cost of laser cutting, comparison' of costs made by other unconventional methods and provides documentation that consists of reports on estimated costs.

Transaction Costs For Innovations Diffusion

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Ilya A. Romanov

2012-10-01

Full Text Available The article deals with the analysis of transaction costs of the innovations distribution. The factors, affecting the innovations diffusion in accordance with the clusters, relations, dynamics of the distribution are disclosed. Transaction costs as a result of bounded rationality of economic entities are detected. The inevitability of transaction costs as an objective phenomenon is shown. Their dependence on the quality of economic information and information uncertainty is indicated. Correlative approach for the analysis of these costs is applied. The article justifies that the reduction of transaction costs increases the efficiency of innovations.

A Low-Cost Fluorescent Sensor for pCO2 Measurements

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Xudong Ge

2014-04-01

Full Text Available Global warming is believed to be caused by increasing amounts of greenhouse gases (mostly CO2 discharged into the environment by human activity. In addition to an increase in environmental temperature, an increased CO2 level has also led to ocean acidification. Ocean acidification and rising temperatures have disrupted the water’s ecological balance, killing off some plant and animal species, while encouraging the overgrowth of others. To minimize the effect of global warming on local ecosystem, there is a strong need to implement ocean observing systems to monitor the effects of anthropogenic CO2 and the impacts thereof on ocean biological productivity. Here, we describe the development of a low-cost fluorescent sensor for pCO2 measurements. The detector was exclusively assembled with low-cost optics and electronics, so that it would be affordable enough to be deployed in great numbers. The system has several novel features, such as an ideal 90° separation between excitation and emission, a beam combiner, a reference photodetector, etc. Initial tests showed that the system was stable and could achieve a high resolution despite the low cost.

Calculating cost savings in utilization management.

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MacMillan, Donna

2014-01-01

A major motivation for managing the utilization of laboratory testing is to reduce the cost of medical care. For this reason it is important to understand the basic principles of cost accounting in the clinical laboratory. The process of laboratory testing includes three distinct components termed the pre-analytic, analytic and post-analytic phases. Utilization management efforts may impact the cost structure of these three phases in different ways depending on the specific details of the initiative. Estimates of cost savings resulting from utilization management programs reported in the literature have often been fundamentally flawed due to a failure to understand basic concepts such as the difference between laboratory costs versus charges and the impact of reducing laboratory test volumes on the average versus marginal cost structure in the laboratory. This article will provide an overview of basic cost accounting principles in the clinical laboratory including both job order and process cost accounting. Specific examples will be presented to illustrate these concepts in various different scenarios. © 2013.

Appling a Novel Cost Function to Hopfield Neural Network for Defects Boundaries Detection of Wood Image

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Qi Dawei

2010-01-01

Full Text Available A modified Hopfield neural network with a novel cost function was presented for detecting wood defects boundary in the image. Different from traditional methods, the boundary detection problem in this paper was formulated as an optimization process that sought the boundary points to minimize a cost function. An initial boundary was estimated by Canny algorithm first. The pixel gray value was described as a neuron state of Hopfield neural network. The state updated till the cost function touches the minimum value. The designed cost function ensured that few neurons were activated except the neurons corresponding to actual boundary points and ensured that the activated neurons are positioned in the points which had greatest change in gray value. The tools of Matlab were used to implement the experiment. The results show that the noises of the image are effectively removed, and our method obtains more noiseless and vivid boundary than those of the traditional methods.

Energetic Cost of Ichthyophonus Infection in Juvenile Pacific Herring (Clupea pallasii

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Johanna J. Vollenweider

2011-01-01

Full Text Available The energetic costs of fasting and Ichthyophonus infection were measured in juvenile Pacific herring (Clupea pallasii in a lab setting at three temperatures. Infected herring incurred significant energetic costs, the magnitude of which depended on fish condition at the time of infection (fat versus lean. Herring that were fed continually and were in relatively good condition at the time of infection (fat never stored lipid despite ad libitum feeding. In feeding herring, the energetic cost of infection was a 30% reduction in total energy content relative to controls 52 days post infection. Following food deprivation (lean condition, infection caused an initial delay in the compensatory response of herring. Thirty-one days after re-feeding, the energetic cost of infection in previously-fasted fish was a 32% reduction in total energy content relative to controls. Body composition of infected herring subsequently recovered to some degree, though infected herring never attained the same energy content as their continuously fed counterparts. Fifty-two days after re-feeding, the energetic cost of infection in previously-fasted fish was a 6% reduction in total energy content relative to controls. The greatest impacts of infection occurred in colder temperatures, suggesting Ichthyophonus-induced reductions in body condition may have greater consequences in the northern extent of herring's range, where juveniles use most of their energy reserves to survive their first winter.

Alcoholism treatment and medical care costs from Project MATCH.

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Holder, H D; Cisler, R A; Longabaugh, R; Stout, R L; Treno, A J; Zweben, A

2000-07-01

This paper examines the costs of medical care prior to and following initiation of alcoholism treatment as part of a study of patient matching to treatment modality. Longitudinal study with pre- and post-treatment initiation. The total medical care costs for inpatient and outpatient treatment for patients participating over a span of 3 years post-treatment. Three treatment sites at two of the nine Project MATCH locations (Milwaukee, WI and Providence, RI). Two hundred and seventy-nine patients. Patients were randomly assigned to one of three treatment modalities: a 12-session cognitive behavioral therapy (CBT), a four-session motivational enhancement therapy (MET) or a 12-session Twelve-Step facilitation (TSF) treatment over 12 weeks. Total medical care costs declined from pre- to post-treatment overall and for each modality. Matching effects independent of clinical prognosis showed that MET has potential for medical-care cost-savings. However, patients with poor prognostic characteristics (alcohol dependence, psychiatric severity and/or social network support for drinking) have better cost-savings potential with CBT and/or TSF. Matching variables have significant importance in increasing the potential for medical-care cost-reductions following alcoholism treatment.

Health care resource utilization before and after natalizumab initiation among patients with multiple sclerosis in Germany

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Watson C

2017-02-01

Full Text Available Crystal Watson,1 Christine Prosser,2 Sebastian Braun,2 Pamela B Landsman-Blumberg,3 Erika Gleissner,4 Sarah Naoshy1 1Health Economics and Outcomes Research, Global Market Access, Biogen, Cambridge, MA, USA; 2Real World Evidence, Xcenda GmbH, Hanover, Germany; 3Applied Data Analytics, Xcenda LLC, Palm Harbor, FL, USA; 4Market Access, Biogen, Ismaning, Germany Background: Multiple sclerosis (MS, a progressive neurodegenerative disease, greatly impacts the quality of life and economic status of people affected by this disease. In Germany, the total annual cost of MS is estimated at €40,000 per person with MS. Natalizumab has shown to slow MS disease progression, reduce relapses, and improve the quality of life of people with MS.Objective: To evaluate MS-related and all-cause health care resource utilization and costs among German MS patients during the 12 months before and after initiation of natalizumab in a real-world setting.Methods: The current analysis was conducted using the Health Risk Institute research database. Identified patients were aged ≥18 years with ≥1 diagnosis of MS and had initiated natalizumab therapy (index, with 12-month pre– and post–index-period data. Patients were stratified by prior disease-modifying therapy (DMT usage or no DMT usage in the pre-index period. Outcome measures included corticosteroid use and number of sick/disability days, inpatient stays, and outpatient visits. Health care costs were calculated separately for pre- and post-index periods on a per-patient basis and adjusted for inflation.Results: In a final sample of 193 natalizumab-treated patients, per-patient MS-related corticosteroid use was reduced by 62.3%, MS-related sick days by 27.6%, and inpatient costs by 78.3% from the pre- to post-index period. Furthermore, the proportion of patients with MS-related hospitalizations decreased from 49.7% to 14.0% (P<0.001; this reduction was seen for patients with and without prior DMT use

Activity-based costing methodology as tool for costing in hematopathology laboratory

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Gujral Sumeet

2010-01-01

Full Text Available Background: Cost analysis in laboratories represents a necessary phase in their scientific progression. Aim: To calculate indirect cost and thus total cost per sample of various tests at Hematopathology laboratory (HPL Settings and Design: Activity-based costing (ABC method is used to calculate per cost test of the hematopathology laboratory. Material and Methods: Information is collected from registers, purchase orders, annual maintenance contracts (AMCs, payrolls, account books, hospital bills and registers along with informal interviews with hospital staff. Results: Cost per test decreases as total number of samples increases. Maximum annual expense at the HPL is on reagents and consumables followed by manpower. Cost per test is higher for specialized tests which interpret morphological or flow data and are done by a pathologist. Conclusions: Despite several limitations and assumptions, this was an attempt to understand how the resources are consumed in a large size government-run laboratory. The rate structure needs to be revised for most of the tests, mainly for complete blood counts (CBC, bone marrow examination, coagulation tests and Immunophenotyping. This costing exercise is laboratory specific and each laboratory needs to do its own costing. Such an exercise may help a laboratory redesign its costing structure or at least understand the economics involved in the laboratory management.

Risk of stroke/systemic embolism, major bleeding and associated costs in non-valvular atrial fibrillation patients who initiated apixaban, dabigatran or rivaroxaban compared with warfarin in the United States Medicare population.

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Amin, Alpesh; Keshishian, Allison; Trocio, Jeffrey; Dina, Oluwaseyi; Le, Hannah; Rosenblatt, Lisa; Liu, Xianchen; Mardekian, Jack; Zhang, Qisu; Baser, Onur; Vo, Lien

2017-09-01

To compare the risk and cost of stroke/systemic embolism (SE) and major bleeding between each direct oral anticoagulant (DOAC) and warfarin among non-valvular atrial fibrillation (NVAF) patients. Patients (≥65 years) initiating warfarin or DOACs (apixaban, rivaroxaban, and dabigatran) were selected from the Medicare database from 1 January 2013 to 31 December 2014. Patients initiating each DOAC were matched 1:1 to warfarin patients using propensity score matching to balance demographics and clinical characteristics. Cox proportional hazards models were used to estimate the risks of stroke/SE and major bleeding of each DOAC vs. warfarin. Two-part models were used to compare the stroke/SE- and major-bleeding-related medical costs between matched cohorts. Of the 186,132 eligible patients, 20,803 apixaban-warfarin pairs, 52,476 rivaroxaban-warfarin pairs, and 16,731 dabigatran-warfarin pairs were matched. Apixaban (hazard ratio [HR] = 0.40; 95% confidence interval [CI] 0.31, 0.53) and rivaroxaban (HR = 0.72; 95% CI 0.63, 0.83) were significantly associated with lower risk of stroke/SE compared to warfarin. Apixaban (HR = 0.51; 95% CI 0.44, 0.58) and dabigatran (HR = 0.79; 95% CI 0.69, 0.91) were significantly associated with lower risk of major bleeding; rivaroxaban (HR = 1.17; 95% CI 1.10, 1.26) was significantly associated with higher risk of major bleeding compared to warfarin. Compared to warfarin, apixaban ($63 vs. $131) and rivaroxaban ($93 vs. $139) had significantly lower stroke/SE-related medical costs; apixaban ($292 vs. $529) and dabigatran ($369 vs. $450) had significantly lower major bleeding-related medical costs. Among the DOACs in the study, only apixaban is associated with a significantly lower risk of stroke/SE and major bleeding and lower related medical costs compared to warfarin.

CONCEPT-5 user's manual. [Power plant costs

Energy Technology Data Exchange (ETDEWEB)

Hudson, C.R. II

1979-01-01

The CONCEPT computer code package was developed to provide conceptual capital cost estimates for nuclear-fueled and fossil-fired power plants. Cost estimates can be made as a function of plant type, size, location, and date of initial operation. The output includes a detailed breakdown of the estimate into direct and indirect costs similar to the accounting system described in document NUS--531. Cost models are currently provided in CONCEPT 5 for single- and multiunit pressurized-water reactors, boiling-water reactors, and cost-fired plants with and without flue gas desulfurization equipment.

Costing and competition.

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Bates, K; Brignall, S

1994-01-01

Working for patients established a new system of contracts between providers and purchasers of healthcare, with prices based on full costs, avoiding cross-subsidization. The new regime necessitates greatly improved costing systems, to improve the efficiency of service provision by creating price competition between providers. Ken Bates and Stan Brignall argue that non-price competition also occurs, with providers 'differentiating' on quality of service/product, flexibility or innovation.

Cost analysis of the use of botulinum toxin type A in Spain

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F. de Andrés-Nogales

2014-05-01

Full Text Available Objective: To estimate treatment costs of blepharospasm, cervical dystonia(CD, upper limb spasticity (ULS and spasticity in children withcerebral palsy (SCCP with botulinum neurotoxin type A (BoNT-A inSpain. Method: Annual BoNT-A treatment costs were calculated (2013 ex-factoryprice ( applying RDL 8/2010 and RDL 9/2011 deductions, basedon initial dose (id, average dose (ad and maximum dose (md accordingto Summary of Product Characteristics of Botox® (100U/50U, Dysport®(500U and Xeomin® (100U and considering the use of complete vials.In addition, annual treatment costs were calculated considering the useof vials in more than one patient and also patient population annualtreatment costs based on diseases’ prevalence. Results: Annual BoNT-A treatment costs per patient were estimated atbetween 265 and 2,120 with savings from 10% to 55% accordingto the selected BoNT-A. CD and ULS treatment provided the greatestcost per patient. Botox® provided greater savings in ULS (id/ad, CD(id, and in blepharospasm and SCCP (id/ad/md. Dysport® treatmentwas less costly in CD (md and ULS (md, while Xeomin® was in CD(ad. Based on the estimated treated population in Spain, the annualtreatment costs ranged from 368,392 to 13,958,836 dependingon indication, dose and BoNT-A considered. Conclusions: The appropriate BoNT-A choice would lead to considerablesavings

Brain network analysis: separating cost from topology using cost-integration.

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Cedric E Ginestet

Full Text Available A statistically principled way of conducting brain network analysis is still lacking. Comparison of different populations of brain networks is hard because topology is inherently dependent on wiring cost, where cost is defined as the number of edges in an unweighted graph. In this paper, we evaluate the benefits and limitations associated with using cost-integrated topological metrics. Our focus is on comparing populations of weighted undirected graphs that differ in mean association weight, using global efficiency. Our key result shows that integrating over cost is equivalent to controlling for any monotonic transformation of the weight set of a weighted graph. That is, when integrating over cost, we eliminate the differences in topology that may be due to a monotonic transformation of the weight set. Our result holds for any unweighted topological measure, and for any choice of distribution over cost levels. Cost-integration is therefore helpful in disentangling differences in cost from differences in topology. By contrast, we show that the use of the weighted version of a topological metric is generally not a valid approach to this problem. Indeed, we prove that, under weak conditions, the use of the weighted version of global efficiency is equivalent to simply comparing weighted costs. Thus, we recommend the reporting of (i differences in weighted costs and (ii differences in cost-integrated topological measures with respect to different distributions over the cost domain. We demonstrate the application of these techniques in a re-analysis of an fMRI working memory task. We also provide a Monte Carlo method for approximating cost-integrated topological measures. Finally, we discuss the limitations of integrating topology over cost, which may pose problems when some weights are zero, when multiplicities exist in the ranks of the weights, and when one expects subtle cost-dependent topological differences, which could be masked by cost-integration.

Solar PV Manufacturing Cost Model Group: Installed Solar PV System Prices (Presentation)

Energy Technology Data Exchange (ETDEWEB)

Goodrich, A. C.; Woodhouse, M.; James, T.

2011-02-01

EERE's Solar Energy Technologies Program is charged with leading the Secretary's SunShot Initiative to reduce the cost of electricity from solar by 75% to be cost competitive with conventional energy sources without subsidy by the end of the decade. As part of this Initiative, the program has funded the National Renewable Energy Laboratory (NREL) to develop module manufacturing and solar PV system installation cost models to ensure that the program's cost reduction targets are carefully aligned with current and near term industry costs. The NREL cost analysis team has leveraged the laboratories' extensive experience in the areas of project finance and deployment, as well as industry partnerships, to develop cost models that mirror the project cost analysis tools used by project managers at leading U.S. installers. The cost models are constructed through a "bottoms-up" assessment of each major cost element, beginning with the system's bill of materials, labor requirements (type and hours) by component, site-specific charges, and soft costs. In addition to the relevant engineering, procurement, and construction costs, the models also consider all relevant costs to an installer, including labor burdens and overhead rates, supply chain costs, and overhead and materials inventory costs, and assume market-specific profits.

The neuroeconomics of alcohol demand: an initial investigation of the neural correlates of alcohol cost-benefit decision making in heavy drinking men.

Science.gov (United States)

MacKillop, James; Amlung, Michael T; Acker, John; Gray, Joshua C; Brown, Courtney L; Murphy, James G; Ray, Lara A; Sweet, Lawrence H

2014-07-01

Neuroeconomics integrates concepts and methods from psychology, economics, and cognitive neuroscience to understand how the brain makes decisions. In economics, demand refers to the relationship between a commodity's consumption and its cost, and, in behavioral studies, high alcohol demand has been consistently associated with greater alcohol misuse. Relatively little is known about how the brain processes demand decision making, and the current study is an initial investigation of the neural correlates of alcohol demand among heavy drinkers. Using an event-related functional magnetic resonance imaging (fMRI) paradigm, participants (N=24) selected how much they would drink under varying levels of price. These choices determined access to alcohol during a subsequent bar laboratory self-administration period. During decisions to drink in general, greater activity was present in multiple distinct subunits of the prefrontal and parietal cortices. In contrast, during decisions to drink that were demonstrably affected by the cost of alcohol, significantly greater activation was evident in frontostriatal regions, suggesting an active interplay between cognitive deliberation and subjective reward value. These choices were also characterized by significant deactivation in default mode network regions, suggesting suppression resulting from greater cognitive load. Across choice types, the anterior insula was notably recruited in diverse roles, further implicating the importance of interoceptive processing in decision-making behavior. These findings reveal the neural signatures subserving alcohol cost-benefit decision making, providing a foundation for future clinical applications of this paradigm and extending this approach to understanding the neural correlates of demand for other addictive commodities.

Cost analysis of breast cancer diagnostic assessment programs.

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Honein-AbouHaidar, G N; Hoch, J S; Dobrow, M J; Stuart-McEwan, T; McCready, D R; Gagliardi, A R

2017-10-01

Diagnostic assessment programs (daps) appear to improve the diagnosis of cancer, but evidence of their cost-effectiveness is lacking. Given that no earlier study used secondary financial data to estimate the cost of diagnostic tests in the province of Ontario, we explored how to use secondary financial data to retrieve the cost of key diagnostic test services in daps, and we tested the reliability of that cost-retrieving method with hospital-reported costs in preparation for future cost-effectiveness studies. We powered our sample at an alpha of 0.05, a power of 80%, and a margin of error of ±5%, and randomly selected a sample of eligible patients referred to a dap for suspected breast cancer during 1 January-31 December 2012. Confirmatory diagnostic tests received by each patient were identified in medical records. Canadian Classification of Health Intervention procedure codes were used to search the secondary financial data Web portal at the Ontario Case Costing Initiative for an estimate of the direct, indirect, and total costs of each test. The hospital-reported cost of each test received was obtained from the host-hospital's finance department. Descriptive statistics were used to calculate the cost of individual or group confirmatory diagnostic tests, and the Wilcoxon signed-rank test or the paired t-test was used to compare the Ontario Case Costing Initiative and hospital-reported costs. For the 191 identified patients with suspected breast cancer, the estimated total cost of $72,195.50 was not significantly different from the hospital-reported total cost of $72,035.52 ( p = 0.24). Costs differed significantly when multiple tests to confirm the diagnosis were completed during one patient visit and when confirmatory tests reported in hospital data and in medical records were discrepant. The additional estimated cost for non-salaried physicians delivering diagnostic services was $28,387.50. It was feasible to use secondary financial data to retrieve the cost

QUALITY IMPROVEMENT INITIATIVES FOR SUPPORT FUNCTIONS IN AN INDUSTRY: TWO CASES

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Shirshendu Roy

2011-09-01

Full Text Available The concept of quality improvement in industry has originated from the involvement of inspector which has become the most important part of manufacturing process or development activity. Over years, this initiative is migrated to various support functions of the industry. In this paper, emphasis has been given particularly in the areas related to support functions where improvement project s can be effectively done and hence organization wide impact is assessed. Two case studies are presented here in this context. The first study shows how smaller change in content structure and delivery met hod can drastically improve the training feedback and the second one demonstrates minimizing lead time to recruitment with a cost-effective process modification.

The cost of Clostridium difficile infection (CDI in hospital in Italy

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Nicola Petrosillo

2017-04-01

Full Text Available The cost of Clostridium difficile infection (CDI in hospital in ItalyObjectiveTo describe characteristics, resource utilization and cost for patients experiencing a primary episode of CDI and recurrent CDI.MethodsA retrospective observational cohort study was conducted. CDI data were collected with an electronic case report form (CRF from five Hospitals in Italy. Hospitals collected all resource use attributable to CDI during the period 2011-2014. All resource use from initial presentation to the healthcare provider for CDI symptoms, until resolution of infection attributable to CDI in each enrolled patient was included. The patient cohort was analysed both as a whole and in stratified subgroups (by age, gender and co-morbidities. The impact of CDI on hospital length of stay (LOS was used to calculate CDI-attributable costs. The total cost of a CDI episode was estimated by multiplying each resource used by its unit cost (national tariffs and market prices; finally, the mean cost/patient was calculated across the cohort.ResultsIn total, data were collected for 488 adult infected patients (mean age 76.0 years [SD ± 15.48]; female 56.6%. Five hundred and three (503 episodes were evaluated (mean number per patient: 1.03 [SD ± 0.23]. LOS attributable to CDI was 14.6 days (SD ± 13.14. Attributable cost per adult patient was €10,224.08 (SD ± €8,963.86, with the majority of the cost being due to hospitalization. The mean cost of a recurrent episode of CDI was €9,504.87 [SD ± €8,614.11].ConclusionsThese findings show that the economic burden of CDI is considerable in Italy. The most important cost driver was the LOS attributable to CDI.

Determination production costs using PBC method

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Todić Vladimir V.

2014-01-01

Full Text Available Basic characteristics of modern markets make requirements in quality increasing, decreasing prices and shortening delivery of products. In the middle of this requirements are production costs for whose determination are developed many traditional and alternative methods including PBC method (Process Based Costing. This method enables precisely locating and calculating indirect production costs, and with determined direct costs enables determination of total production costs. This paper shows usage of PBC method for determination production costs for three forms of processing cutting tools.